Human Reproduction, Vol. 7, No. 1, pp. 117-119, 1992
© 1992 European Society of Human Reproduction and Embryology
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SHORT COMMUNICATION: The cumulative embryo score: a predictive embryo scoring technique to select the optimal number of embryos to transfer in an in-vitro fertilization and embryo transfer programme
1Bourn Hallam Medical Centre 112 Harley Street, London W1N 1AS, UK 2Department of Obstetrics and Gynaecology, King's College School of Medicine and Dentistry London SE5 8RX, UK
Correspondence: 3To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, North Middlesex Hospital, Stirling Way, Edmonton, N18 1BX
Correspondence: 4To whom reprint requests should be addressed
In order to achieve a clinical pregnancy rate higher than that achieved following initial adoption of in-vitro fertilization embryo transfers, more than one embryo is transferred. This has led to a substantial increase in unwanted multiple pregnancy rates with IVF as compared with natural conception. What is therefore required is a simple, clinically useful embryo scoring system, to reflect embryo developmental potential, which will enable the selection of the optimal number of embryos to transfer in order to achieve the maximum pregnancy rate with a low incidence of high order multiple pregnancies. We believe that the Cumulative Embryo Score (CES) achieves these aims. On the day of embryo transfer the grade of each embryo transferred was multiplied by the number of blastomeres to produce a score for each embryo, and summation of the scores obtained for all the embryos transferred gave the CES. The grouped pregnancy rates obtained rose as the CES increased to maximum of 42. A continued increase in the CES above 42 did not result in any further rise in the pregnancy rate. However, an analysis of all our IVF pregnancies showed that the multiple pregnancy rate continued to rise above a CES of 42. By restricting the CES per embryo transfer to 42, 78% of triplet pregnancies and 100% of the quadruplet IVF pregnancies could have been predicted and potentially avoided.
Key words: cumulative embryo score/IVF-ET/pregnancy/multiple pregnancy
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|
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|
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|
|
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|
|
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