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Hum. Reprod. Advance Access published online on November 9, 2006
Human Reproduction, doi:10.1093/humrep/del403
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received February 27, 2006
Revised September 6, 2006
Accepted September 12, 2006

Article

Construction of an evidence-based integrated morphology cleavage embryo score for implantation potential of embryos scored and transferred on day 2 after oocyte retrieval

J. Holte 1 *, L. Berglund 2, K. Milton 1, C. Garello 3, G. Gennarelli 3, A. Revelli 3, and T. Bergh 1

1 Carl von Linné Clinic, Uppsala University, Uppsala Science Park, Uppsala, Sweden
2 Uppsala Clinical Research Center, Uppsala University, Uppsala Science Park, Uppsala, Sweden
3 Department of Gynaecological and Obstetrical Sciences, University of Turin, Turin, Italy

* To whom correspondence should be addressed.
J. Holte, E-mail: jan.holte{at}linne.se


  Abstract

BACKGROUND: Evidence-based morphological embryo scoring models for ranking of implantation potential are still scarce, and the need for a precise model increases when aiming for singleton pregnancies. METHODS: Prospectively, 2266 IVF/ICSI double-embryo, day 2 transfers were studied. The five variables scored in 3- to 5-step scales for the embryos transferred are blastomere number (BL), fragmentation, blastomere size variation (‘equality’, EQ), symmetry of the cleavage and mononuclearity in the blastomeres (NU). The scoring results of embryos with an individual traceability from scoring to implantation, i.e. treatments resulting in either no implantation (n = 1385) or twin implantation (n = 228), were studied for prognostic potential. RESULTS: Although all five variables correlated highly with implantation potential, only BL, NU and EQ remained independently significant after regression analysis. The equation thus derived formed the basis for a 10-point integrated morphology cleavage (IMC) embryo score. A table with the scoring point for each possible combination of the embryo variables is presented. The scoring model was statistically validated on the singleton pregnancy group (n = 653). CONCLUSIONS: We suggest that this IMC embryo scoring, incorporating cleavage stage and information on the variation in blastomere size and the number of mononucleated blastomeres, may optimize embryo ranking and selection for day 2 transfers.

Keywords: embryo morphology/embryo score/implantation potential/prediction.
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