In our decision tree, the classical morphological score is the most predictive parameter. Among embryos with better morphological scores, morphokinetics permits deselection of embryos with the lowest implantation potential.
Purpose: To relate pronuclear patterns (PN) and zygote cytoplasmic appearance and embryo morphology.Methods: The usefulness of PN classification described by Tesarik et al. 1999 (patterns p0-5) and Scott et al. 2000 (Z1-4), for embryo selection is assessed.Results: Sinchrony on polarization and number of nucleolar precursor bodies (NPB) were associated with good quality embryos (p0 60.9% and p3 67.3%, and Z1 62.5% and Z2 64.7%; p < 0.01). Pattern 4 zygotes were associated with small number of NPB developed into multinucleated embryos (14.3%) and poor quality embryos (61.9%). No significant differences were found in the pregnancy rate between transfer of at least one good prognosis PN pattern and transfer of poor prognosis PN patterns, although 75% of the transfers included at least one embryo derived from a pattern 0 zygote, and 55% included embryos from categories Z1 or Z2.Conclusions: Sequential assessment involving the evaluation of oocyte quality, the classification of PN patterns and embryo morphology allows a more accurate evaluation of embryos to be selected for transfer.
SummaryShortly after the implementation of comprehensive chromosome screening (CCS) techniques for preimplantation genetic testing for aneuploidies (PGT-A), the discussion about the transition from day 3 to blastocyst stage biopsy was initiated. Trophectoderm biopsy with CCS is meant to overcome the limitations of cleavage-stage biopsy and single-cell analysis. The aim of this study was to assess the results obtained in our PGT-A programme after the implementation of this new strategy. Comparisons between the results obtained in 179 PGT-A cycles with day 3 biopsy (D+3) and fresh embryo transfer, and 204 cycles with trophectoderm biopsy and deferred (frozen-thawed) embryo transfer were established. Fewer embryos were biopsied and a higher euploidy rate was observed in the trophectoderm biopsy group. No differences in implantation (50.3% vs. 61.4%) and clinical pregnancy rate per transfer (56.1% vs. 65.3%) were found. Although the mean number of euploid embryos per cycle did not differ between groups (1.5 ± 1.7 vs. 1.7 ± 1.8), the final number of euploid blastocysts available for transfer per cycle was significantly higher in the trophectoderm biopsy group (1.1 ± 1.3 vs. 1.7 ± 1.8). This factor led to an increased cumulative live birth rate in this last group (34.1% vs. 44.6%). Although both strategies can offer good results, trophectoderm biopsy offers a more robust diagnosis and the intervention is less harmful for the embryos so more euploid blastocysts are finally available for transfer and/or vitrification.
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