Morphologic grading of euploid blastocysts influences implantation and ongoing pregnancy rates

Irani, Mohamad; Reichman, Daniël; Robles, Alex; Melnick, A.P.; Davis, Owen; Zaninović, Nikica; Xu, Kangpu; Rosenwaks, Zev

doi:10.1016/j.fertnstert.2016.11.012

Cited by 140 publications

(120 citation statements)

References 27 publications

(62 reference statements)

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“…In a total of 417 cryopreserved embryo transfer cycles, excellent quality embryos (n = 38 [84.2%]) yielded a statistically significantly higher ongoing pregnancy rate compared with poor quality (n = 106 [35.8%]) and average quality (n = 197 [55.8%]) embryos (adjusted OR 11.0, 95% CI 3.8 to 32.1 and adjusted OR 4.8, 95% CI 1.7 to 13.3, respectively); good-quality embryos (n = 76) were associated with a statistically significant higher ongoing pregnancy rate than poor-quality embryos (61.8% versus 35.8%; P < 0.01). The authors also reported that inner cell morphology was a better predictor of pregnancy outcome than trophoectoderm morphology or blastocoel expansion (Irani et al, 2017). Concordant with this study, we, in our series, reported an overall effect of blastocyst morphology on ongoing pregnancy as depicted by linearby-linear association ( Table 3).…”

Section: Discussionsupporting

confidence: 91%

“…They reported similar ongoing implantation rates after SEBT of excellent (n = 110 [49.1%]), good (n = 32 [59.4%]), average (n = 60 [43.3%]) and poor (n = 13 [53.8%]) morphology blastocysts. A recent study, however, refuted these findings and reported that blastocyst morphology was still an independent predictor of ongoing pregnancy in PGS cycles (Irani et al, 2017). In a total of 417 cryopreserved embryo transfer cycles, excellent quality embryos (n = 38 [84.2%]) yielded a statistically significantly higher ongoing pregnancy rate compared with poor quality (n = 106 [35.8%]) and average quality (n = 197 [55.8%]) embryos (adjusted OR 11.0, 95% CI 3.8 to 32.1 and adjusted OR 4.8, 95% CI 1.7 to 13.3, respectively); good-quality embryos (n = 76) were associated with a statistically significant higher ongoing pregnancy rate than poor-quality embryos (61.8% versus 35.8%; P < 0.01).…”

Section: Discussionmentioning

confidence: 99%

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Duration of blastulation may be associated with ongoing pregnancy rate in single euploid blastocyst transfer cycles

Mümüşoğlu

Ozbek²,

Sökmensüer

et al. 2017

Reproductive BioMedicine Online

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Not all euploid embryos implant, necessitating additional tools to select viable blastocysts in preimplantation genetic screening cycles. In this retrospective cohort study, 129 consecutive patients who underwent 129 single euploid blastocyst transfers in cryopreserved embryo transfer cycles were included. All embryos were individually cultured in a time-lapse incubator from intracytoplasmic sperm injection up to trophoectoderm biopsy. Twenty-three time-lapse morphokinetic variables were tested among patients with (n = 68) or without (n = 61) ongoing pregnancy. All 23 time-lapse morphokinetic variables, apart from duration of blastulation (tB-tSB), were comparable between patients with or without ongoing pregnancy. Duration of blastulation was significantly shorter in patients with ongoing pregnancy (8.1 ± 3.2 versus 9.5 ± 3.4 h; P = 0.014); shorter duration of blastulation remained an independent predictor for ongoing pregnancy, when tested by logistic regression analysis (OR 0.81; 95% CI 0.70 to 0.93). One important limitation of this study, and a reason for caution, is the use of multiple comparisons, which can lead to differences at the 0.05 level simply by chance or random variation. Nonetheless, the study suggests that when more than one euploid blastocyst is available, priority might be given to those with a shorter duration of blastulation.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Duration of blastulation may be associated with ongoing pregnancy rate in single euploid blastocyst transfer cycles

Mümüşoğlu

Ozbek²,

Sökmensüer

et al. 2017

Reproductive BioMedicine Online

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“…In humans, although this ratio cannot be implemented in a clinical setting, the morphological grading of ICM and TE is linked with embryo ploidy [40] and impacts on blastocyst potential even in euploid blastocysts [41].…”

Section: Resultsmentioning

confidence: 99%

Does air pollution play a role in infertility?: a systematic review

et al. 2017

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Background: Air pollution is involved in many pathologies. These pollutants act through several mechanisms that can affect numerous physiological functions, including reproduction: as endocrine disruptors or reactive oxygen species inducers, and through the formation of DNA adducts and/or epigenetic modifications. We conducted a systematic review of the published literature on the impact of air pollution on reproductive function. Eligible studies were selected from an electronic literature search from the PUBMED database from January 2000 to February 2016 and associated references in published studies. Search terms included (1) ovary or follicle or oocyte or testis or testicular or sperm or spermatozoa or fertility or infertility and (2) air quality or O 3 or NO 2 or PM2.5 or diesel or SO 2 or traffic or PM10 or air pollution or air pollutants. The literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We have included the human and animal studies corresponding to the search terms and published in English. We have excluded articles whose results did not concern fertility or gamete function and those focused on cancer or allergy. We have also excluded genetic, auto-immune or iatrogenic causes of reduced reproduction function from our analysis. Finally, we have excluded animal data that does not concern mammals and studies based on results from in vitro culture. Data have been grouped according to the studied pollutants in order to synthetize their impact on fertility and the molecular pathways involved.

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“…It is known that factors such as embryo quality, maternal age, the patient's genetic background, clinical diagnosis, and treatment-related characteristics can affect pregnancy outcome 25,26 . Because embryo quality is one of the most important of these factors, the ultimate aim of any embryo-assessment approach is to identify embryos that have the highest implantation potential, resulting in live birth 24,27,28 .…”

Section: Predicting Pregnancy Likelihood Using the Trained Algorithm mentioning

confidence: 99%

Robust Automated Assessment of Human Blastocyst Quality using Deep Learning

Khosravi

Kazemi

Toschi

et al. 2018

Preprint

Self Cite

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Morphology assessment has become the standard method for evaluation of embryo quality and selecting human blastocysts for transfer in in vitro fertilization (IVF). This process is highly subjective for some embryos and thus prone to human bias. As a result, morphological assessment results may vary extensively between embryologists and in some cases may fail to accurately predict embryo implantation and live birth potential. Here we postulated that an artificial intelligence (AI) approach trained on thousands of embryos can reliably predict embryo quality without human intervention.To test this hypothesis, we implemented an AI approach based on deep neural networks (DNNs). Our approach called STORK accurately predicts the morphological quality of blastocysts based on raw digital images of embryos with 98% accuracy. These results indicate that a DNN can automatically and accurately grade embryos based on raw images.Using clinical data for 2,182 embryos, we then created a decision tree that integrates 2 clinical parameters such as embryo quality and patient age to identify scenarios associated with increased or decreased pregnancy chance. This IVF data-driven analysis shows that the chance of pregnancy varies from 13.8% to 66.3%.In conclusion, our AI-driven approach provides a novel way to assess embryo quality and uncovers new, potentially personalized strategies to select embryos with an improved likelihood of pregnancy outcome.

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Morphologic grading of euploid blastocysts influences implantation and ongoing pregnancy rates

Abstract: Contrary to prior published studies, the current data suggest that blastocyst morphologic grading and particularly inner cell mass grade is a useful predictor of OPR per euploid embryo. Morphologic grading should be used to help in the selection among euploid blastocysts.

Cited by 140 publications

References 27 publications

Duration of blastulation may be associated with ongoing pregnancy rate in single euploid blastocyst transfer cycles

Duration of blastulation may be associated with ongoing pregnancy rate in single euploid blastocyst transfer cycles

Does air pollution play a role in infertility?: a systematic review

Robust Automated Assessment of Human Blastocyst Quality using Deep Learning

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