title: The graduated embryo score predicts the outcome of assisted reproductive technologies better than a single day 3 evaluation and achieves results associated with blastocyst transfer from day 3 embryo transfer.
abstract: OBJECTIVE
  To evaluate the graduated embryo score (GES) for predicting assisted reproductive technology (ART) outcome compared to a single morphologic evaluation on day 3 of culture (grade A: > or =7 cells; <20% fragmentation).
  
  
  METHODS
  Prospective cohort analysis.
  
  
  METHODS
  Private practice.
  
  
  METHODS
  Women aged <40 years with a normal uterine cavity treated with ART (n = 106).
  
  
  METHODS
  Embryos were graded by GES and by day 3 morphologic characteristics alone before ET. Cycle outcomes were compared with embryo grade.
  
  
  METHODS
  Ongoing gestation and implantation rates.
  
  
  RESULTS
  Overall ongoing gestation and implantation rates were 48% and 26%, respectively. With 1+ embryo GES > or =70 (n = 77), the rates were 62% and 36%, respectively, which were significantly higher than for those with 0 embryos GES > or =70 (n = 29). With 1+ grade A embryo (n = 102), the rates were 50% and 27%, respectively. Transfer of more than one embryo GES > or =70 did not improve the pregnancy rate, but did increase the risk of multiple gestations. A single day 3 evaluation had an extremely low specificity (7%) compared to GES (47%). Graduated embryo scoring (GES) was an excellent predictor of pregnancy and implantation rates from blastocyst transfer. Day of transfer did not affect pregnancy rates, although implantation was higher from day 5 embryo transfer (ET) than from day 3 ET, as fewer embryos were transferred.
  
  
  CONCLUSIONS
  Transfer of one or more embryo GES > or =70 predicts pregnancy and implantation rates better than a single morphologic evaluation on day 3 and achieves ART outcomes associated with blastocyst transfer from day 3 ET, making extended culture unnecessary for most patients.
authors.affiliation: Sher Institute for Reproductive Medicine, Las Vegas, Nevada 89109, USA. jfisch@sherinstitute.com
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Fisch
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Sher
authors.forename: Mark
authors.initials: M
authors.lastname: Adamowicz
authors.forename: Levent
authors.initials: L
authors.lastname: Keskintepe
mesh_terms: D000328:Adult; D001755:Blastocyst / Q000166:cytology*; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome