title: Construction of an evidence-based integrated morphology cleavage embryo score for implantation potential of embryos scored and transferred on day 2 after oocyte retrieval.
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.
authors.affiliation: Carl von Linné Clinic, Uppsala Science Park, Uppsala, Sweden. jan.holte@linne.se
authors.forename: J
authors.initials: J
authors.lastname: Holte
authors.forename: L
authors.initials: L
authors.lastname: Berglund
authors.forename: K
authors.initials: K
authors.lastname: Milton
authors.forename: C
authors.initials: C
authors.lastname: Garello
authors.forename: G
authors.initials: G
authors.lastname: Gennarelli
authors.forename: A
authors.initials: A
authors.lastname: Revelli
authors.forename: T
authors.initials: T
authors.lastname: Bergh
mesh_terms: D000328:Adult; D000367:Age Factors; D002970:Cleavage Stage, Ovum / Q000648:ultrastructure*; D010064:Embryo Implantation; D004624:Embryo Transfer / Q000592:standards; D019317:Evidence-Based Medicine; D005260:Female; D005544:Forecasting; D006801:Humans; D018587:Oocyte Donation; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies