title: Is there an advantage in scoring early embryos on more than one day?
abstract: BACKGROUND
  This study was undertaken to determine what characteristics should be recorded on which days to build a predictive model for selection of Day 3 embryos.
  
  
  METHODS
  Embryos failing to form a clinical sac or that formed a viable fetus (to > or =12 weeks), and transferred singly (n = 269) or in pairs (n = 1326) were scored for early cleavage and pronuclear status on Day 1, and cell number, fragmentation, and symmetry on Days 2 and 3, with number of nuclei per blastomere also recorded on Day 2. Seven candidate models were identified using a priori clinical knowledge and univariate analyses. Each model was fit on a training-set and evaluated on a test-set with resampling, with discrimination assessed using the area under the ROC curve (AUC) and calibration assessed using the Hosmer-Lemeshow statistics.
  
  
  RESULTS
  Models built using Day 1, 2 or 3 scores independently on the 30 resampled data sets showed that Day 1 evaluations provided the poorest predictive value (median AUC = 0.683 versus 0.729 and 0.725, for Day 2 and 3). Combining information from Day 1, 2 and 3 marginally improved discrimination (median AUC = 0.737). Using the final Day 3 model fitted on the whole dataset, the median AUC was 0.732 (95% CI, 0.700-0.764), and 68.6% of embryos would be correctly classified with a cutoff probability equal to 0.3.
  
  
  CONCLUSIONS
  Day 2 or Day 3 evaluations alone are sufficient for morphological selection of cleavage stage embryos. The derived regression coefficients can be used prospectively in an algorithm to rank embryos for selection.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB 1+3, Rm 082, Boston, MA 02115, USA. cracowsky@partners.org
authors.forename: Catherine
authors.initials: C
authors.lastname: Racowsky
authors.forename: Lucila
authors.initials: L
authors.lastname: Ohno-Machado
authors.forename: Jihoon
authors.initials: J
authors.lastname: Kim
authors.forename: John D
authors.initials: JD
authors.lastname: Biggers
mesh_terms: D000328:Adult; D000465:Algorithms; D046149:Embryo Culture Techniques / Q000379:methods*; D004624:Embryo Transfer / Q000379:methods; D004622:Embryo, Mammalian; D047108:Embryonic Development; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D008423:Maternal Age; D011237:Predictive Value of Tests; D011247:Pregnancy; D012044:Regression Analysis; D018570:Risk Assessment; D020554:Sperm Injections, Intracytoplasmic; D013997:Time Factors; D016896:Treatment Outcome