title: Analysis of embryo morphokinetics, multinucleation and cleavage anomalies using continuous time-lapse monitoring in blastocyst transfer cycles.
abstract: BACKGROUND
  Time-lapse imaging combined with embryo morphokinetics may offer a non-invasive means for improving embryo selection. Data from clinics worldwide are necessary to compare and ultimately develop embryo classifications models using kinetic data. The primary objective of this study was to determine if there were kinetic differences between embryos with limited potential and those more often associated with in vitro blastocyst formation and/or implantation. We also wanted to compare putative kinetic markers for embryo selection as proposed by other laboratories to what we were observing in our own laboratory setting.
  
  
  METHODS
  Kinetic data and cycle outcomes were retrospectively analyzed in patients age 39 and younger with 7 or more zygotes cultured in the Embryoscope. Timing of specific events from the point of insemination were determined using time-lapse (TL) imaging. The following kinetic markers were assessed: time to syngamy (tPNf), t2, time to two cells (c), 3c (t3), 4c ( t4), 5c (t5), 8c (t8), morula (tMor), start of blastulation (tSB); tBL, blastocyst (tBL); expanded blastocyst (tEBL). Durations of the second (cc2) and third (cc3) cell cycles, the t5-t2 interval as well as time to complete synchronous divisions s1, s2 and s3 were calculated. Incidence and impact on development of nuclear and cleavage anomalies were also assessed.
  
  
  RESULTS
  A total of 648 embryos transferred on day 5 were analyzed. The clinical pregnancy and implantation rate were 72% and 50%, respectively. Morphokinetic data showed that tPNf, t2,t4, t8, s1, s2,s3 and cc2 were significantly different in embryos forming blastocysts (ET or frozen) versus those with limited potential either failing to blastulate or else forming poor quality blastocysts ,ultimately discarded. Comparison of embryo kinetics in cycles with all embryos implanting (KID+) versus no implantation (KID-) suggested that markers of embryo competence to implant may be different from ability to form a blastocyst. The incidence of multinucleation and reverse cleavage amongst the embryos observed was 25% and 7%, respectively. Over 40% of embryos exhibiting these characteristics did however form blastocysts meeting our criteria for freezing.
  
  
  CONCLUSIONS
  These data provide us with a platform with which to potentially enhance embryo selection for transfer.
authors.affiliation: Department of Reproductive Endocrinology and Infertility, Cleveland Clinic, Beachwood, Ohio, USA. desain@ccf.org.
authors.forename: Nina
authors.initials: N
authors.lastname: Desai
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ploskonka
authors.forename: Linnea R
authors.initials: LR
authors.lastname: Goodman
authors.forename: Cynthia
authors.initials: C
authors.lastname: Austin
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Goldberg
authors.forename: Tommaso
authors.initials: T
authors.lastname: Falcone
mesh_terms: D000328:Adult; D001755:Blastocyst / Q000145:classification / Q000166:cytology* / Q000473:pathology; D001757:Blastomeres / Q000166:cytology* / Q000473:pathology; D048750:Cell Nucleus Division; D049109:Cell Proliferation; D015925:Cryopreservation; D004477:Ectogenesis; D046149:Embryo Culture Techniques; D004622:Embryo, Mammalian / Q000166:cytology* / Q000473:pathology; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D007248:Infertility, Male; D008297:Male; D018715:Microscopy, Video; D009028:Morula / Q000166:cytology* / Q000473:pathology; D009820:Ohio / Q000453:epidemiology; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D059008:Time-Lapse Imaging; D015053:Zygote / Q000166:cytology* / Q000473:pathology