title: Quantitative and qualitative trophectoderm grading allows for prediction of live birth and gender.
abstract: OBJECTIVE
  Prolonged in vitro culture is thought to affect pre- and postnatal development of the embryo. This prospective study was set up to determine whether quality/size of inner cell mass (ICM) (from which the fetus ultimately develops) and trophectoderm (TE) (from which the placenta ultimately develops) is reflected in birth and placental weight, healthy live-birth rate, and gender after fresh and frozen single blastocyst transfer.
  
  
  METHODS
  In 225 patients, qualitative scoring of blastocysts was done according to the criteria expansion, ICM, and TE appearance. In parallel, all three parameters were quantified semi-automatically.
  
  
  RESULTS
  TE quality and cell number were the only parameters that predicted treatment outcome. In detail, pregnancies that continued on to a live birth could be distinguished from those pregnancies that aborted on the basis of TE grade and cell number. Male blastocysts had a 2.53 higher chance of showing TE of quality A compared to female ones. There was no correlation between the appearance of both cell lineages and birth or placental weight, respectively.
  
  
  CONCLUSIONS
  The presented correlation of TE with outcome indicates that TE scoring could replace ICM scoring in terms of priority. This would automatically require a rethinking process in terms of blastocyst selection and cryopreservation strategy.
authors.affiliation: Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria. Thomas.ebner@gespag.at.|Department of Gynecology and Obstetrics, Kepler University Hospital, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria. Thomas.ebner@gespag.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ebner
authors.affiliation: Institute of Human Genetics, Medical University, Harrachgasse 21/8, 8010, Graz, Styria, Austria.
authors.forename: Katja
authors.initials: K
authors.lastname: Tritscher
authors.affiliation: Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.|Department of Gynecology and Obstetrics, Kepler University Hospital, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.|Institute of Human Genetics, Medical University, Harrachgasse 21/8, 8010, Graz, Styria, Austria.|Department of Human Genetics, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.|Department for Mathematics and Scientific Computing, Karl-Franzens-University Graz, Universitätsstr. 15, 8010, Graz, Styria, Austria.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Mayer
authors.affiliation: Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.|Department of Gynecology and Obstetrics, Kepler University Hospital, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Oppelt
authors.affiliation: Department of Human Genetics, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Duba
authors.affiliation: Department of Human Genetics, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.
authors.forename: Maria
authors.initials: M
authors.lastname: Maurer
authors.affiliation: Department for Mathematics and Scientific Computing, Karl-Franzens-University Graz, Universitätsstr. 15, 8010, Graz, Styria, Austria.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Schappacher-Tilp
authors.affiliation: Institute of Human Genetics, Medical University, Harrachgasse 21/8, 8010, Graz, Styria, Austria.
authors.forename: Erwin
authors.initials: E
authors.lastname: Petek
authors.affiliation: Department of Gynecological Endocrinology and Kinderwunsch Zentrum, Landes- Frauen- und Kinderklinik, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.|Department of Gynecology and Obstetrics, Kepler University Hospital, Krankenhausstr. 26-30, 4020, Linz, Upper Austria, Austria.
authors.forename: Omar
authors.initials: O
authors.lastname: Shebl
mesh_terms: D000328:Adult; D053624:Blastocyst Inner Cell Mass / Q000166:cytology* / Q000378:metabolism; D015925:Cryopreservation; D004475:Ectoderm / Q000166:cytology* / Q000378:metabolism; D010064:Embryo Implantation / Q000502:physiology; D004624:Embryo Transfer / Q000379:methods; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D050498:Live Birth / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D018873:Pregnancy Rate; D019849:Sex Determination Processes
keywords: Blastocyst; Inner cell mass; Live-birth; Neonatal outcome; Trophectoderm