title: Oocyte Scoring Enhances Embryo-Scoring in Predicting Pregnancy Chances with IVF Where It Counts Most.
abstract: BACKGROUND
  Our center's quality improvement optimization process on many occasions anecdotally suggested that oocyte assessments might enhance embryo assessment in predicting pregnancy chances with in vitro fertilization (IVF).
  
  
  OBJECTIVE
  To prospectively compare a morphologic oocyte grading system to standard day-3 morphologic embryo assessment.
  
  
  METHODS
  We prospectively investigated in a private academically-affiliated infertility center 94 consecutive IVF cycles based on 6 criteria for oocyte quality: morphology, cytoplasm, perivitelline space (PVS), zona pellucida (ZP), polar body (PB) and oocyte size, each assigned a value of -1 (worst), 0 (average) or +1 (best), so establishing an average total oocyte score (TOS). Embryo assessment utilized grade and cell numbers of each embryo on day-3 after oocyte retrieval. Clinical pregnancy was defined by presence of at least one intrauterine gestational sac.
  
  
  METHODS
  Standard IVF cycles in infertile women.
  
  
  METHODS
  Predictability of pregnancy based on oocyte and embryo-grading systems.
  
  
  RESULTS
  Average age for all patients was 36.5 ± 7.3 years; mean oocyte yield was 7.97± 5.76; Patient specific total oocyte score (PTOS) was -1.05 ± 2.24. PTOS, adjusted for patient age, was directly related to odds of increased embryo cell numbers (OR 1.12, P = 0.025), embryo grade (OR 1.19, P < 0.001) and clinical pregnancy [OR 1.58 (95%CI 1.23 to 2.02), P < 0.001]. Restricting the analysis to day three embryos of high quality (8-cell/ good grades), TOS was still predictive of clinical pregnancy (OR 2.08 (95%CI 1.26 to 3.44, P = 0.004). Among the 69 patients with embryos of Grade 4 or better available for transfer 23 achieved Clinical Pregnancy. When the analysis was restricted to the 69 transfers with good quality embryos (≥ Grade 4) the Oocyte Scoring System (TOS) (AUC±SE 0.863±0.044, oocyte score) provided significantly greater predictive value for clinical pregnancy compared to the embryo grade alone (AUC 0.646 ± 0.072, embryo grade) p = 0.015.
  
  
  CONCLUSIONS
  Oocyte-scoring, thus, provides useful clinical information especially in good prognosis patients with large numbers of high quality embryos. This finding appears of particular importance at a time when many IVF centers are committing sizable investments to closed incubation systems with time-lapse photography, which are exclusively meant to define embryo morphology.
authors.affiliation: The Center for Human Reproduction, New York, New York, United States of America.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Lazzaroni-Tealdi
authors.affiliation: The Center for Human Reproduction, New York, New York, United States of America.|The Foundation for Reproductive Medicine, New York, New York, United States of America.|Department of Obstetrics and Gynecology, Albert Einstein College of Medicine, Bronx, New York, United States of America.
authors.forename: David H
authors.initials: DH
authors.lastname: Barad
authors.affiliation: The Center for Human Reproduction, New York, New York, United States of America.|Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas, United States of America.
authors.forename: David F
authors.initials: DF
authors.lastname: Albertini
authors.affiliation: The Center for Human Reproduction, New York, New York, United States of America.
authors.forename: Yao
authors.initials: Y
authors.lastname: Yu
authors.affiliation: The Center for Human Reproduction, New York, New York, United States of America.|Department of Obstetrics and Gynecology, Wake Forest University, Winston Salem, North Carolina, United States of America.
authors.forename: Vitaly A
authors.initials: VA
authors.lastname: Kushnir
authors.affiliation: School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, United States of America.
authors.forename: Helena
authors.initials: H
authors.lastname: Russell
authors.affiliation: The Center for Human Reproduction, New York, New York, United States of America.
authors.forename: Yan-Guang
authors.initials: YG
authors.lastname: Wu
authors.affiliation: The Center for Human Reproduction, New York, New York, United States of America.|The Foundation for Reproductive Medicine, New York, New York, United States of America.|Stem Cell and Molecular Embryology Laboratory, The Rockefeller University, New York, New York, United States of America.
authors.forename: Norbert
authors.initials: N
authors.lastname: Gleicher
mesh_terms: D000328:Adult; D004622:Embryo, Mammalian / Q000196:embryology*; D005260:Female; D005307:Fertilization in Vitro / Q000592:standards*; D006801:Humans; D009865:Oocytes / Q000502:physiology*; D011247:Pregnancy; D016896:Treatment Outcome