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Day-3 embryo morphology predicts euploidy among older subjects
Sharon E Moayeri1, Rene B Allen, Wendy R Brewster
1Department of Obstetrics and Gynecology, Stanford University Medical Center, Stanford, California 94305, USA. smoayeri@stanford.edu
Objective:
To evaluate whether day-3 embryo morphology predicts euploidy.
Design:
Retrospective.
Setting:
Private IVF center.
Patient(S):
Subjects (n = 144) undergoing in vitro fertilization and preimplantation genetic diagnosis (PGD).
Intervention(S):
Translate day-3 embryo characteristics into a standardized score.
Main Outcome Measure(S):
Day-3 embryo morphology score and PGD fluorescence in situ hybridization results for chromosomes: 13, 15, 16, 17, 18, 21, 22, X, and Y.
Result(S):
Of 1,043 biopsied blastomeres, 67% (n = 696) were chromosomally abnormal. Women with advanced maternal age (AMA) were 1.3 times more likely to have chromosomal errors (95% CI 1.1-1.4) than younger subjects (<38 years old). Morphology predicted PGD results in the AMA group (n = 553), but not in younger women. Fragmentation predicted euploidy in both the younger and the AMA group, but cell number did not.
Conclusion(S):
Day-3 embryo morphology selects for euploidy among AMA subjects but not among younger women who may have other factors responsible for embryo dysmorphism. However, cellular fragmentation is a sensitive proxy for selecting chromosomally normal embryos in both age groups. It is unclear that PGD-aneuploidy screening is a better tool for selecting which embryos to transfer than the standard approach of using day-3 embryo features, particularly among older women, a group for whom this technology is targeted.
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