Improving embryo selection using a computer-automated time-lapse image analysis test plus day 3 morphology: results from a prospective multicenter trial

OBJECTIVE

To assess the first computer-automated platform for time-lapse image analysis and blastocyst prediction and to determine how the screening information may assist embryologists in day 3 (D3) embryo selection.

DESIGN

Prospective, multicenter, cohort study.

SETTING

Five IVF clinics in the United States.

PATIENT(S)

One hundred sixty women ≥ 18 years of age undergoing fresh IVF treatment with basal antral follicle count ≥ 8, basal FSH <10 IU/mL, and ≥ 8 normally fertilized oocytes.

INTERVENTION(S)

A noninvasive test combining time-lapse image analysis with the cell-tracking software, Eeva (Early Embryo Viability Assessment), was used to measure early embryo development and generate usable blastocyst predictions by D3.

MAIN OUTCOME MEASURE(S)

Improvement in the ability of experienced embryologists to select which embryos are likely to develop to usable blastocysts using D3 morphology alone, compared with morphology plus Eeva.

RESULT(S)

Experienced embryologists using Eeva in combination with D3 morphology significantly improved their ability to identify embryos that would reach the usable blastocyst stage (specificity for each of three embryologists using morphology vs. morphology plus Eeva: 59.7% vs. 86.3%, 41.9% vs. 84.0%, 79.5% vs. 86.6%). Adjunctive use of morphology plus Eeva improved embryo selection by enabling embryologists to better discriminate which embryos would be unlikely to develop to blastocyst and was particularly beneficial for improving selection among good-morphology embryos. Adjunctive use of morphology plus Eeva also reduced interindividual variability in embryo selection.

CONCLUSION(S)

Previous studies have shown improved implantation rates for blastocyst transfer compared with cleavage-stage transfer. Addition of Eeva to the current embryo grading process may improve the success rates of cleavage-stage ETs.

Familial posterior labial fusion

Partial virilization at birth of a genotypic female resulting in varying degrees of posterior labial fusion and clitoral enlargement is most commonly due to excess androgen production from congenital adrenal hyperplasia. Rarely, labial fusion arises secondary to maternal androgen ingestion or an androgen-secreting tumor during pregnancy. We report a case of posterior labial fusion without clitorimegaly in a 12-year-old girl in which there was no evidence of androgen excess. The family history was remarkable for a similar congenital defect in two aunts and their daughters, suggesting an autosomal dominant trait with incomplete penetrance.

Glucose threshold for macrosomia in pregnancy complicated by diabetes

We analyzed 205 diabetic women treated with insulin during pregnancy to assess the effects of several maternal factors on the development of fetal macrosomia. A total of 95 women were selected for study because they had clearly defined gestational criteria, two or more daytime glucose profiles during the third trimester, and no other complications known to affect fetal growth. The incidence of macrosomia was not found to increase significantly until the mean glucose concentration reached 130 mg/dl; macrosomia occurred in 65% of mothers with glucose values greater than or equal to 130 mg/dl compared with 27% in those with lower values. Other factors strongly associated with fetal macrosomia were maternal weight and insulin dosage. Multiple logistic analysis was performed to control for each risk factor and to obtain estimates of the relative risk for macrosomia. The risk of macrosomia was two times greater in women with mean glucose concentrations greater than or equal to 130 mg/dl, approximately threefold in women whose weight exceeded 80 kg, and one and one half times greater in women with insulin dosages more than 80 units/day. We conclude that several maternal factors in addition to glucose concentration play important roles in the development of fetal macrosomia among diabetic women and that the glucose concentration threshold for macrosomia may exceed 130 mg/dl.