www.oc2017.cme-congresses.com Sheila Fieldust Kaplan Medical Center Rehovot, Israel The relationship between blastocyst inner cell mass size and pregnancy outcome Nothing to declare
www.oc2017.cme-congresses.com
Sheila Fieldust
Kaplan Medical Center
Rehovot, Israel
The relationship between blastocyst inner cell mass size and
pregnancy outcome
Nothing to declare
http://www.cogen2016.cme-congresses.com/http://www.cogen2016.cme-congresses.com/http://www.cogen2016.cme-congresses.com/http://www.cogen2016.cme-congresses.com/http://www.cogen2016.cme-congresses.com/
The relationship between blastocyst
inner cell mass size and
pregnancy outcome
S. Fieldust, M. Almagor, Y. Harir, Y. Or, Z. Shoham
IVF Unit, Kaplan Medical Center, Israel
http://www.google.co.il/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwifpYTtleDUAhUSrRQKHS93CdgQjRwIBw&url=http%3A%2F%2Fclipartix.com%2Fbaby-girl-clipart%2F&psig=AFQjCNFW6qivxP4gsGoEtKXf_EOk0HmlQw&ust=1498726574963626
Blastocyst Transfer
Preferable to day 3 transfer:
• Better odds of transferring a viable embryo
• Better embryo-endometrium synchrony
Hatching Blastocyst
Blastocyst Scoring
Gardner and Schoolcraft (2000) scoring of blastocysts:
• The stage of expansion of the blastocyst
• Inner cell mass (ICM) consistency
• Trophectoderm cohesiveness
Richter et al. 2001
• Positive correlation between ICM shape and size and
blastocyst viability
Gardner DK et al. Fertil Steril 2000; 73:1155-8.
Richter KS et al. Fertil Steril 2001; 76:1157-1167.
EmbryoScope
Positive Predictors
• Time to: – 2, 4 and 8 cells
– Start of Blastulation
– Expansion of Blastocyst
• Synchrony of cell divisions
Negative Predictors
• Multinucleation
• Direct Cleavage from 1-3 cells
2 cells
4 cells
8 cells
Morula
Blastocyst
Hatching BL
Our aim
To provide an additional tool for
selecting the best blastocyst for
transfer
Inclusion criteria
• Continuous culture in the EmbryoScope
• Single blastocyst transfer on day 5
• Easily measured inner cell mass
Phase I
Retrospective review of 63 Single Blastocyst
transfers
Age and cycle number were not taken into consideration
Blastocysts were measured 114 – 116 hours after ICSI
ICM/BL ratio = ICM diameter
Blastocyst diameter
63
25 (40%) 38 (60%)
1 BT
ICM/BL ratio ?
http://www.google.co.il/url?url=http://www.clipartkid.com/pregnancy-cliparts/&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjHmr-RpuPMAhXDmBoKHQTGD64QwW4IFTAA&usg=AFQjCNHmoRKSNxx0m1ydq0EBuwuBG4wIdwhttp://www.google.co.il/url?url=http://clipartfreefor.com/files/2/44221_female-clip-art.html&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjFnozipuPMAhVaOMAKHeCjC8g4FBDBbggZMAI&usg=AFQjCNHIZeIC9LX0zsWNk2UaaI_yH0AC9Ahttp://www.google.co.il/url?url=http://clipartfreefor.com/files/2/44221_female-clip-art.html&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjFnozipuPMAhVaOMAKHeCjC8g4FBDBbggZMAI&usg=AFQjCNHIZeIC9LX0zsWNk2UaaI_yH0AC9A
0.2
0.3
0.4
0.5
0.6
Age- 32.6 Age- 33.7
ICM
/BL
ratio
25 (40%) 38 (60%)
Age-32.6 Age-33.7
0.48
0.34
P
• Based on phase I – desired ICM/BL ratio ~ 0.48
• Blastocysts were measured before transfer
• Single blastocyst transfer to 64 women with
average ICM/BL ratio of 0.46 (SD+0.073)
Phase II
0
10
20
30
40
50
60
70
80
Age-33.8 Age-35.1
Pre
gn
an
cy r
ate
Ratio =0.46 Ratio =0.44
Pregnancy rate
43(67%)
21(33%)
Phase II
http://www.google.co.il/url?url=http://www.clipartkid.com/pregnancy-cliparts/&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjHmr-RpuPMAhXDmBoKHQTGD64QwW4IFTAA&usg=AFQjCNHmoRKSNxx0m1ydq0EBuwuBG4wIdwhttp://www.google.co.il/url?url=http://clipartfreefor.com/files/2/44221_female-clip-art.html&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjFnozipuPMAhVaOMAKHeCjC8g4FBDBbggZMAI&usg=AFQjCNHIZeIC9LX0zsWNk2UaaI_yH0AC9A
Conclusions
• Average ICM/BL ratio of 0.48 is associated
with significantly increased pregnancy
rates
• Measurement of ICM/BL ratio may be
used as an additional strongly predictive
parameter of successful implantation
• Blastocyst inner cell measurement has
become routine policy in our lab
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