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The Biological Basis of Oocyte and Embryo Competence: Morphodynamic Criteria for Embryo Selection in In-Vitro Fertilization

  • Chapter
Essential IVF

Abstract

The implantation rate of embryos in human assisted reproduction (ART) is low with between 10 and 40% of transferred embryos implanting. It has been estimated that the overall natural fecundity in normal healthy couples is approximately 20–25% in any one cycle, not too different from that seen in ART, however the expectation of doing better than nature has crept into the practice of ART (Edwards and Beard, 1997). To increase success rates, some practitioners have resorted to multiple embryo replacements with a resulting escalation of high-order pregnancies worldwide without a corresponding increase in the overall implantation rate (Racowsky, 2002). Some countries have mandated limits to the number of embryos that can be replaced (Ludwig et al., 2000) and others have proposed guidelines and recommendations to reduce the risk of higher order gestations. To comply with the regulations and limit the number of embryos replaced while not reducing the probability of implantation requires reliable methods of selecting embryos with the most potential for implantation. If it is assumed that human embryos obtained by in vitro fertilization (IVF) at different ART centers have after similar ranges of competence after fertilization, a 4-fold difference in implantation rate is troublesome and suggests that clinic-specific practices and procedures have an important impact on outcome. This chapter reviews the relevant findings pertaining to how signs of high competence can be recognized at the earliest stages of human embryo development in vitro and describes criteria that, if adopted by IVF programs, should significantly improve outcome in centers where ongoing pregnancy rates persist at low levels.

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  1. Fertility Center of New England, 20 Pond Meadow Drive, Reading, MA, USA

    Lynette Scott

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  1. Lynette Scott
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  1. Department of Molecular, Cellular, and Developmental Biology, University of Colorado, Boulder, Colorado, USA

    Jonathan Van Blerkom

  2. Colorado Reproductive Endocrinology, Rose Medical Center, Denver, Colorado, USA

    Jonathan Van Blerkom

  3. Cardiff Assisted Reproduction Unit, University Hospital of Wales, Heath Park Cardiff, Wales, UK

    Linda Gregory

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Scott, L. (2004). The Biological Basis of Oocyte and Embryo Competence: Morphodynamic Criteria for Embryo Selection in In-Vitro Fertilization. In: Van Blerkom, J., Gregory, L. (eds) Essential IVF. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-8955-0_13

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