A Prospective Randomized Pilot Study Comparing Pregnancy Rates and Implantation Rates When Embryos are Selected Based on a Single day 3 (D.3) Score vs. a Graduated Embryo Score (GES) Plus Soluble Human Leukocyte Antigen-G (sHLA-G) Expression

Abstract

In most IVF programs, the morphological characteristics of the embryos are evaluated on the day of transfer and the embryos with the highest morphological scores are transferred. We compared two different embryo-scoring methods, D.3 vs. GES and found no differences in either the pregnancy rates or the implantation rates with either scoring method. Embryos expressing a high concentration of sHLA-G, have been shown to improve implantation rates. The aim of this study was to compare pregnancy rates and implantation rates when embryos are selected based on a single D.3 score vs. a GES score plus sHLA-G expression. Prospective randomized pilot study Patients undergoing ICSI, were randomized to receive embryos based on a single D.3 score or a GES score plus sHLA-G expression. The D.3 score was based on the number of blastomeres and the extent of fragmentation on D.3. The GES score was based on the alignment of the nucleoli at the 2-pronuclear (2PN) stage, early cleavage (ie cleaved or not cleaved at 26 hours after ICSI), the number of blastomeres and the extent of fragmentation on D.3. sHLA-G expression was monitored by assaying the culture media. Embryos were cultured individually in 50 μl droplets of P-1 medium (Irvine Scientific, Santa Ana, CA) for 44-46 hours and moved to Complete Blastocyst Medium (Irvine Scientific, Santa Ana, CA). At this point, the P-1 culture media drops were collected and assayed for sHLA-G, using an enzyme-linked immunosorbent sandwich (ELISA) assay. Patients were treated by the same physician. A human derived gonadotropin (Bravelle; Ferring Pharmaceuticals Inc, Suffern, NY) was used in all patients. The same embryologist did the scoring of all embryos. Embryos with the highest D.3 score or GES score and expressing sHLA-G within a range of 0.190 ± 0.006 (mean ± SD) were transferred on D.3. Analysis of variance (ANOVA) and Chi-square tests were used for comparisons. Statistical significance was achieved if P<0.05. Of the 35 patients studied, 21 received embryos based only on a D. 3 score. The remaining 14 patients received embryos based on a GES score plus sHLA-G expression. The results are shown in the table below. Data expressed as means ± SD or % Tabled 1 Continuing pregnancy rates and implantation rates tended to be higher (p=0.05) when embryos were selected based on a GES score plus sHLA-G expression. We believe, pregnancy rates and implantation rates in IVF patients could be improved by selecting embryos based on a GES score plus sHLA-G expression.