Abstract
BackgroundEmbryo selection has been an integral feature of in vitro fertilization (IVF) almost since its inception. Since the advent of extended blastocyst stage embryo culture, and especially with increasing popularity of elective single embryo transfer (eSET), the concept of embryo selection has increasingly become a mainstay of routine IVF.DiscussionWe here, however, argue that embryo selection via blastocyst stage embryo transfer (BSET), as currently practiced, at best improves IVF outcomes only for a small minority of patients undergoing IVF cycles. For a large majority BSET is either ineffective or, indeed, may actually be harmful by decreasing IVF pregnancy chances. Overall, only a small minority of patients, thus, benefit from prolonged embryo culture, while BSET, as a tool to enhance IVF outcomes, is increasingly utilized as routine care in IVF for all patients.SummarySince newer methods of embryo selection, like preimplantation genetic screening (PGS) and closed system embryo incubation with time-lapse photography are practically dependent on BSET, these concepts of embryo selection, currently increasingly adopted in mainstream IVF, require reconsideration. They, automatically, transfer the downsides of BSET, including decreases in IVF pregnancy chances in some patients, to these new procedures, and in addition raise serious questions about cost-effectiveness.
Highlights
Embryo selection has been an integral feature of in vitro fertilization (IVF) almost since its inception
Summary: Since newer methods of embryo selection, like preimplantation genetic screening (PGS) and closed system embryo incubation with time-lapse photography are practically dependent on blastocyst stage embryo transfer (BSET), these concepts of embryo selection, currently increasingly adopted in mainstream IVF, require reconsideration
The authors concluded that the study provided evidence of significant difference in pregnancy and live birth rates in favor of BSET in “good-prognosis” patients, with high numbers of 8-cell embryos on day-3 being the most favored subgroup, and being the only sub-group demonstrating no difference in cycle cancellation rates because of absence of transferrable embryos [10]
Summary
BSET has to be the starting point for such a discussion. It is based on the seemingly logical concept that longer embryo culture in vitro favorably selects best embryos, while poorer quality embryos will arrest on the way to culture days-5/6. The authors concluded that the study provided evidence of significant difference in pregnancy and live birth rates in favor of BSET in “good-prognosis” patients, with high numbers of 8-cell embryos on day-3 being the most favored subgroup, and being the only sub-group demonstrating no difference in cycle cancellation rates because of absence of transferrable embryos [10]. They, added a very important additional analysis of cumulative pregnancy rates from single embryo cohorts, obtained during one retrieval, and either transferred by CSET or BSET These authors concluded that, overall, their study provided evidence of a small but significant difference in live birth rates favoring BSET. Despite marginal outcome improvements in “good-prognosis” patients, this study, again raises questions about utility of ET in only a relatively small group of “good-prognosis” patients, and about cost-effectiveness, especially considering that costs of currently marketed automated embryo culture systems in the U.S exceed $100,000. Authors’ contributions All authors read and approved the final manuscript
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