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R2012.05
Embryo Selection by near-infrared spectroscopy. READ ON
A double blind prospective study fails to improve embryo selection over visual morphology assessment.
 
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Alternative tools for embryo selection.
   
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IVF currently relies on individual embryologists selection of embryos for transfer, cryopreservation or discarding. Analysis of culture medium has been explored before but using Near-Infrared Spectroscopy [NIS] to analyse all the metabolic wastes is a novel tool. Several previous studies have suggested NIS may improve the pregnancy rate by selecting embryos on their metabolic activity rather than their appearance.
 
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The Data Set
   
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This was a double blind prospective study with ethical approval where good quality embryos were selected for transfer by either morphology [n=163] or their NIS vitality score [n=143]. This is about as good as it can get. All women had a single embryo transferred but there was no limit on age, previous cycles or IVF x ICSI.
 
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Their observations.
   
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The clinical and the live birth rate was the same in both the morphology [31.7%] only and the NIS selected group [26.8%]. In 71% of cases, the best embryo based upon NIS scoring was NOT the best embryo selected by morphology.
 
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Comments.
   
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This must have been a disappointing outcome for the NIS providers since previous retrospective studies have suggested a positive selection performance. In this cases, the challenge was to select from a group of acceptable quality embryo one for transfer. The NIS algorithm if anything selected embryos of poorer visual quality (more fragmentation, faster cleavage) possibly explaining their poorer pregnancy rate. As indicated by the authors, at this level, there may well be more than one embryo with the potential to establish a pregnancy and therefore one may expect a similar result. They also suggested the NIS unit may not be a portable as anticipated and its establishment in a new laboratory is a possible factor. Still, if the plan had always been for laboratories to purchase a unit, this suggests the units stability may need further development.
 
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Where to now.
   
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The problem with the NIS concept is that it provides a score without any further information such as the spectograph. It may be the algorithm used may need further refinement to improve the sensitivity when comparing top quality embryos. It may also be that the metabolic wastes are sufficiently low in concentration that this approach will have limitations. Notwithstanding this, the data shows visual inspection to date to be reliable and maybe more effort needs to be placed in education and training (OK it's plug for QAPonline). Alternative approaches such as the Embryoscope looking at rates of development may prove more rewarding but remember it is set against a efficient background - experienced eyes!
Carlijn G. Vergouw, et. al (2012).Day 3 embryo selection by metabolomic profiling of culture medium with near-infrared spectroscopy as an adjunct to morphology: a randomized controlled trial. Hum. Reprod. (2012) doi: 10.1093/humrep/des175 - View
Reviewed on 17/07/2012 2:56:36 PM by J Stanger
Review Groups: Embryo Culture / Results / Pregnancy /
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