Emerging technologies for improving embryo selection: a systematic review

Figures & data

Figure 1 PRISMA flow diagram of study selection.

Figure 2 The number of PubMed publications on embryo assessment and embryo selection for each year between 2003 and 2014.

Table 1 Summary of the studies reporting clinical outcomes obtained using a novel embryo selection technique in comparison with morphology alone assessment

Study	Embryo selection method	Study population (number of patients)	Outcome measure	Outcome rate - novel technique (%)	Outcome rate - morphology alone (%)	Results
Forman et al^Citation46	Aneuploidy screening	175	Delivery rate	69	72	The delivery rates were similar (69% after euploid eSET vs 72% after untested two-embryo transfer; P=0.6) through the fresh cycle and up to one frozen transfer, with a dramatic difference in multiple births (1.6% vs 47%; P<0001)
vergouw et al^Citation47	Metabolomics	417	Live birth rate	31.7	26.8	Day 3 embryo selection by metabolomic profiling of culture medium with NIR spectroscopy as an addition to morphology was not able to improve the ongoing pregnancy and live birth rates compared with embryo selection by morphology alone
Hardarson et al^Citation48	Metabolomics	327	Pregnancy rate	34.8	35.6	NIR spectroscopy-based metabolomic profiling of embryo does not improve the chance of a viable pregnancy when performing SET
Sfontouris et al^Citation49	Metabolomics	125	Implantation rate	46.8	28.9	No significant difference for day 2 and day 3 transfers on implantation rates, where there is a significant difference on day 5 transfers
Rubio et al^Citation50	Morphokinetic	843	Implantation rate	44.9	37.1	Implantation rate was statistically significantly increased with morphokinetic evaluation (44.9%) in comparison with standard morphological evaluation (37.1%)

Abbreviations: eSET, elective single embryo transfer; NIR, near infrared; SET, single embryo transfer.

Figure 3 IVF success rates obtained online from the Society for Assisted Reproductive Technology (SART) Clinical Outcomes Reporting System, Clinical Summary Report, for the period of 2003–2013.

Notes: Assessed success rates are reported separately for the age groups consistent with SART age categorization. (A) Number of cycles; (B) average number of transferred embryos; (C) implantation rate; (D) pregnancy rate; (E) live birth rate; (F) multiple pregnancy rate. Data from the SART Clinical Outcomes Reporting System, Clinical Summary Report; © Copyright 2015 SART, All Rights Reserved. The investigators summarized publicly available data collected by SART, and are not SART members themselves. The data is accessed from the National Summary provided annually from 2004-2013 on www.sart.org.⁴⁵
Abbreviation: IVF, in vitro fertilization.

Forman EJ, Hong KH, Franasiak JM, Scott RT Jr. Obstetrical and neonatal outcomes from the BEST Trial: single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates. Am J Obstet Gynecol. 2014; 210(157):e151–e156.

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Vergouw CG, Kieslinger DC, Kostelijk EH, et al. 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;27:2304–2311.

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Hardarson T, Ahlström A, Rogberg L, et al. Non-invasive metabolomic profiling of Day 2 and 5 embryo culture medium: a prospective randomized trial. Hum Reprod. 2012;27:89–96.

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Sfontouris IA, Lainas GT, Sakkas D, Zorzovilis IZ, Petsas GK, Lainas TG. Non-invasive metabolomic analysis using a commercial NIR instrument for embryo selection. J Hum Reprod Sci. 2013;6:133–139.

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Rubio I, Galán A, Larreategui Z, et al. Clinical validation of embryo culture and selection by morphokinetic analysis: a randomized, controlled trial of the EmbryoScope. Fertil Steril. 2014;102(1287–1294):e1285.

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Society for Assisted Reproductive Technology, Clinical Outcome Reporting System, Clinical Summary Report. Available from: https://www.sartcorsonline.com/rptCSR_PublicMultYe`ar.aspx?ClinicPKID=0. Accessed March 11, 2015.

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