www.oc2017.cme-congresses.com

Sheila Fieldust

Kaplan Medical Center

Rehovot, Israel

The relationship between blastocyst inner cell mass size and

pregnancy outcome

Nothing to declare

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The relationship between blastocyst

inner cell mass size and

pregnancy outcome

S. Fieldust, M. Almagor, Y. Harir, Y. Or, Z. Shoham

IVF Unit, Kaplan Medical Center, Israel

http://www.google.co.il/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwifpYTtleDUAhUSrRQKHS93CdgQjRwIBw&url=http%3A%2F%2Fclipartix.com%2Fbaby-girl-clipart%2F&psig=AFQjCNFW6qivxP4gsGoEtKXf_EOk0HmlQw&ust=1498726574963626

Blastocyst Transfer

Preferable to day 3 transfer:

• Better odds of transferring a viable embryo

• Better embryo-endometrium synchrony

Hatching Blastocyst

Blastocyst Scoring

Gardner and Schoolcraft (2000) scoring of blastocysts:

• The stage of expansion of the blastocyst

• Inner cell mass (ICM) consistency

• Trophectoderm cohesiveness

Richter et al. 2001

• Positive correlation between ICM shape and size and

blastocyst viability

Gardner DK et al. Fertil Steril 2000; 73:1155-8.

Richter KS et al. Fertil Steril 2001; 76:1157-1167.

EmbryoScope

Positive Predictors

• Time to: – 2, 4 and 8 cells

– Start of Blastulation

– Expansion of Blastocyst

• Synchrony of cell divisions

Negative Predictors

• Multinucleation

• Direct Cleavage from 1-3 cells

2 cells

4 cells

8 cells

Morula

Blastocyst

Hatching BL

Our aim

To provide an additional tool for

selecting the best blastocyst for

transfer

Inclusion criteria

• Continuous culture in the EmbryoScope

• Single blastocyst transfer on day 5

• Easily measured inner cell mass

Phase I

Retrospective review of 63 Single Blastocyst

transfers

Age and cycle number were not taken into consideration

Blastocysts were measured 114 – 116 hours after ICSI

ICM/BL ratio = ICM diameter

Blastocyst diameter

63

25 (40%) 38 (60%)

1 BT

ICM/BL ratio ?

http://www.google.co.il/url?url=http://www.clipartkid.com/pregnancy-cliparts/&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjHmr-RpuPMAhXDmBoKHQTGD64QwW4IFTAA&usg=AFQjCNHmoRKSNxx0m1ydq0EBuwuBG4wIdwhttp://www.google.co.il/url?url=http://clipartfreefor.com/files/2/44221_female-clip-art.html&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjFnozipuPMAhVaOMAKHeCjC8g4FBDBbggZMAI&usg=AFQjCNHIZeIC9LX0zsWNk2UaaI_yH0AC9Ahttp://www.google.co.il/url?url=http://clipartfreefor.com/files/2/44221_female-clip-art.html&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjFnozipuPMAhVaOMAKHeCjC8g4FBDBbggZMAI&usg=AFQjCNHIZeIC9LX0zsWNk2UaaI_yH0AC9A

0.2

0.3

0.4

0.5

0.6

Age- 32.6 Age- 33.7

ICM

/BL

ratio

25 (40%) 38 (60%)

Age-32.6 Age-33.7

0.48

0.34

P

• Based on phase I – desired ICM/BL ratio ~ 0.48

• Blastocysts were measured before transfer

• Single blastocyst transfer to 64 women with

average ICM/BL ratio of 0.46 (SD+0.073)

Phase II

0

10

20

30

40

50

60

70

80

Age-33.8 Age-35.1

Pre

gn

an

cy r

ate

Ratio =0.46 Ratio =0.44

Pregnancy rate

43(67%)

21(33%)

Phase II

http://www.google.co.il/url?url=http://www.clipartkid.com/pregnancy-cliparts/&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjHmr-RpuPMAhXDmBoKHQTGD64QwW4IFTAA&usg=AFQjCNHmoRKSNxx0m1ydq0EBuwuBG4wIdwhttp://www.google.co.il/url?url=http://clipartfreefor.com/files/2/44221_female-clip-art.html&rct=j&frm=1&q=&esrc=s&sa=U&ved=0ahUKEwjFnozipuPMAhVaOMAKHeCjC8g4FBDBbggZMAI&usg=AFQjCNHIZeIC9LX0zsWNk2UaaI_yH0AC9A

Conclusions

• Average ICM/BL ratio of 0.48 is associated

with significantly increased pregnancy

rates

• Measurement of ICM/BL ratio may be

used as an additional strongly predictive

parameter of successful implantation

• Blastocyst inner cell measurement has

become routine policy in our lab

Thank you!

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