Gleicher Norbert, Gayete-Lafuente Sonia, Barad David H, Patrizio Pasquale, Albertini David F
Center for Human Reproduction (CHR), New York, NY, USA.
Foundation for Reproductive Medicine, New York, NY, USA.
Hum Reprod Open. 2025 Mar 20;2025(2):hoaf011. doi: 10.1093/hropen/hoaf011. eCollection 2025.
Embryo selection (ES) during IVF is expected to select the 'best' embryo(s) from among a cycle's embryo cohort and has been a core concept of IVF for over 40 years. However, among 36 492 articles on ES in a recent PubMed search, we were unable to locate even a single one questioning the concept that, beyond standard oocyte and embryo morphology, ES has remained an unproven hypothesis. In unselected patient populations, attempts at ES have universally, indeed, failed to improve cumulative pregnancy and live birth rates. The only benefit ES appears to offer is a marginal shortening in time to pregnancy, and even this benefit manifests only in best-prognosis patients with large oocyte and embryo numbers. Excluding maturation efforts, oocytes, once retrieved, and their resulting embryos have predetermined finite cumulative pregnancy and live birth chances that cannot be further improved. The hypothesis of ES has, however, remained a driving force for research and the introduction of a multitude of 'add-ons' to IVF. Enormous investments over decades in ES, therefore, should be better redirected from post- to pre-retrieval efforts.
体外受精（IVF）过程中的胚胎选择（ES）旨在从一个周期的胚胎群体中挑选出“最佳”胚胎，40多年来一直是IVF的核心概念。然而，在最近一次PubMed搜索中关于ES的36492篇文章中，我们甚至找不到一篇质疑以下观点的文章：除了标准的卵母细胞和胚胎形态外，ES仍然是一个未经证实的假设。在未经过选择的患者群体中，ES尝试普遍未能提高累积妊娠率和活产率。ES似乎唯一的好处是略微缩短了怀孕时间，而且这种好处仅在卵母细胞和胚胎数量较多、预后最佳的患者中体现。排除成熟相关操作，一旦获取卵母细胞及其产生的胚胎，它们就具有预先确定的有限累积妊娠和活产机会，无法进一步提高。然而，ES假说仍然是研究的驱动力以及IVF众多“附加技术”引入的推动力。因此，数十年来在ES上的巨大投入应更好地从取卵后努力转向取卵前努力。
