The predictive value of day 3 embryo morphology regarding blastocyst formation, pregnancy and implantation rate after day 5 transfer following in-vitro fertilization or intracytoplasmic sperm injection.

The transfer of blastocysts has been associated with a very high implantation rate. However, not all embryos achieve the blastocyst stage. Our study was set up to demonstrate whether embryo morphology on day 3 predicts subsequent blastocyst formation. A prospective study was carried out in 48 patients with a mean of 2.9 failed in-vitro fertilization (IVF) attempts. In this new cycle, the morphology of the embryos on day 3 was noted. After pre-selection of the embryos which would have been transferred on day 3, all embryos were cultured individually and allowed to develop further until transfer on day 5. The clinical pregnancy rate per transfer was 46%, and the overall implantation rate was 24%. When only blastocysts were transferred the pregnancy rate was 53% with an implantation rate of 30%. Thirty-nine per cent of all embryos reached the blastocyst stage on day 5; 47% of class 1 and 2 embryos (good quality) in contrast to 21% of class 3 and 4 embryos (poor quality). Respectively 45% of class 1 and 2 embryos and 69% of class 3 and 4 embryos arrested in development or degenerated. Only 51% of the embryos that were transferred on day 5 had been pre-selected for transfer on day 3. In conclusion, it appears that the predictive value of embryo morphology on day 3 for subsequent blastocyst formation is limited.