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Vertebrate reproductive science and technology
RESEARCH ARTICLE

Association of pronuclear Z score with rates of aneuploidy in in vitro-fertilised embryos

W. R. Edirisinghe A B , R. Jemmott A , C. Smith A and J. Allan A
+ Author Affiliations
- Author Affiliations

A The Wesley IVF Service, The Wesley Hospital, 451 Coronation Drive, Auchenflower, Qld 4066, Australia.

B Corresponding author. Email: rohini.edirisinghe@wesley.com.au

Reproduction, Fertility and Development 17(5) 529-534 https://doi.org/10.1071/RD04065
Submitted: 25 June 2004  Accepted: 31 March 2005   Published: 19 May 2005

Abstract

The present study aimed to correlate the Z-scoring system to outcomes in in vitro fertilisation (IVF) cycles performed in conjunction with preimplantation genetic diagnosis. In 178 cycles, a total of 468 pronuclear embryos was scored prospectively using the Z score before culture and biopsy on Day 3 to detect chromosomes 13, 16, 18, 21, 22, X and Y. The results showed significant differences between Z1 and Z4 scoring embryos, with Z1 giving an increased biopsy rate (83.3% v. 51.1%), embryo quality (≥fair: 83.3% v. 57.8%) and embryo growth rate (≥six cells: 87.0% v. 44.4%). The incidence of chromosomally normal embryos decreased from Z1 to Z4 (Z1: 40%; Z2: 29.7%; Z3: 22.7%; Z4: 13.6%; P < 0.04). Thus, the Z scoring, mainly Z1 and Z4, correlated significantly with the expected embryo outcomes and preimplantation genetic diagnosis findings. Further improvement of pronuclear scoring with the use of a two-stage assessment is proposed.

Extra keywords: embryo outcomes, preimplantation genetic diagnosis.


Acknowledgments

The authors greatly appreciate the help and support given by all the clinicians, nurse coordinators and embryologists at the Wesley IVF Service and the scientists at the Cytogenetics Laboratory, Sullivan Nicolaides Pathology (Brisbane, Queensland, Australia).


References

Allan, J. , Edirisinghe, R. , Anderson, J. , Jemmott, R. , Nandini, A. V. , and Gattas, M. (2004). Dilemmas encountered with preimplantation diagnosis of aneuploidy in human embryos. Aust. NZ J. Obstet. Gynaecol. 44, 117–123.
Crossref | GoogleScholarGoogle Scholar |

Balaban, B. , Urman, B. , Isiklar, A. , Alatas, C. , Aksoy, S. , Mercan, R. , Muncu, A. , and Nuhoglu, A. (2001). The effect of pronuclear morphology on embryo quality parameters and blastocyst transfer outcome. Hum. Reprod. 16, 2357–2361.
PubMed |

Chen, C.-K. , Shen, G.-Y. , Horng, S.-G. , Wang, C.-W. , Huang, H.-Y. , Wang, H.-S. , and Soong, Y.-K. (2003). The relationship of pronuclear stage morphology and chromosomal status at cleavage stage. J. Assist. Reprod. Genet. 20, 413–420.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Claman, P. , Armant, D. R. , Seibel, M. M. , Wang, T.-A. , Oskowitz, S. P. , and Taymor, M. L. (1987). The impact of embryo quality and quantity on implantation and the establishment of viable pregnancies. J. In Vitro Fert. Embryo Transf. 4, 218–222.
PubMed |

Coskun, S. , Hollanders, J. , Al-Hassan, S. , Al-Sufyan, H. , Al-Mayman, H. , and Jaroudi, K. (2000). Day 5 versus day 3 embryo transfer: a controlled randomized trial. Hum. Reprod. 15, 1947–1952.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Eppig, J. J. (1996). Coordination of nuclear and cytoplasmic oocyte maturation in eutherian mammals. Reprod. Fertil. Dev. 8, 485–489.
PubMed |

Erenus, M. , Zouves, C. , Rajamahendran, M. , Lueng, S. , Fluker, M. , and Gomel, V. (1991). The effect of embryo quality on subsequent pregnancy rates after in vitro fertilization. Fertil. Steril. 56, 707–710.
PubMed |

Gardner, D. K. , and Leese, H. J. (1986). Non-invasive measurement of nutrient uptake by single cultured pre-implantation mouse embryos. Hum. Reprod. 1, 25–27.
PubMed |

Gardner, D. K. , and Leese, H. J. (1987). Assessment of embryo viability prior to transfer by the noninvasive measurement of glucose uptake. J. Exp. Zool. 242, 103–105.
PubMed |

Gianaroli, L. , Magli, M. C. , Ferraretti, A. P. , Fortini, D. , and Grieco, N. (2003). Pronuclear morphology and chromosomal abnormalities as scoring criteria for embryo selection. Fertil. Steril. 80, 341–349.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Giorgetti, C. , Terriou, P. , Auquier, P. , Hans, E. , Spach, J. L. , Salzmann, J. , and Roulier, R. (1995). Embryo score to predict implantation after in-vitro fertilization: based on 957 single embryo transfers. Hum. Reprod. 10, 2427–2431.
PubMed |

Joris, H. , Van den Abbeel, E. , De Vos, A. D. , and Van Steirteghem, A. (1999). Reduced survival after human embryo biopsy and subsequent cryopreservation. Hum. Reprod. 14, 2833–2837.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Kahraman, S. , Kumtepe, J. , Sertyel, S. , Donmez, E. , Benkhalifa, M. , Findikli, N. , and Vanderzwalmen, P. (2002). Pronuclear morphology scoring and chromosomal status of embryos in severe male infertility. Hum. Reprod. 17, 3193–3200.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Lan, K.-C. , Huang, F.-J. , Lin, Y.-C. , Kung, F.-T. , Hsieh, C.-H. , Huang, H.-W. , Tan, P.-H. , and Chang, S. Y. (2003). The predictive value of using a combined Z-score and day 3 embryo morphology score in the assessment of embryo survival on day 5. Hum. Reprod. 18, 1299–1306.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Ludwig, M. , Schopper, B. , Al-Hassani, S. , and Diedrich, K. (2000). Clinical use of a pronuclear stage score following intracytoplasmic sperm injection: impact on pregnancy rates under the conditions of the German embryo protection law. Hum. Reprod. 15, 325–329.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Lundin, K. , Bergh, C. , and Hardarson, T. (2001). Early embryo cleavage is a strong indicator of embryo quality in human IVF. Hum. Reprod. 16, 2652–2657.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Magli, M. C. , Gianaroli, L. , Fortini, D. , Ferraretti, A. P. , and Munne, S. (1999). Impact of blastomere biopsy and cryopreservation techniques on human embryo viability. Hum. Reprod. 14, 770–773.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Montag, M. , and van der Ven, H. (2001). Evaluation of pronuclear morphology as the only selection criterion for further embryo culture and transfer: results of a prospective multicentre study. Hum. Reprod. 16, 2384–2389.
PubMed |

Nagy, Z. P. , Dozortsev, D. , Diamond, M. , Rienzi, L. , Ubaldi, F. , Abdelmassih, R. , and Greco, E. (2003). Pronuclear morphology evaluation with subsequent evaluation of embryo morphology significantly increases implantation rates. Fertil. Steril. 80, 67–74.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Neuber, E. , Rinaudo, P. , Trimarchi, J. R. , and Sakkas, D. (2003). Sequential assessment of individually cultured human embryos as an indicator of subsequent good quality blastocyst development. Hum. Reprod. 18, 1307–1312.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Payne, D. , Flaherty, S. P. , Barry, M. F. , and Matthews, C. (1997). Preliminary observations on polar body extrusion and pronuclear formation in human oocytes using time-lapse video cinematography. Hum. Reprod. 12, 532–541.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Puissant, F. , Van Rysselberge, M. , Barlow, P. , Deweze, J. , and Leroy, F. (1987). Embryo scoring as a prognostic tool in IVF treatment. Hum. Reprod. 2, 705–708.
PubMed |

Rienzi, L. , Ubaldi, F. , Iacobelli, M. , Ferrero, S. , Minasi, M. G. , Martinez, F. , Tesarik, J. , and Greco, E. (2002). Day 3 embryo transfer with combined evaluation at the pronuclear and cleavage stages compares favorably with day 5 blastocyst transfer. Hum. Reprod. 17, 1852–1855.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Sakkas, D. , Shoukir, Y. , Chardonnens, D. , Bianchi, P. G. , and Campana, A. (1998). Early cleavage of human embryos to the two-cell stage after intracytoplasmic sperm injection as an indicator of embryo viability. Hum. Reprod. 13, 182–187.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Salumets, A. , Hyden-Granskog, C. , Suikkari, A.-M. , Tiitinen, A. , and Tuuri, T. (2001). The predictive value of pronuclear morphology of zygotes in the assessment of human embryo quality. Hum. Reprod. 16, 2177–2181.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Salumets, A. , Hyden-Granskog, C. , Makinen, S. , Suikkari, A.-M. , Tiitinen, A. , and Tuuri, T. (2003). Early cleavage predits the viability of human embryos in elective single embryo transfer procedures. Hum. Reprod. 18, 821–825.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Scholtes, M. C. , and Zeilmaker, G. H. (1998). Blastocyst transfer in day-5 embryo transfer depends primarily on the number of oocytes retrieved and not on age. Fertil. Steril. 69, 78–83.
PubMed |

Scott, L. (2003). Pronuclear scoring as a predictor of embryo development. Reprod. Biomed. Online 6, 201–214.
PubMed |

Scott, L. , and Smith, S. (1998). The successful use of pronuclear embryo transfers the day following oocyte retrieval. Hum. Reprod. 13, 1003–1013.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Scott, L. , Alvero, R. , Leondires, M. , and Miller, B. (2000). The morphology of human pronuclear embryos is positively related to blastocyst development and implantation. Hum. Reprod. 15, 2394–2403.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Sher, G. , Keskintepe, L. , Nouriani, M. , and Batzofin, J. (2004). Expression of sHLA-G in supernatants of individually cultured 46-h embryos: a potentially valuable indicator of ‘embryo competency’ and IVF outcome. Reprod. Biomed. Online 9, 74–78.
PubMed |

Steer, C. V. , Mills, C. L. , Tan, S. L. , Campbell, S. , and Edwards, R. G. (1992). The cumulative embryo score: a predictive embryo scoring technique to select the optimal number of embryos to transfer in an in-vitro fertilization and embryo transfer programme. Hum. Reprod. 7, 117–119.
PubMed |

Tesarik, J. , and Greco, E. (1999). The probability of abnormal preimplantation development can be predicted by a single static observation on pronuclear stage morphology. Hum. Reprod. 14, 1318–1323.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Tesarik, J. , and Kopecny, V. (1989). Development of human male pronucleus: ultrastructure and timing. Gamete Res. 24, 135–149.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Van Blerkom, J. (2004). Mitochondria in human oogenesis and preimplantation embryogenesis: engines of metabolism, ionic regulation and developmental competence. Reproduction 128, 269–280.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Wittemer, C. , Bettahar-Lebugle, K. , Ohl, J. , Rongieres, C. , Nisand, I. , and Gerlinger, P. (2000). Zygote evaluation: an efficient tool for embryo selection. Hum. Reprod. 15, 2591–2597.
Crossref | GoogleScholarGoogle Scholar | PubMed |

Zollner, U. , Zollner, K.-P. , Hartl, G. , Dietl, J. , and Steck, J. (2002). The use of a detailed zygote score after IVF/ICSI to obtain good quality blastocysts: the German experience. Hum. Reprod. 17, 1327–1333.
Crossref | GoogleScholarGoogle Scholar | PubMed |