Morphological assessment of embryo quality during assisted reproduction: A systematic review

Background: Various parameters of embryo morphology have been routinely used to select the embryo/s with maximum implantation potential during in vitro fertilization (IVF). Hence, there is a dilemma in clinical practice as to which morphological scoring system/test to use. We performed a systemic review to determine the predictive power as well as the clinical and cost-effectiveness of existing morphological tests of embryo quality described in an IVF setting. Materials and Methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic review were followed. A mixed-method analysis was performed. Qualitative and quantitative techniques were used to synthesize the final results. A narrative summary approach was used for initial data exploration and description, followed by the pooling of data, where appropriate, using Meta-DiSc software. Receiver operating characteristic (ROC) curves were plotted wherever appropriate, and the area under the curve (AUROC) was determined. Results: Day 3, day 5, and early cleavage (EC) all had similar discriminatory value for predicting implantation (AUC 0.66, 067, and 0.63 respectively). There was no evidence of improvement in pregnancy rates due to routinely doing EC. No studies were identified that determined the cost-effectiveness of any of the tests. Conclusions: All tests have low accuracy. They lack the discriminatory power to identify an embryo that will/will not lead to implantation. Appropriately designed studies are required to assess the predictive value and the clinical and cost-effectiveness of novel embryo scoring technologies.