MORPHOLOGICAL V CHROMOSOMAL ASSESSMENT

When trying to decide between IVF treatment at Cornell (CRMI), with Dr. Goldschlag, and CCRM, with Dr. Schoolcraft, I was basically deciding between two different methods of embryo assessment:

  • Dr. G/CRMI: Day 3 morphological assessment.
  • Dr.S/CCRM: Day 5 chromosomal assessment (CCS).

Please see my post “Bootcamp for uncertainty” for a detailed discussion of these two methods and my consultations with these two doctors.

What confused me the most was that Dr. G said that chromosomal screening would not increase my chances of live birth but would only decrease my chance of miscarriage–and I did not want to spend 7 thousand dollars simply to avoid a miscarriage (I’ve had four, for goodness sake–what’s one more?). Dr. G claimed that the Grade A embryos detected through a Day 3 morphological assessment would wind up being the very same embryos detected as the best through chromosomal screening. Dr. S was adamant in his response to this claim—CCS increases live birth rates (does not just decrease miscarriage rates), he said, and morphological assessment does not detect abnormality or normality with as much accuracy as CCS.

After researching academic/medical journals, I decided that CCS at CCRM was the right choice for me.

Below are some of the articles I found supporting each doctor’s claim. (Some of the articles refer to a method of chromosomal screening called PGS.)

_________________________________________________

Assessment of day-3 morphology and euploidy for individual chromosomes in embryos that develop to the blastocyst stage

Conclusion: Our data suggest that PGS may detect potentially viable but detrimental chromosomal abnormalities that are not detected by embryo morphology alone.

Year: 2009

Supports: Dr. Schoolcraft/CCRM/CCS

_________________________________________________

Chromosomal screening improves IVF pregnancy rates

Conclusion: The researchers found that 44.9 percent of the blastocysts analyzed by aCGH were aneuploid. Compared with morphology alone, the aCGH group had significantly higher clinical pregnancy rates (70.9 versus 45.8 percent; P = 0.017) and significantly higher ongoing pregnancy rates (after 20 weeks, 69.1 versus 41.7 percent; P = 0.009). No twin pregnancies were identified.

Year: 2012

Supports: Dr. Schoolcraft/CCRM/CCS

_________________________________________________

 

Single embryo transfer with comprehensive chromosome screening results in improved ongoing pregnancy rates and decreased miscarriage rates

Conclusion: Compared with traditional blastocyst SET, SET after trophectoderm biopsy and rapid PCR-based CCS increases OPR (ongoing pregnancy rate) and reduces the miscarriage rate.

Year: 2012

Supports: Dr. Schoolcraft/CCRM/CCS
_________________________________________________

The relationship between blastocyst morphology, chromosomal abnormality, and embryo gender

Conclusion: 

Morphology and aneuploidy are linked at the blastocyst stage. However, the association is weak, and consequently, morphologic analysis cannot be relied on to ensure transfer of chromosomally normal embryos. A significant proportion of aneuploid embryos are capable of achieving the highest morphologic scores, and some euploid embryos are of poor morphology. Gender was associated with blastocyst grading, male embryos developing at a significantly faster rate than females.

Year: 2011

Supports: Dr. Schoolcraft/CCRM/CCS

[Note that Dr. Schoolcraft is one of the authors.]

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Pronuclear morphology predicts embryo development and chromosome constitution

Conclusion: It is concluded that PN morphology predicts both the risk of embryo developmental arrest and that of chromosomal abnormalities.

Year: 2004

Supports: Dr. Goldschlag/CRMI/morphological assessment

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Studies on in vitro fertilised human pre embryos. Morphological and chromosomal aspects

Conclusion: Blastocyst stage: Preembryos considered morphologically suboptimal at the four to eight cell stage, were cultured to the blastocyst stage. The aim was to study the chromosomal status of these blastocysts. As a control group we used preembryos of good morphological quality that had been frozen-stored and were not intended for transfer to the patient. It was found that blastocysts from suboptimal preembryos were of lower quality, both morphologically and chromosomally, than blastocysts from preembryos of good quality.

Year: 2002

Supports: Dr. Goldschlag/CRMI/morphological assessment

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  1. Bootcamp for uncertainty « the unexpected trip

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