Skip to main content
SpringerLink
Log in

Limitations and Benefits of Morphologic Embryo Assessment Strategies: How Far Can Morphological Assessment Go in the Identification of Viable Embryos?

  • Chapter
  • First Online:
Human Gametes and Preimplantation Embryos

Abstract

Morphological assessment has been the primary tool of the embryologist for selecting which embryo(s) to replace. Since the early years of in vitro fertilization (IVF), it was noted that embryos cleaving faster and those of better morphological appearance were more likely to lead to a pregnancy. Indeed, Edwards and colleagues noted only a few years after the birth of Louise Brown “that cleavage rates on a certain day and overall embryo morphology were valuable in choosing which embryo to transfer.” In 1986 one of the initial large studies (N = 1,539 embryos) examining the utility of embryo morphology was published by Cummins et al. It was reported that embryo quality scores were valuable in predicting success. Indeed Cummins et al. calculated an embryo development rating based on the ratio between the time at which embryos were observed at a particular stage after insemination and the time at which they would be expected to reach that stage of a hypothetical “ideal” growth rate with a cell cycle length of 11.9 h. Using this scoring system, “normally” growing embryos scored 100; however, the scoring system appears to have never been assessed prospectively.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Edwards R, Fishel S, Cohen J. Factors influencing the success of in vitro fertilization for alleviating human infertility. J In Vitro Fert Embryo Transf. 1984;1:3–23.

    Article  PubMed  CAS  Google Scholar 

  2. Cummins J, Breen T, Harrison K, Shaw J, Wilson L, Hennessey J. A formula for scoring human embryo growth rates in in vitro fertilization: its value in predicting pregnancy and in comparison with visual estimates of embryo quality. J In Vitro Fert Embryo Transf. 1986;3:284–95.

    Article  PubMed  CAS  Google Scholar 

  3. Puissant F, Van RM, Barlow P, Deweze J, Leroy F. Embryo scoring as a prognostic tool in IVF treatment. Hum Reprod. 1987;2(8):705–8.

    PubMed  CAS  Google Scholar 

  4. De Neubourg D, Gerris J. Single embryo transfer—state of the art. Reprod Biomed Online. 2003;7(6):615–22.

    Article  PubMed  Google Scholar 

  5. Sakkas, D. Evaluation of embryo quality: A strategy for sequential analysis of embryo development with the aim of single embryo transfer. In: Laboratory and Clinical Perspectives, Gardner D, Weissman A, Howles C, Shoham Z (Eds), Martin Dunitz Press, London; 2001. p. 223.

    Google Scholar 

  6. Sakkas D, Gardner DK. Noninvasive methods to assess embryo quality. Curr Opin Obstet Gynecol. 2005;17(3):283–8.

    Article  PubMed  Google Scholar 

  7. Gardner DK, Surrey E, Minjarez D, Leitz A, Stevens J, Schoolcraft WB. Single blastocyst transfer: a prospective randomized trial. Fertil Steril. 2004;81(3):551–5.

    Article  PubMed  CAS  Google Scholar 

  8. Braude P, Bolton V, Moore S. Human gene expression first occurs between the four- and eight-cell stages of preimplantation development. Nature. 1988;332:459–61.

    Article  PubMed  CAS  Google Scholar 

  9. Tesarik J, Greco E. The probability of abnormal preimplantation development can be predicted by a single static observation on pronuclear stage morphology. Hum Reprod. 1999;14:318–23.

    Article  Google Scholar 

  10. Scott L, Alvero R, Leondires M, Miller B. The morphology of human pronuclear embryos is positively related to blastocyst development and implantation. Hum Reprod. 2000;15(11):2394–403.

    Article  PubMed  CAS  Google Scholar 

  11. Scott LA, Smith S. The successful use of pronuclear embryo transfers the day following oocyte retrieval. Hum Reprod. 1998;13(4):1003–13.

    Article  PubMed  CAS  Google Scholar 

  12. Scott L. Pronuclear scoring as a predictor of embryo development. Reprod Biomed Online. 2003;6(2):201–14.

    Article  PubMed  Google Scholar 

  13. Salumets A, Hyden-Granskog C, Suikkari AM, Tiitinen A, Tuuri T. The predictive value of pronuclear morphology of zygotes in the assessment of human embryo quality. Hum Reprod. 2001;16(10):2177–81.

    Article  PubMed  CAS  Google Scholar 

  14. Nicoli A, Valli B, Di GR, Di TB, Gallinelli A, La Sala GB. Limited importance of pre-embryo pronuclear morphology (zygote score) in assisted reproduction outcome in the absence of embryo cryopreservation. Fertil Steril. 2007;88(4 Suppl):1167–73.

    Article  PubMed  Google Scholar 

  15. Bavister B. Culture of preimplantation embryos: facts and artefacts. Hum Reprod Update. 1995;1:91–148.

    Article  PubMed  CAS  Google Scholar 

  16. Gerris J, De Neubourg D, Mangelschots K, Van Royen E, Van de Meerssche M, Valkenburg M. Prevention of twin pregnancy after in-vitro fertilization or intracytoplasmic sperm injection based on strict embryo criteria: a prospective randomized clinical trial. Hum Reprod. 1999;14(10):2581–7.

    Article  PubMed  CAS  Google Scholar 

  17. Van Royen E, Mangelschots K, De Neubourg D, Valkenburg M, Van de Meerssche M, Ryckaert G, et al. Characterization of a top quality embryo, a step towards single-embryo transfer. Hum Reprod. 1999;14(9):2345–9.

    Article  PubMed  Google Scholar 

  18. De Neubourg D, Gerris J, Mangelschots K, Van Royen E, Vercruyssen M, Elseviers M. Single top quality embryo transfer as a model for prediction of early pregnancy outcome. Hum Reprod. 2004;19(6):1476–9.

    Article  PubMed  Google Scholar 

  19. Skiadas CC, Racowsky C. Development rate, cumulative scoring and embryonic viability. In: Cohen J, Elder KT, editors. Human embryo evaluation & selection. London: Informa Healthcare; 2007. p. 101–21.

    Chapter  Google Scholar 

  20. Fisch JD, Rodriguez H, Ross R, Overby G, Sher G. The Graduated Embryo Score (GES) predicts blastocyst formation and pregnancy rate from cleavage-stage embryos. Hum Reprod. 2001;16(9):1970–5.

    Article  PubMed  CAS  Google Scholar 

  21. Fisch JD, Sher G, Adamowicz M, Keskintepe L. The graduated embryo score predicts the outcome of assisted reproductive technologies better than a single day 3 evaluation and achieves results associated with blastocyst transfer from day 3 embryo transfer. Fertil Steril. 2003;80(6):1352–8.

    Article  PubMed  Google Scholar 

  22. Neuber E, Rinaudo P, Trimarchi JR, Sakkas D. Sequential assessment of individually cultured human embryos as an indicator of subsequent good quality blastocyst development. Hum Reprod. 2003;18(6):1307–12.

    Article  PubMed  CAS  Google Scholar 

  23. Guerif F, Le Gouge A, Giraudeau B, Poindron J, Bidault R, Gasnier O, et al. Limited value of morphological assessment at days 1 and 2 to predict blastocyst development potential: a prospective study based on 4042 embryos. Hum Reprod. 2007;22(7):1973–81.

    Article  PubMed  CAS  Google Scholar 

  24. Racowsky C, Ohno-Machado L, Kim J, Biggers JD. Is there an advantage in scoring early embryos on more than one day? Hum Reprod. 2009;24(9):2104–13.

    Article  PubMed  Google Scholar 

  25. Shoukir Y, Campana A, Farley T, Sakkas D. Early cleavage of in-vitro fertilized human embryos to the 2-cell stage: a novel indicator of embryo quality and viability. Hum Reprod. 1997;12(7):1531–6.

    Article  PubMed  CAS  Google Scholar 

  26. Sakkas D, Shoukir Y, Chardonnens D, Bianchi PG, Campana A. Early cleavage of human embryos to the two-cell stage after intracytoplasmic sperm injection as an indicator of embryo viability. Hum Reprod. 1998;13(1):182–7.

    Article  PubMed  CAS  Google Scholar 

  27. Sakkas D, Percival G, D’Arcy Y, Sharif K, Afnan M. Assessment of early cleaving in vitro fertilized human embryos at the 2-cell stage before transfer improves embryo selection. Fertil Steril. 2001;76(6):1150–6.

    Article  PubMed  CAS  Google Scholar 

  28. Salumets A, Hyden-Granskog C, Makinen S, Suikkari AM, Tiitinen A, Tuuri T. Early cleavage predicts the viability of human embryos in elective single embryo transfer procedures. Hum Reprod. 2003;18(4):821–5.

    Article  PubMed  Google Scholar 

  29. Van Montfoort AP, Dumoulin JC, Kester AD, Evers JL. Early cleavage is a valuable addition to existing embryo selection parameters: a study using single embryo transfers. Hum Reprod. 2004;19(9):2103–8.

    Article  PubMed  Google Scholar 

  30. Alikani M, Calderon G, Tomkin G, Garrisi J, Kokot M, Cohen J. Cleavage anomalies in early human embryos and survival after prolonged culture in-vitro. Hum Reprod. 2000;15(12):2634–43.

    Article  PubMed  CAS  Google Scholar 

  31. Antczak M, Van Blerkom J. Temporal and spatial aspects of fragmentation in early human embryos: possible effects on developmental competence and association with the differential elimination of regulatory proteins from polarized domains. Hum Reprod. 1999;14(2):429–47.

    Article  PubMed  CAS  Google Scholar 

  32. Hardarson T, Lofman C, Coull G, Sjogren A, Hamberger L, Edwards RG. Internalization of cellular fragments in a human embryo: time-lapse recordings. Reprod Biomed Online. 2002;5(1):36–8.

    Article  PubMed  CAS  Google Scholar 

  33. Alikani M, Cohen J, Tomkin G, Garrisi GJ, Mack C, Scott RT. Human embryo fragmentation in vitro and its implications for pregnancy and implantation. Fertil Steril. 1999;71(5):836–42.

    Article  PubMed  CAS  Google Scholar 

  34. Keltz MD, Skorupski JC, Bradley K, Stein D. Predictors of embryo fragmentation and outcome after fragment removal in in vitro fertilization. Fertil Steril. 2006;86(2):321–4.

    Article  PubMed  Google Scholar 

  35. Hardarson T, Hanson C, Sjogren A, Lundin K. Human embryos with unevenly sized blastomeres have lower pregnancy and implantation rates: indications for aneuploidy and multinucleation. Hum Reprod. 2001;16(2):313–8.

    Article  PubMed  CAS  Google Scholar 

  36. Pickering SJ, Taylor A, Johnson MH, Braude PR. An analysis of multinucleated blastomere formation in human embryos. Hum Reprod. 1995;10(7):1912–22.

    PubMed  CAS  Google Scholar 

  37. Royen EV, Mangelschots K, Vercruyssen M, Neubourg DD, Valkenburg M, Ryckaert G, et al. Multinucleation in cleavage stage embryos. Hum Reprod. 2003;18(5):1062–9.

    Article  PubMed  Google Scholar 

  38. Van Royen E, Mangelschots K, Vercruyssen M, De Neubourg D, Valkenburg M, Ryckaert G, et al. Multinucleation in cleavage stage embryos. Hum Reprod. 2003;18(5):1062–9.

    Article  PubMed  Google Scholar 

  39. Yakin K, Balaban B, Urman B. Impact of the presence of one or more multinucleated blastomeres on the developmental potential of the embryo to the blastocyst stage. Fertil Steril. 2005;83(1):243–5.

    Article  PubMed  Google Scholar 

  40. Kligman I, Benadiva C, Alikani M, Munne S. The presence of multinucleated blastomeres in human embryos is correlated with chromosomal abnormalities. Hum Reprod. 1996;11(7):1492–8.

    Article  PubMed  CAS  Google Scholar 

  41. Staessen C, Van SA. The genetic constitution of multinuclear blastomeres and their derivative daughter blastomeres. Hum Reprod. 1998;13(6):1625–31.

    Article  PubMed  CAS  Google Scholar 

  42. Bungum M, Bungum L, Humaidan P, Yding AC. Day 3 versus day 5 embryo transfer: a prospective randomized study. Reprod Biomed Online. 2003;7(1):98–104.

    Article  PubMed  CAS  Google Scholar 

  43. Estes SJ, Hoover LM, Smith SE, Somkuti SG, Schinfeld JS, Barmat LI. Comparison of pregnancy, implantation, and multiple gestation rates for day 3 versus day 5 embryo transfers. J Assist Reprod Genet. 2003;20(10):409–12.

    Article  PubMed  Google Scholar 

  44. Kolibianakis EM, Zikopoulos K, Verpoest W, Camus M, Joris H, Van Steirteghem AC, et al. Should we advise patients undergoing IVF to start a cycle leading to a day 3 or a day 5 transfer? Hum Reprod. 2004;19(11):2550–4.

    Article  PubMed  CAS  Google Scholar 

  45. Racowsky C, Jackson KV, Cekleniak NA, Fox JH, Hornstein MD, Ginsburg ES. The number of eight-cell embryos is a key determinant for selecting day 3 or day 5 transfer. Fertil Steril. 2000;73(3):558–64.

    Article  PubMed  CAS  Google Scholar 

  46. Rienzi L, Ubaldi F, Iacobelli M, Ferrero S, Minasi MG, Martinez F, et al. Day 3 embryo transfer with combined evaluation at the pronuclear and cleavage stages compares favourably with day 5 blastocyst transfer. Hum Reprod. 2002;17(7):1852–5.

    Article  PubMed  Google Scholar 

  47. Rijnders PM, Jansen CA. 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. Hum Reprod. 1998;13(10):2869–73.

    Article  PubMed  CAS  Google Scholar 

  48. Blake D, Proctor M, Johnson N, Olive D. Cleavage stage versus blastocyst stage embryo transfer in assisted conception. Cochrane Database Syst Rev. 2002;2:CD002118.

    PubMed  Google Scholar 

  49. Blake D, Proctor M, Johnson N, Olive D. Cleavage stage versus blastocyst stage embryo transfer in assisted conception. Cochrane Database Syst Rev. 2005;4:CD002118.

    PubMed  Google Scholar 

  50. Blake DA, Proctor M, Johnson NP. The merits of blastocyst versus cleavage stage embryo transfer: a Cochrane review. Hum Reprod. 2004;19(9):2174.

    Article  PubMed  Google Scholar 

  51. Blake DA, Farquhar CM, Johnson N, Proctor M. Cleavage stage versus blastocyst stage embryo transfer in assisted conception. Cochrane Database Syst Rev. 2007;4:CD002118.

    PubMed  Google Scholar 

  52. Balaban B, Urman B, Alatas C, Mercan R, Aksoy S, Isiklar A. Blastocyst-stage transfer of poor-quality cleavage-stage embryos results in higher implantation rates. Fertil Steril. 2001;75(3):514–8.

    Article  PubMed  CAS  Google Scholar 

  53. Balaban B, Urman B, Sertac A, Alatas C, Aksoy S, Mercan R. Blastocyst quality affects the success of blastocyst-stage embryo transfer. Fertil Steril. 2000;74(2):282–7.

    Article  PubMed  CAS  Google Scholar 

  54. Bolton VN, Wren ME, Parsons JH. Pregnancies after in vitro fertilization and transfer of human blastocysts. Fertil Steril. 1991;55(4):830–2.

    PubMed  CAS  Google Scholar 

  55. Gardner DK, Schoolcraft WB. Culture and transfer of human blastocysts. Curr Opin Obstet Gynecol. 1999;11(3):307–11.

    Article  PubMed  CAS  Google Scholar 

  56. Gardner DK, Schoolcraft WB, Wagley L, Schlenker T, Stevens J, Hesla J. A prospective randomized trial of blastocyst culture and transfer in in-vitro fertilization. Hum Reprod. 1998;13(12):3434–40.

    Article  PubMed  CAS  Google Scholar 

  57. Gardner DK, Lane M. Culture of viable human blastocysts in defined sequential serum-free media. Hum Reprod. 1998;13 Suppl 3:148–59.

    Article  PubMed  Google Scholar 

  58. Jones GM, Trounson AO, Lolatgis N, Wood C. Factors affecting the success of human blastocyst development and pregnancy following in vitro fertilization and embryo transfer. Fertil Steril. 1998;70(6):1022–9.

    Article  PubMed  CAS  Google Scholar 

  59. Menezo YJ, Sakkas D, Janny L. Co-culture of the early human embryo: factors affecting human blastocyst formation in vitro. Microsc Res Tech. 1995;32(1):50–6.

    Article  PubMed  CAS  Google Scholar 

  60. Milki AA, Fisch JD, Behr B. Two-blastocyst transfer has similar pregnancy rates and a decreased multiple gestation rate compared with three-blastocyst transfer [see comments]. Fertil Steril. 1999;72(2):225–8.

    Article  PubMed  CAS  Google Scholar 

  61. Olivennes F, Hazout A, Lelaidier C, Freitas S, Fanchin R, de Ziegler D, et al. Four indications for embryo transfer at the blastocyst stage. Hum Reprod. 1994;9(12):2367–73.

    PubMed  CAS  Google Scholar 

  62. Sakkas D, Percival G, D’Arcy Y, Lenton W, Sharif K, Afnan M. Blastocyst transfer for patients with multiple assisted reproduction treatment failures: preliminary experience. Hum Fertil (Camb). 2001;4(2):104–8.

    Article  CAS  Google Scholar 

  63. Schoolcraft WB, Gardner DK, Lane M, Schlenker T, Hamilton F, Meldrum DR. Blastocyst culture and transfer: analysis of results and parameters affecting outcome in two in vitro fertilization programs. Fertil Steril. 1999;72(4):604–9.

    Article  PubMed  CAS  Google Scholar 

  64. Toledo AA, Wright G, Jones AE, Smith SS, Johnson-Ward J, Brockman WW, et al. Blastocyst transfer: a useful tool for reduction of high-order multiple gestations in a human assisted reproduction program. Am J Obstet Gynecol. 2000;183(2):377–82.

    Article  PubMed  CAS  Google Scholar 

  65. Van der Auwera I, Debrock S, Spiessens C, Afschrift H, Bakelants E, Meuleman C, et al. A prospective randomized study: day 2 versus day 5 embryo transfer. Hum Reprod. 2002;17(6):1507–12.

    Article  PubMed  Google Scholar 

  66. Marek D, Langley M, Gardner DK, Confer N, Doody KM, Doody KJ. Introduction of blastocyst culture and transfer for all patients in an in vitro fertilization program. Fertil Steril. 1999;72(6):1035–40.

    Article  PubMed  CAS  Google Scholar 

  67. Gardner DK, Schoolcraft WB. In vitro culture of human blastocysts. In: Jansen R, Mortimer D, editors. Towards reproductive certainty: infertility and genetics beyond. Carnforth: Parthenon Press; 1999. p. 378.

    Google Scholar 

  68. Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000;73(6):1155–8.

    Article  PubMed  CAS  Google Scholar 

  69. Gardner DK, Stevens J, Sheehan CB, Schoolcraft WB. Morphological assessment of the human blastocyst. In: Elder KT, Cohen J, editors. Analysis of the human embryo. London: Taylor & Francis; 2007. p. 79–87.

    Google Scholar 

  70. Ahlstrom A, Westin C, Reismer E, Wikland M, Hardarson T. Trophectoderm morphology: an important parameter for predicting live birth after single blastocyst transfer. Hum Reprod. 2011;26(12):3289–96.

    Article  PubMed  CAS  Google Scholar 

  71. Feil D, Henshaw RC, Lane M. Day 4 embryo selection is equal to Day 5 using a new embryo scoring system validated in single embryo transfers. Hum Reprod. 2008;23(7):1505–10.

    Article  PubMed  Google Scholar 

  72. Milki AA, Hinckley MD, Gebhardt J, Dasig D, Westphal LM, Behr B. Accuracy of day 3 criteria for selecting the best embryos. Fertil Steril. 2002;77(6):1191–5.

    Article  PubMed  Google Scholar 

  73. Rehman KS, Bukulmez O, Langley M, Carr BR, Nackley AC, Doody KM, et al. Late stages of embryo progression are a much better predictor of clinical pregnancy than early cleavage in intracytoplasmic sperm injection and in vitro fertilization cycles with blastocyst-stage transfer. Fertil Steril. 2007;87(5):1041–52.

    Article  PubMed  Google Scholar 

  74. Meseguer M, Herrero J, Tejera A, Hilligsoe KM, Ramsing NB, Remohi J. The use of morphokinetics as a predictor of embryo implantation. Hum Reprod. 2011;26(10):2658–71.

    Article  PubMed  Google Scholar 

  75. Wong CC, Loewke KE, Bossert NL, Behr B, De Jonge CJ, Baer TM, et al. Non-invasive imaging of human embryos before embryonic genome activation predicts development to the blastocyst stage. Nat Biotechnol. 2010;28(10):1115–21.

    Article  PubMed  CAS  Google Scholar 

  76. Balaban B, Urman B, Isiklar A, Alatas C, Aksoy S, Mercan R, et al. The effect of pronuclear morphology on embryo quality parameters and blastocyst transfer outcome. Hum Reprod. 2001;16(11):2357–61.

    PubMed  CAS  Google Scholar 

  77. Senn A, Urner F, Chanson A, Primi MP, Wirthner D, Germond M. Morphological scoring of human pronuclear zygotes for prediction of pregnancy outcome. Hum Reprod. 2006;21(1):234–9.

    Article  PubMed  Google Scholar 

  78. Scott L, Finn A, O’Leary T, McLellan S, Hill J. Morphologic parameters of early cleavage-stage embryos that correlate with fetal development and delivery: prospective and applied data for increased pregnancy rates. Hum Reprod. 2007;22(1):230–40.

    Article  PubMed  CAS  Google Scholar 

  79. James AN, Hennessy S, Reggio B, Wiemer K, Larsen F, Cohen J. The limited importance of pronuclear scoring of human zygotes. Hum Reprod. 2006;21(6):1599–604.

    Article  PubMed  Google Scholar 

  80. Chen C, Kattera S. Comparison of pronuclear zygote morphology and early cleavage status of zygotes as additional criteria in the selection of day 3 embryos: a randomized study. Fertil Steril. 2006;85(2):347–52.

    Article  PubMed  Google Scholar 

  81. Payne JF, Raburn DJ, Couchman GM, Price TM, Jamison MG, Walmer DK. Relationship between pre-embryo pronuclear morphology (zygote score) and standard day 2 or 3 embryo morphology with regard to assisted reproductive technique outcomes. Fertil Steril. 2005;84(4):900–9.

    Article  PubMed  Google Scholar 

  82. Terriou P, Giorgetti C, Hans E, Salzmann J, Charles O, Cignetti L, et al. Relationship between even early cleavage and day 2 embryo score and assessment of their predictive value for pregnancy. Reprod Biomed Online. 2007;14(3):294–9.

    Article  PubMed  CAS  Google Scholar 

  83. Hesters L, Prisant N, Fanchin R, Mendez Lozano DH, Feyereisen E, Frydman R, et al. Impact of early cleaved zygote morphology on embryo development and in vitro fertilization-embryo transfer outcome: a prospective study. Fertil Steril. 2008;89(6):1677–84.

    Article  PubMed  Google Scholar 

  84. Lundqvist M, Johansson U, Lundkvist O, Milton K, Westin C, Simberg N. Does pronuclear morphology and/or early cleavage rate predict embryo implantation potential? Reprod Biomed Online. 2001;2(1):12–6.

    Article  PubMed  Google Scholar 

  85. Platteau P, Fenwick J, Murdoch AP, Herbert C. Time from insemination to first cleavage predicts developmental competence of human preimplantation embryos in vitro. Hum Reprod. 2002;17(2):407–12.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Boston IVF, 130 Second Avenue, Waltham, MA, 02451, USA

    Denny Sakkas

  2. Department of Zoology, University of Melbourne, Melbourne, VIC, Australia

    David K. Gardner

Authors
  1. Denny Sakkas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David K. Gardner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Denny Sakkas .

Editor information

Editors and Affiliations

  1. University of Melbourne, Department of Zoology, Royal Parade, Melbourne, 3010, Victoria, Australia

    David K. Gardner

  2. Boston IVF, Second Ave. 130, Waltham, 02451, Massachusetts, USA

    Denny Sakkas

  3. Yale School of Medicine, Dept. of Ob/Gyn & Reproductive Sciences, Cedar St. 333, New Haven, 06510, Connecticut, USA

    Emre Seli

  4. Obstetrics & Gynaecology, University of Oxford, Nuffield Department of, Garsington Road, Oxford, OX4 2HW, Oxfordshire, United Kingdom

    Dagan Wells

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Sakkas, D., Gardner, D.K. (2013). Limitations and Benefits of Morphologic Embryo Assessment Strategies: How Far Can Morphological Assessment Go in the Identification of Viable Embryos?. In: Gardner, D., Sakkas, D., Seli, E., Wells, D. (eds) Human Gametes and Preimplantation Embryos. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6651-2_6

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6651-2_6

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6650-5

  • Online ISBN: 978-1-4614-6651-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation