Metabolic activity of human blastocysts correlates with their morphokinetics, morphological grade, KIDScore and artificial intelligence ranking

STUDY QUESTION Is there a relationship between blastocyst metabolism and biomarkers of embryo viability? SUMMARY ANSWER Blastocysts with higher developmental potential and a higher probability of resulting in a viable pregnancy consume higher levels of glucose and exhibit distinct amino acid profiles. WHAT IS KNOWN ALREADY Morphological and morphokinetic analyses utilized in embryo selection provide insight into developmental potential, but alone are unable to provide a direct measure of embryo physiology and inherent health. Glucose uptake is a physiological biomarker of viability and amino acid utilization is different between embryos of varying qualities. STUDY DESIGN, SIZE, DURATION Two hundred and nine human preimplantation embryos from 50 patients were cultured in a time-lapse incubator system in both freeze all and fresh transfer cycles. A retrospective analysis of morphokinetics, morphology (Gardner grade), KIDScore, artificial intelligence grade (EmbryoScore), glucose and amino acid metabolism, and clinical pregnancies was conducted. PARTICIPANTS/MATERIALS, SETTING, METHODS ICSI was conducted in all patients, who were aged <= 37 years and previously had no more than two IVF cycles. Embryos were individually cultured in a time-lapse incubator system, and those reaching the blastocyst stage had their morphokinetics annotated and were each assigned a Gardner grade, KIDScore and EmbryoScore. Glucose and amino acid metabolism were measured. Clinical pregnancies were confirmed by the presence of a fetal heartbeat at 6 weeks of gestation. MAIN RESULTS AND THE ROLE OF CHANCE Glucose consumption was at least 40% higher in blastocysts deemed of high developmental potential using either the Gardner grade (P<0.01, n=209), KIDScore (P<0.05, n=207) or EmbryoScore (P<0.05, n=184), compared to less viable blastocysts and in blastocysts that resulted in a clinical pregnancy compared to those that failed to implant (P<0.05, n=37). Additionally, duration of cavitation was inversely related to glucose consumption (P<0.05, n=200). Total amino acid consumption was significantly higher in blastocysts with an EmbryoScore higher than the cohort median score (P<0.01, n=185). Furthermore, the production of amino acids was significantly lower in blastocysts with a high Gardner grade (P<0.05, n=209), KIDScore (P<0.05, n=207) and EmbryoScore (P<0.01, n=184). LIMITATIONS, REASONS FOR CAUTION Samples were collected from patients who had ICSI treatment and from only one clinic. WIDER IMPLICATIONS OF THE FINDINGS These results confirm that metabolites, such as glucose and amino acids, are valid biomarkers of embryo viability and could therefore be used in conjunction with other systems to aid in the selection of a healthy embryo. STUDY FUNDING/COMPETING INTEREST(S) Work was supported by Virtus Health. D.K.G is contracted with Virtus Health. The other authors have no conflict of interest to declare. TRIAL REGISTRATION NUMBER N/A.