National collection of embryo morphology data into Society for Assisted Reproductive Technology Clinic Outcomes Reporting System: associations among day 3 cell number, fragmentation and blastomere asymmetry, and live birth rate

Objective: To evaluate the validity of collecting day 3 embryo morphology variables into the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS). Design: Retrospective. Setting: National database-SART CORS. Patient(s): Fresh autologous assisted reproductive technology (ART) cycles from 2006-2007 in which embryos were transferred singly (n = 1,020) or in pairs (n = 6,508) and embryo morphology was collected. Intervention(s): None. Main Outcome Measure(s): Relationship between live birth, maternal age, and morphology of transferred day 3 embryos as defined by cell number, fragmentation, and blastomere symmetry. Logistic multiple regressions and receiver operating characteristic curve analyses were applied to determine specificity and sensitivity for correctly classifying embryos as either failures or successes. Result(s): Live birth rate was positively associated with increasing cell number up to eight cells (< 6 cells: 2.9%; 6 cells: 9.6%; 7 cells: 15.5%; 8 cells: 24.3%; and > 8 cells: 16.2%), but was negatively associated with maternal age, increasing fragmentation, and asymmetry scores. An area under the receiver operating curve of 0.753 (95% confidence interval 0.740-0.766) was derived, with a sensitivity of 45.0%, a specificity of 83.2%, and 76.4% of embryos being correctly classified with a cutoff probability of 0.3. Conclusion(s): This analysis provides support for the validity of collecting morphology fields for day 3 embryos into SART CORS. Standardization of morphology collections will assist in controlling for embryo quality in future database analyses. (Fertil Steril (R) 2011; 95:1985-9. (C) 2011 by American Society for Reproductive Medicine.)