Novel noninvasive embryo selection algorithm combining time-lapse morphokinetics and oxidative status of the spent embryo culture medium

Fertil Steril. 2019 May;111(5):918-927.e3. doi: 10.1016/j.fertnstert.2019.01.022. Epub 2019 Mar 25.


Objective: To develop a noninvasive embryo selection algorithm consisting of time-lapse morphokinetics and the oxidative status of the spent embryo culture medium determined using the Thermochemiluminescence (TCL) Analyzer.

Design: Retrospective cohort.

Setting: Not applicable.

Patient(s): From women participating in the oocyte donation program, data from 505 samples of spent embryo culture media samples from 292 intracytoplasmic sperm injection cycles.

Intervention(s): None.

Main outcome measure(s): Morphokinetic parameters assessed during incubation in the time-lapse system Embryoscope. Oxidative parameters (H1sm, H2sm, and H3sm) from the spent culture medium on day 5 of incubation measured using the TCL assay; and a combined assessment algorithm, including morphology, morphokinetics, and the embryo's culture medium oxidative status, developed as a tool for embryo selection, based on implantation success and confirmed ongoing pregnancy.

Result(s): The levels of the oxidative parameters H1sm, H2sm, and H3sm on day 5 of incubation were statistically significantly higher in transferred and vitrified embryos compared with discarded embryos and in successfully implanted embryos compared with those that did not result in pregnancy. The assessment algorithm resulted in a hierarchical classification with six embryo quality categories (A to F), associated with implantation rates of between 76.5% and 29.2%.

Conclusion(s): An assessment algorithm combining morphology, morphokinetics and the embryo's culture medium oxidative status may help to improve current embryo selection methods criteria and in vitro fertilization success.

Keywords: Culture media; embryo quality; embryo selection; oxidative status; thermochemiluminescence (TCL).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Algorithms*
  • Cohort Studies
  • Culture Media / analysis*
  • Embryo Culture Techniques / methods*
  • Embryo Transfer / methods*
  • Female
  • Humans
  • Kinetics
  • Oxidative Stress / physiology*
  • Pregnancy
  • Retrospective Studies
  • Time-Lapse Imaging / methods*


  • Culture Media