Given the importance of embryo developmental competence assessment in reproductive medicine and biology, the aim of this study was to compare the performance of fertilization and cleavage morphokinetics with embryo morphology to predict post-ICSI live birth. Data from embryos cultured in a time-lapse microscopy (TLM) incubator and with known live birth outcomes (LB: embryos achieving live birth, n = 168; NLB: embryos not achieving live birth, n = 1633) were used to generate receiver operating characteristic (ROC) curves based on morphokinetic or morphological scores, and the respective areas under the curve (AUC) were compared. The association between live birth and 12 combinations of four morphokinetic quality degrees (A–D) with three morphological quality degrees (A–C) was assessed using multivariate analysis. Morphokinetic parameters from tPNa to t8 were reached earlier in LB compared with NLB embryos. The ROC curve analysis indicated that morphokinetic information is more accurate than conventional morphology to predict live birth [AUC = 0.64 (95% CI 0.58–0.70) versus AUC = 0.58 (95% CI 0.51–0.65)]. The multivariate analysis was in line with AUCs, revealing that embryos with poor morphokinetics, independently of their morphology, provide lower live birth rates (P < 0.001). A considerable percentage of embryos with top morphology presented poor morphokinetics (20.10%), accompanied by a severely reduced live birth rate in comparison with embryos with top morphology and morphokinetics (P < 0.001). In conclusion, TLM-derived early morphokinetic parameters were more predictive of live-birth achievement following ICSI than conventional morphology.

中文翻译：

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早期胚胎形态动力学比胚胎形态更能预测ICSI后活产：在卵裂阶段速度比美丽更重要

鉴于胚胎发育能力评估在生殖医学和生物学中的重要性，本研究的目的是比较受精和卵裂形态动力学与胚胎形态学的表现，以预测 ICSI 后活产。来自在延时显微镜 (TLM) 培养箱中培养且具有已知活产结果的胚胎的数据（LB：实现活产的胚胎，n= 168; NLB：未实现活产的胚胎，n= 1633) 用于生成基于形态动力学或形态学评分的受试者工作特征 (ROC) 曲线，并比较各自的曲线下面积 (AUC)。使用多变量分析评估了活产与四个形态动力学质量等级 (A-D) 和三个形态学质量等级 (A-C) 的 12 种组合之间的关联。与 NLB 胚胎相比，LB 中从 tPNa 到 t8 的形态动力学参数较早达到。ROC 曲线分析表明，形态动力学信息比传统形态学更准确地预测活产 [AUC = 0.64 (95% CI 0.58–0.70) 与 AUC = 0.58 (95% CI 0.51–0.65)]。多变量分析与 AUC 一致，表明形态动力学较差的胚胎，与其形态无关，提供较低的活产率。磷< 0.001)。相当比例的具有顶级形态的胚胎表现出较差的形态动力学（20.10%），与具有顶级形态和形态动力学的胚胎相比，伴随着严重降低的活产率。磷< 0.001)。总之，TLM 衍生的早期形态动力学参数比传统形态学更能预测 ICSI 后的活产成就。