Assessment of the implantation of day 2 human embryos by morphometric nonsubjective parameters

The aim of this work is to define what objective variables, obtained by image analysis, show better predictive value of embryo quality for implantation in women age <36 years. Smaller circular embryos with thinner zona pellucida are more likely to implant.

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Inmaculada Molina, Ph.D., Juan V. Martínez, M.S., José F. Pertusa, Ph.D., Sebastian Balasch, Ph.D., Ignacio Iniesta, M.S., Antonio Pellicer, M.D.

Volume 102, Issue 4, Pages 1022-1028


To demonstrate the usefulness of image analysis in designing objective embryonic morphometric variables.


Retrospective study of 214 top-quality day-2 embryo photographs from 50 double-embryo transfers resulting in no pregnancy (group 0) and 57 resulting in twin pregnancy (group 1).


Human reproduction unit.


Study of 107 in vitro fertilization–intracytoplasmic sperm injection (IVF–ICSI) cycles in women age <36 years with double-embryo transfer of top-quality embryos. Only the first cycle of IVF–ICSI was included. Intervention(s):

Standard IVF–ICSI protocols.

Main Outcome Measure(s):

The embryo photographs were analyzed using the ImageJ program. The effects of the embryo variables and the clinical variables on embryo implantation were evaluated using a stepwise dichotomous logistic regression.


Significant differences were observed, owing to the women’s ages, internal perimeter, roundness factor, and zona pellucida thickness. Embryos with smaller internal perimeter, circular shape, and thinner zona pellucida were more likely to implant.


Morphometric variables lower the subjectivity of the current embryo grading systems. These variables are nonsubjective factors to consider when predicting implantation. Embryo image analysis is an accurate tool that can improve IVF–ICSI outcomes and reduce the number of twin pregnancies.

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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.