Potential for Empowering and Broadening the Application of the SART Embryo Grading System
The Journal of Clinical Embryology03 February 2013
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Amjad Hossain, Ph.D.
Division of Reproductive Endocrinology and Infertility
Department of Obstetrics & Gynecology • The University of Texas Medical Branch 301 University Blvd • Galveston, Texas 77555
Email: [email protected]
Morphological assessment of embryo quality has been the method of embryo selection for embryo transfer since the very beginning of the application of assisted reproductive technology (ART) in infertility treatment (1-5). However, there is no known single morphological charcteristic available to enable a simple method for embryo viability assessment. Different grading methods have been developed and utilized in selecting embryos for transfer (6-14). The necessity
of developing a unifying standard method of grading and reporting embryo quality as acceptable to all has long been recognized. The embryologists under the banner of SART (Society for Assisted Reproductive Technology) took the initiative by including embryo quality in the SART data base, establishing an embryo grading system that uses a uniform grading method
by all reporting embryologists at least in the United States(15-20). The initiative was a brilliant attempt at standardizing the grading method across the SART member programs. Accordingly, in 2005, SART
charged a task force for developing a grading system
for the SART database (SARTCORS). This SART body developed 3-point grading system (good, fair and poor) using morphological parameters relevant to different developmental stages (15, 16). The voluntary collection of embryo data for transferred embryos using the grading system, (designated as ‘SART embryo grading system’, SART grading system’ or ‘SART system in this manuscript), was initiated in 2006 and collection of data became mandatory from 2010 (15-20).
The necessity of such a unifying embryo grading method has also been felt by the international community. The European embryologists are working
toward adopting an embryo classification system
similar to that of SART (21-26, 61, 62, 63). The intention behind these efforts is to produce a de facto international standard for morphological embryo grading. The SART embryo grading system has begun to draw global attention due to its inherent simplicity and predictive power. The SART system emphasized that the grading method must be simple, should have a basis in scientific inquiry with some proven predictive value and be easily adoptable in IVF laboratories of any capacity, and was intended for grading cleavage, morula, and blastocyst stage embryos (15, 16). The objective
of the present study was to see if the SART grading system can be improved upon and whether it can have wider application in the field of ART. Our study found the SART method to be full of potential to become an international standard of embryo viability assessment by showing how to make it more efficient and applicable to all developmental stages of a developing embryo.