In human cumulus cells, the apoptotic rate may be considered an indicator for the selection of embryos to improve ongoing pregnancy and implantation rates

In order to identify the embryos with higher implantation potential to increase the clinical outcomes after ICSI, the apoptotic rate in human cumulus cells for the embryo selection on day 3, as an adjunct to morphology evaluation, could be considered a new tool compared with embryo selection by morphology alone. Several studies have demonstrated a lower cumulus cell apoptotic rate in women who achieved pregnancy compared with women who did not become pregnant after ICSI. A prospective randomized observational study on 76 ICSI patients was performed before Ovum Pick-Up. Patients were randomized into either the control group (embryo selection by morphology only, A group: 48 patients) or the treatment group (morphology plus cumulus cell apoptosis evaluation, B group: 28 patients). On Day 3, embryo transfer of a maximum of 3 embryo of “grade A” was performed. Patient demographics and baseline characteristics were distributed equally over the two groups. No statistical differences were found between the A group vs B group in terms of FSH units for ovarian stimulation (1833 ± 754 vs 1927 ± 826), E2 at hCG administration (1872 ± 788 vs 1787 ± 796), the numbers of oocytes collected (6.4 ± 2.1 Vs 6.7 ±3.7), the number of transferred embryos (A group: 126; B group: 69), the “grade A” transferred embryos (126 vs 69). No differences was found in the cumulative DNA fragmentation rate in the cumulus cells (16.39 ±12.9 vs 15.7 ± 11.3). Significant differences were found in ongoing pregnancy rate (33.3 vs 57.1) and implantation rate (23.1 vs 12.6). Embryo selection according to cumulus cells apoptosis rate could help to identify competent embryos with higher implantation potential, suggesting a new diagnostic tool in IVF laboratories to increase the clinical outcomes reducing the number of embryos to transfer.