ArticleGynecologic and obstetric investigation2026
Validation of Optimized Embryo Scoring Procedures: Single-Day versus 2-Day Assessment.
Article in Gynecologic and obstetric investigation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe aim of this study was to determine whether single-day embryo selection (day 3 or day 5) achieves comparable sensitivity, specificity, and accuracy to 2-day selection (day 2 + day 3 or day 3 + day 5).
designThis was a retrospective cohort study conducted over a 15-year period (2008-2023).
settingThe review was conducted in a single assisted reproductive technology (ART) center.
participantsA total of 9,095 patients undergoing ART were included: 7,365 were managed under a day 3 policy (77,543 embryo assessments) and 1,730 patients under a day 5 policy (14,538 embryo assessments).
methodsAll patients underwent routine ART procedures with morphological embryo scoring according to established criteria. Cleavage-stage selection based on a 2-day assessment (day 2 + day 3) was compared with a hypothetical selection of a single-day assessment (day 3). Blastocyst-stage selection based on a 2-day assessment (day 3 + day 5) was compared with a hypothetical selection of a single-day assessment (day 5). Sensitivity, specificity, and overall accuracy were calculated retrospectively for single-day versus 2-day evaluation.
resultsDay 3 single-day assessment demonstrated sensitivity of 98.9%, specificity of 93.6%, and accuracy of 96.7%, comparable to day 2 + day 3 scoring. Day 5 single-day assessment yielded sensitivity of 99.5%, specificity of 89.7%, and accuracy of 93.4%, similar to day 3 + day 5 evaluation. LIMITATIONS: Limitations of this study include the retrospective design and the inherently subjective nature of embryo selection, in which prior assessments can bias subsequent evaluations. In addition, 2-day scoring reflected routine clinical practice, whereas single-day scoring represented a hypothetical approach based solely on embryo scores. This hypothetical single-day selection did not take the clinical context into account, as it was performed by a single embryologist based only on morphological scores, whereas actual clinical selection typically incorporates broader clinical considerations. Prospective randomized trials are therefore needed.
conclusionSingle-day embryo selection on day 3 or day 5 provides diagnostic accuracy (≥90%) comparable to 2-day protocols. Our data show that single-day assessments can be considered to cope with increased workload.
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