Abstract
In assisted reproductive technology (ART), predictive models are becoming increasingly important for improving pregnancy rates and reducing the risks associated with multiple pregnancies. The current standards for selective single-embryo transfer, especially the use of day 5 (D5) blastocysts, are known to enhance pregnancy outcomes. However, variability in embryonic development poses ongoing challenges, necessitating more accurate predictive tools for embryo viability. This study developed a novel predictive model to forecast D5 blastocyst viability using early cleavage stage embryo indicators. Based on a retrospective analysis of 764 in vitro fertilization-embryo transfer cycles, 13 key factors influencing blastocyst formation were identified. Multivariate analysis revealed four independent predictors, including the number of cleavage-stage embryos with > 10 cells, high-quality embryos, 2-pronuclei cleavages, and a menopause-related age metric. The predictive model was formulated and demonstrated high predictive accuracy with an area under the curve of 0.929. Diagnostic testing and internal validation using an independent cohort of 318 blastocyst culture cycles demonstrated that the combined predictor L performed better than the empirical prediction. This study highlights the importance of ART prediction, improving clinical decision-making, and reducing multiple pregnancy risks. This approach empowers patients and enhances the overall effectiveness of reproductive treatments.