Embryo Assessment and Selection in Assisted Reproduction: A Review of Current Technologies and Clinical Evidence

Abstract

Embryo evaluation and selection are the most important determinants of outcomes in assisted reproductive technology. The objective of this review is to provide a comprehensive overview of recent technologies for embryo assessment and selection.

In assisted reproductive treatment, including their scientific background, clinical evidence, strengths, and weaknesses. A detailed narrative review was conducted using the PubMed, Scopus, and Web of Science databases. Articles reporting conventional morphology, time-lapse imaging, and/or morphokinetic analysis, pre-implantation genetic testing, or non-invasive embryo assessment techniques, including those based on artificial intelligence pathways, were included if they were peer-reviewed studies. Clinical outcomes focused on implantation, clinical pregnancy, live birth, and miscarriage rates. Conventional morphology remains an essential part of daily practice; however, its ability to predict chromosomal competence and live birth is limited. Time-lapse imaging improves monitoring and standardization of development, yet it remains unclear whether it routinely improves live birth rates. The clinical applications of pre-implantation genetic testing for monogenic disorders and structural rearrangements are well defined. However, its use for aneuploidy is more patient-specific and has been controversial. Non-invasive molecular techniques and artificial intelligence-based embryo selection systems show promising predictive capacity, but they are not yet prospectively and multicenter validated for universal clinical use. 

Therefore, combining traditional assessment with genotype tests and AI applications, applied selectively based on solid clinical evidence, established outcome reporting, and ethical oversight, is the most balanced approach to enhancing reproductive performance in assisted reproductive treatment.