Non-Invasive Embryo Quality Assessment via Matrix-Optimized Untargeted LC-MS Metabolomics of Spent Embryo Culture Media and Weighted Ensemble Machine Learning

BackgroundNon-invasive embryo quality assessment is a critical unmet need in assisted reproductive technology (ART). Preimplantation genetic testing for aneuploidy (PGT-A) is effective but requires invasive biopsy that may compromise embryo viability. Metabolomics of spent embryo culture media (SECM) offers a non-invasive alternative, yet analytical challenges--limited sample volume, high salt content, and abundant proteins--have hindered standardization and clinical translation. ResultsWe systematically optimized sample preparation for untargeted LC-MS metabolomics of SECM using human serum as a reference. Optimal conditions were highly matrix-dependent: SECM required 7x volume of 50% acetonitrile for extraction and 40% acetonitrile for reconstitution, whereas serum required 10x volume of 100% methanol and 100% water--reflecting that SECM contains more non-polar species than serum. Applying the optimized workflow to 120 clinical SECM samples (72 euploid, 48 aneuploid), we identified 102 differential metabolites between euploid and aneuploid embryos, with prominent enrichment of lipid pathways (fatty acid metabolism, {beta}-oxidation, sphingolipid metabolism) and involvement of amino acid (methionine, tryptophan) and TCA cycle metabolism. A weighted ensemble machine learning model discriminated aneuploid from euploid embryos with an AUC of 0.977, 100.0% specificity, and 89.6% sensitivity. Among 72 euploid embryos stratified by morphological grading (good, fair, poor), metabolic alterations progressed from mitochondrial energy deficiency (good vs. fair) to broader lipid dysregulation (fair vs. poor), with the ensemble model achieving AUCs of 0.944, 0.889, and 0.943, respectively. ConclusionsThis study establishes a rigorously optimized and validated SECM metabolomics workflow that overcomes key analytical barriers in this challenging matrix. Our findings demonstrate that metabolic signatures--particularly in lipid and energy metabolism--are strongly associated with both embryo ploidy and morphological quality, providing biological insights into the metabolic underpinnings of embryo developmental competence. The high predictive performance of the ensemble model supports the feasibility of non-invasive embryo assessment as a complementary tool to existing methods, with potential to reduce reliance on invasive biopsy in ART. External validation in prospective multi-center cohorts is warranted to further assess clinical utility and generalizability. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=122 SRC="FIGDIR/small/741666v1_ufig1.gif" ALT="Figure 1"> View larger version (59K): org.highwire.dtl.DTLVardef@10fbe40org.highwire.dtl.DTLVardef@936273org.highwire.dtl.DTLVardef@246e5dorg.highwire.dtl.DTLVardef@1c9d115_HPS_FORMAT_FIGEXP M_FIG C_FIG