The goal of this observational study is to determine multiomics patterns related to global embryo quality to help overcome the limitations of conventional embryo quality assessment. The main question it aims to answer is:

• Do discarded blastocysts that reach the blastocyst stage (days 5-6) show characteristic multiomics profiles which correlate with chromosomal abnormalities, providing insights into embryo viability?

For that, patients undergoing an IVF treatment will be asked to donate their clinically discarded 5/6-day embryos (those that do not meet clinical criteria to be used for reproductive purposes). Participation in the study will not interfere with the planned IVF treatment. Patient participation is limited to signature of the informed consent to donate embryos and no other study-specific procedures will be performed on participants.

In vitro fertilization has advanced infertility treatment, but accurately assessing embryo viability remains challenging because conventional selection methods may miss subtle molecular indicators of developmental potential. Increasing evidence shows that some embryos discarded based on morphology or developmental timing may be chromosomally normal and possess favorable molecular traits, prompting interest in multiomics analysis as a more sensitive assessment tool. Studies have demonstrated that omics patterns can distinguish chromosomally normal from abnormal embryos and correlate with key indicators of developmental competence, such as morphology, arrest status, and implantation success, with high-potential blastocysts showing distinct developmental gene signatures. The blastocyst stage is particularly critical, as inner cell mass (ICM) and trophectoderm (TE) lineages diverge, and emerging data suggest these cell types exhibit different multiomics responses to chromosomal abnormalities. However, many prior studies relied on vitrified embryos, where cryopreservation may alter multiomic profiles.

To address this limitation, this study focuses on fresh, non-vitrified blastocysts, offering a more accurate representation of embryos' intrinsic molecular states and developmental potential. Therefore, the aim of the present pilot study is to define multiomics patterns associated with euploidy, chromosomal abnormalities and embryo quality at the blastocyst stage.

Once the study is approved by the competent Research Ethics Committee, the recruitment and selection of patients will follow. Every potential participant will be asked to sign the study informed consent. To comply with the study design and the proposed hypothesis, an estimated total number of 150 patients will be recruited to obtain around 200 discarded embryos.

This is a prospective, descriptive, observational pilot study which will include all eligible discarded blastocysts donated by IVF patients from a single Norwegian centre. This site will be responsible for patients' recruitment and embryonic samples collection, while sample analysis will take place in a Central Laboratory in Spain. On day 5/6 of development, blastocysts that do not meet the standard clinical criteria to be transferred, will be donated to the study by the participants. Additionally, when possible, cumulus cells and sperm cells will also be collected. After embryo donation, 2 trophectoderm and 1 inner cell mass biopsies will be collected and analysed for multiomics profiling.

Data exported from the medical records and source documents will be duly codified to protect the clinical and personal information of patients in accordance with the current legislation on data protection. This information will be exported to an internal database.

Participants' involvement in the study will be limited to the consent; participants will not undergo any other study specific procedures.

Inclusion Criteria:

• Patients whose written informed consent approved by the Ethic Committee has been obtained, after having been duly informed of the nature of the study and voluntarily accepted to participate after being fully aware of the potential risks, benefits, and any discomfort involved.
• Patients undergoing regular IVF/ICSI cycles with fresh oocytes and embryo culture to the blastocyst stage (day 5-6 after fertilization)
• Patients' age will be between 20-42 years of age.
• Patients without PGT-M or PGT-SR indication.

Exclusion Criteria:

• Patients who do not have at least one discarded blastocyst on day 5-6 of development.
• Patients with discarded blastocysts that do not meet these criteria:
• Presence of ICM
• Non-degenerated

All of them.

The study will involve 200 discarded embryos from approximately 150 women undergoing IVF treatment at Oslo University Hospital. The selected population will fall within the age range of 20 to 42, representing the common demographic for IVF patients.