Dataset Information

Transfers of lower quality embryos based on morphological appearance result in appreciable live birth rates: a Canadian center's experience.

ABSTRACT:

Objective

To determine the reproductive outcomes resulting from transfer of lower-grade blastocysts to support the practice of cryopreserving and transferring lower-grade embryos.

Design

Retrospective chart review.

Setting

Single infertility center.

Patients

Women who have undergone a fresh (n = 570) or frozen (n = 885) transfer of a single blastocyst embryo between December 2013 and December 2018.

Interventions

None.

Main outcome measures

The primary outcome was live birth rate. The secondary outcomes included implantation rate, ongoing pregnancy rate, associations with inner cell mass (ICM) and trophectoderm epithelium (TE) grades determined by morphological assessment, and antenatal/perinatal complications.

Results

Reproductive outcomes directly correlated with embryo quality. Transfers of AA embryos resulted in a 41.4% live birth rate compared to 31.1% for BB embryos and 13.3% for CC embryos. The TE grade was significantly associated with the live birth rate. Embryos with a TE grade of "B" had an odds ratio of 0.677 and embryos with a TE grade of "C" had an odds ratio of 0.394 compared to embryos with a TE grade of "A" for live birth.

Conclusion

Embryos with a TE "C" grade should be considered for transfer and cryopreservation, as they are shown to result in appreciable live birth rates. Such treatment should involve a thorough discussion with patients, however, as these live birth rates are significantly lower than those associated with higher-grade embryos.

SUBMITTER: Lai I

PROVIDER: S-EPMC8244281 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundLate follicular phase progesterone elevation (LFPE) during ovarian stimulation is associated with reduced live birth rates (LBRs) after cleavage-stage embryo transfer. However, due to better synchronization with a stimulated endometrium, prior studies shown that LFPE had no effect on transferring embryos at blastocyst stage. The study aim to exam whether the developmental stage of embryos and serum progesterone levels on the day of human chorionic gonadotropin (hCG) administration jointly affect the odds of live birth in fresh fresh IVF/intracytoplasmic sperm injection (ICSI) cycles. METHODS: The single-center retrospective cohort study included a total of 4,471 fresh embryo transfer cycles with 2,342 at cleavage stage versus 2,129 at blastocyst stage. Patients underwent IVF/ICSI with ovarian stimulation in gonadotropin-releasing hormone antagonist protocol. The serum progesterone level was examined both as a continuous variable and as a categorical variable by quartiles. Analysis was performed using the generalized estimating equations framework and multivariate regression models.ResultsLBRs were inversely associated with progesterone as a continuous variable on the day of hCG in both the cleavage-stage (crude OR 0.87, 95%CI 0.73-1.03; adjusted OR 0.80, 95% CI 0.65-0.98) and the blastocyst-stage (crude OR 0.66, 95%CI 0.56-0,78; adjusted OR 0.61, 95%CI 0.50-0.73) groups. The interaction testing was highly significant (P = 0.018) indicating an effect modifying role of stage of embryos transferred on the association of pregesterone values with the LBRs in fresh cycles. A similar pattern for a greater reduction in ORs for live birth in cycles with blastocysts transfer was also observed when progesterone was analyzed by interquartile ranges. The findings remained unchanged in subgroup analysis stratified by types of ovarian response.ConclusionsIn fresh cycles, detrimental effect of late follicular phase progesterone elevation on live birth was more prominent in blastocyst-stage group compared with that in clevaged-stage group.

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