Dataset Information

Embryo morphology and live birth in the United States.

ABSTRACT:

Objective

To determine the best-fit live birth rate per embryo based on maternal age, embryo stage, and embryo morphology.

Design

Retrospective data analysis.

Setting

Fertility clinics.

Patients

The patients included were treated with in vitro fertilization in the United States at clinics reporting data to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System. We analyzed live birth data of unbiopsied autologous cleavage and blastocyst stage embryos for cycles started from 2016 through 2018. The analysis included 223,377 embryo transfers with a total of 336,888 embryos.

Interventions

None.

Main outcome measures

Live birth rate per embryo and rate of multiple gestations per pregnancy.

Results

At the mean maternal age of 34 years, fresh embryos produced live birth rates of 19%, 38%, 26%, and 27% for embryos aged 3, 5, 6, and 7 days, respectively. At the age 34 years, live birth rates for day 5 fresh embryos by overall morphology grade were 43% for good, 30% for fair, and 21% for poor. For the transfer of 2 fresh day 5 blastocysts, the rate of multiple gestations per pregnancy was 47% at 25 years old, 44% at 30 years old, 35% at 35 years old, and 23% at 40 years old.

Conclusions

The analysis of pregnancy data in the Society for Assisted Reproductive Technology database can be used to calculate live birth rates per embryo based on maternal age, embryo age, and morphology. This information can be used for evidence-based decision making, quality control, and planning multicenter studies.

SUBMITTER: Awadalla MS

PROVIDER: S-EPMC9250116 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe scoring system for human blastocysts is traditionally based on morphology; however, there are controversies on the effect of morphology parameters on pregnancy outcomes. The aim of this study is to evaluate the predicting value of each morphology parameter on pregnancy outcomes in a setting of single embryo transfer.MethodsThis is a retrospective cohort study on patients undergoing frozen-thawed single blastocyst transfer at our center, between Jan. 2009 and Dec. 2018. A total of 10,482 cycles were analyzed. The blastocysts were scored according to the expansion and hatching status, morphology of inner cell mass (ICM), and cells of trophectoderm (TE). The primary outcome measure was live birth rate. One-way analysis of variance, chi-square test, and multiple logistic regression were used for statistical analysis.ResultsThe clinical pregnancy rate was lower in the blastocysts of stage 3 (48.15%), compared with those of stage 4 (56.15%), stage 5 (54.91%), and stage 6 (53.37%). The live birth rate was lower in the blastocysts of stage 3 (37.07%), compared with those of stage 4 (44.21%) and stage 5 (41.67%). The rates of clinical pregnancy (A: 66.60%, B: 53.25%, C: 39.33%) and live birth (A: 54.62%, B: 41.29%, C: 28.45%) were both decreased with decreasing grade of ICM morphology, and these differences were pairwise significant. The miscarriage rate of blastocysts with ICM grade A was lower, compared with ICM grade C (17.53 vs. 27.66%). Blastocysts with TE morphology of C had lower rates of clinical pregnancy (43.53%) and live birth (32.57%), compared with those with TE morphology of A and B (clinical pregnancy rate: 64.26% for A, 58.11% for B; live birth rate: 52.74% for A, 45.64% for B). There were no significant differences in rates of clinical pregnancy, live birth, and miscarriage between the blastocysts with TE grade A and B.ConclusionsThe blastocyst expansion stage, ICM grade, and TE grade are all associated with pregnancy outcomes. ICM grade is the strongest predictor of live birth. A blastocyst with stage 4-5, ICM grade A, and TE grade A/B should be given priority for single embryo transfer.

Project description:In recent years, the freeze-all strategy has been widely adopted and applied. However, with the exception of age, the factors that affect the outcomes of frozen embryo transfer are still unclear. Therefore, the identification and mitigation of factors that influence the live birth rate after frozen embryo transfer is a good way to increase the "take-home-baby" rate of frozen embryo transfer. The objective of this study was to identify factors affecting the live birth rate after cleavage-stage frozen embryo transfer in young ovulatory women. This was a secondary analysis from a previously published multicenter randomized controlled trial (ChiCTR-IOR-14005406) that was originally designed to compare the live birth rate and perinatal complications after fresh embryo transfer to those after frozen embryo transfer among ovulatory women. This study was carried out using a portion of the data from the original randomized controlled trial, which included 917 young women who underwent cleavage-stage frozen embryo transfer. The 16 clinical candidate variables potentially affecting the live birth rate after frozen embryo transfer were analyzed. Univariable analysis and multivariable analysis were performed to assess the relationship between predictive factors and outcomes, with the aim of identifying independent predictors of live birth after frozen embryo transfer. In this study, the live birth rate was 53.0% (486/917). Three independent predictors were ultimately identified as the main factors affecting the live birth rate of ovulatory young women. Infertility duration [odds ratio (OR): 0.933, 95% confidence interval (CI): 0.876-0.995, p = 0.033], endometrial thickness before frozen embryo transfer (OR: 3.375, 95% CI: 1.556-7.321 p = 0.002), and the number of embryos transferred (OR: 2.653, 95% CI:1.226-5,743, p = 0.013) were the major factors contributing to the live birth rate after cleavage-stage frozen embryo transfer among young women. The cut-off point for infertility duration was 4.5 years, and the cut-off point for endometrial thickness was 0.89 cm. Infertility duration, endometrial thickness and number of embryos transferred might affect the live birth rate after frozen embryo transfer among young women. This result could help inform clinical decisions and counseling to increase the live birth rate after frozen embryo transfer among young women.