Effect of Blastocyst Morphology and Developmental Speed on Transfer Strategy for Grade “C” Blastocyst in Vitrified-Warmed Cycles

Abstract Background: High-quality single blastocyst transfer (SBT) is increasingly recommended to patients because of its acceptable pregnancy outcomes and significantly reduced multiple pregnancy rate compared to double blastocyst transfer (DBT). However, there is no consensus on whether this transfer strategy is also suitable for poor-quality blastocysts. Moreover, the effect of the development speed of poor-quality blastocysts on pregnancy outcomes has been controversial. Therefore, this study aimed to explore the effects of blastocyst development speed and morphology on pregnancy and neonatal outcomes during the frozen embryo transfer (FET) cycle of poor-quality blastocysts and to ultimately provide references for clinical transfer strategies.Methods: A total of 2,038 FET cycles of poor-quality blastocysts were analyzed from January 2014 to December 2019 and divided based on the blastocyst development speed and number of embryos transferred: the D5-SBT (n=476), D5-DBT (n=365), D6-SBT (n=730), and D6-DBT (n=467) groups. The SBT group was further divided based on embryo morphology: D5-AC/BC (n=407), D5-CA/CB (n=69), D6-AC/BC (n=580), and D6-CA /CB (n=150).Results: When blastocysts reach the same development speed, the live birth and multiple pregnancy rates of DBT were significantly higher than those of SBT. Moreover, there was no statistical difference in the rates of early miscarriage and live birth between the AC/BC and CA/CB groups. When patients in the SBT group were stratified by blastocyst development speed, the rates of clinical pregnancy (42.44% vs. 20.82%) and live birth (32.35% vs. 14.25%) of D5-SBT group were significantly higher than those of D6-SBT group. Furthermore, for blastocysts in the same morphology group (AC/BC or CA/CA group), the rates of clinical pregnancy and live birth in the D5 group were also significantly higher than those of D6 group. Conclusion: For poor-quality D5 blastocysts, SBT can be recommended to patients because of acceptable pregnancy outcomes and significantly reduced multiple pregnancy rate compared with DBT. For poor-quality D6, the DBT strategy is recommended to patients to improve pregnancy outcomes. When blastocysts reach the same development speed, the transfer strategy of selecting blastocyst with inner cell mass “C” or blastocyst with trophectoderm “C” does not affect the pregnancy and neonatal outcomes.

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Effect of blastocyst morphology and developmental speed on transfer strategy for grade “C” blastocyst in vitrified‐warmed cycles

Journal of Ovarian Research ◽

10.1186/s13048-021-00798-w ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Yuxia He ◽

Shiping Chen ◽

Jianqiao Liu ◽

Xiangjin Kang ◽

Haiying Liu

Keyword(s):

Pregnancy Rate ◽

Live Birth ◽

Pregnancy Outcomes ◽

Multiple Pregnancy ◽

Poor Quality ◽

Clinical Pregnancy ◽

Neonatal Outcomes ◽

Blastocyst Transfer ◽

Blastocyst Development ◽

Multiple Pregnancy Rate

Abstract Background High-quality single blastocyst transfer (SBT) is increasingly recommended to patients because of its acceptable pregnancy outcomes and significantly reduced multiple pregnancy rate compared to double blastocyst transfer (DBT). However, there is no consensus on whether this transfer strategy is also suitable for poor-quality blastocysts. Moreover, the effect of the development speed of poor-quality blastocysts on pregnancy outcomes has been controversial. Therefore, this study aimed to explore the effects of blastocyst development speed and morphology on pregnancy and neonatal outcomes during the frozen embryo transfer (FET) cycle of poor-quality blastocysts and to ultimately provide references for clinical transfer strategies. Methods A total of 2,038 FET cycles of poor-quality blastocysts from patients 40 years old or less were included from January 2014 to December 2019 and divided based on the blastocyst development speed and number of embryos transferred: the D5-SBT (n = 476), D5-DBT (n = 365), D6-SBT (n = 730), and D6-DBT (n = 467) groups. The SBT group was further divided based on embryo morphology: D5-AC/BC (n = 407), D5-CA/CB (n = 69), D6-AC/BC (n = 580), and D6-CA /CB (n = 150). Results When blastocysts reach the same development speed, the live birth and multiple pregnancy rates of DBT were significantly higher than those of SBT. Moreover, there was no statistical difference in the rates of early miscarriage and live birth between the AC/BC and CA/CB groups. When patients in the SBT group were stratified by blastocyst development speed, the rates of clinical pregnancy (42.44 % vs. 20.82 %) and live birth (32.35 % vs. 14.25 %) of D5-SBT group were significantly higher than those of D6-SBT group. Furthermore, for blastocysts in the same morphology group (AC/BC or CA/CA group), the rates of clinical pregnancy and live birth in the D5 group were also significantly higher than those of D6 group. Conclusions For poor-quality D5 blastocysts, SBT can be recommended to patients because of acceptable pregnancy outcomes and significantly reduced multiple pregnancy rate compared with DBT. For poor-quality D6, the DBT strategy is recommended to patients to improve pregnancy outcomes. When blastocysts reach the same development speed, the transfer strategy of selecting blastocyst with inner cell mass “C” or blastocyst with trophectoderm “C” does not affect the pregnancy and neonatal outcomes.

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Effect of Blastocyst Morphology and Developmental Speed on Transfer Strategy for Grade “C” Blastocyst in Vitrified-warmed Cycles

10.21203/rs.3.rs-136802/v1 ◽

2021 ◽

Author(s):

yuxia He ◽

shiping Chen ◽

jianqiao Liu ◽

xiangjin Kang ◽

haiying Liu

Keyword(s):

Pregnancy Rate ◽

Live Birth ◽

Pregnancy Outcomes ◽

Multiple Pregnancy ◽

Poor Quality ◽

Clinical Pregnancy ◽

Neonatal Outcomes ◽

Blastocyst Transfer ◽

Blastocyst Development ◽

Multiple Pregnancy Rate

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Is the cumulative live birth rate following in vitro fertilization (IVF) lower with government coverage than prior to coverage?

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184983 ◽

2018 ◽

Vol 7 (12) ◽

pp. 5150

Author(s):

Adhwaa Khudhari ◽

Chamile Sylvestre ◽

Simon Phillips

Keyword(s):

Pregnancy Rate ◽

Live Birth ◽

Multiple Pregnancy ◽

Fertilization Rate ◽

Good Prognosis ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Cumulative Pregnancy Rate ◽

Frozen Embryos ◽

Multiple Pregnancy Rate

Background: Most studies conclude that the cumulative pregnancy rate depends on embryo quality and quantity, which is directly related to patient’s age. In the best-case scenario, the cumulative pregnancy rate reaches 79% when the number of embryos reaches 15. Other studies reported 75% probability of live birth after 6 cycles of controlled ovarian stimulation and IVF.Methods: Retrospective cohort study comparing IVF cycles between January 2008 to December 2009 (before governmental coverage), and between January 2012 to December 2013. University-affiliated private IVF clinic. 298 good prognosis IVF patients from 2008-2009 and 610 patients from 2012-2013 were included. The cumulative LBR per IVF cycle was the main outcome measure; the secondary outcome measures were the type of protocol used, percentage of ICSI cycles, fertilization rate, proportion of day 3 versus (vs) day 5 embryo transfers, average number of embryos transferred, average number of frozen embryos, the clinical pregnancy rate and the multiple pregnancy.Results: no statistically significant difference in the cumulative LBR; it was 44.8% in 2008-2009 but 40.3% in 2012-2013. p: 0.134. The long agonist protocol was used the most 2008-2009 (75.5% of the cycles) compared to antagonist protocol in 2012-2013 (77.2%) p <0.01. There was no difference in the use of ICSI, but the fertilization rate in 2012-2013 (60.9% vs 65.9%, p=0.001). The proportion of day 3 embryos transferred in 2008-2009 (82.2%) and 2012-2013 (43.9%), p=0.005, and the proportion of day 5 embryos transferred is 3.7% in 2008-2009 but 54.9% in 2012-2013, p<0.001. The average number of embryos transferred in 2008-2009 was 1.96 vs 1.08 in 2012-2013. The average number of frozen embryos per cycle was not significantly different. The clinical pregnancy rate was not significantly different (56.8% vs 54.3%). The multiple pregnancy rate is 19.4% in 2008-2009 and 0.5% in 2012-2013.Conclusions: In good prognosis IVF patients, the cumulative LBR per cycle started was not significantly different after IVF provincial coverage and the move towards eSET on day 3 or day 5. No advantage of transferring multiple embryos in this group of patients, and that transferring one at a time reduces significantly the multiple pregnancy rate and its complications.

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Incidence of multiple births in relation to current regulations in Turkey regarding embryo transfer

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03616-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Semra Kahraman ◽

Ipek Nur Balin Duzguner ◽

Soner Duzguner ◽

Yucel Sahin ◽

Cihat Sen

Keyword(s):

Pregnancy Rate ◽

Clinical Outcomes ◽

Embryo Transfer ◽

Live Birth ◽

Birth Rate ◽

Multiple Pregnancy ◽

Blastocyst Transfer ◽

Routine Practice ◽

Significant Difference ◽

Multiple Pregnancy Rate

Abstract Background Before 2010, there were no regulations in Turkey regarding the number of embryos to be transferred in one cycle. In March 2010, regulations restricting this number were implemented by the Turkish Ministry of Health. These specify the transfer of a maximum of one embryo in the first and second cycles and a maximum of two embryos in subsequent cycles in women aged < 35, and a maximum of two embryos in women aged ≥35 in any one cycle. Our study evaluates the effect of these regulations. Methods This large retrospective single center study first evaluates the incidence of multiple pregnancies before and after the implementation of the 2010 regulations. Secondly, it compares the clinical outcomes of double blastocyst transfer (DBT) and single blastocyst transfer (SBT) performed in compliance with these regulations from 2014 onwards. Results After the introduction of the 2010 regulations, the multiple pregnancy rate decreased significantly from 37.9 to 15.7%. The singleton live birth rate increased significantly, whereas multıiple live birth rates significantly decreased (p = < 0.001). When the clinical outcomes of SBT and DBT performed in compliance with regulations from 2014 onwards were evaluated, in patients < 35 years, the multiple pregnancy rate decreased from 47.2% in the DBT group to 1.7% in the SBT group (p = < 0.001). In patients ≥35 years, in the DBT group, the twin birth rate was again high at 28.4%, whereas in the SBT group, it was only 1.8% (p = < 0.001). Importantly, there was no statistically significant difference in clinical pregnancy rates between these two groups. Conclusion Turkish regulations have led to an encouragement of double embryo transfer (DET) as a routine practice, with many patients understanding it as an absolute right to have two embryos transferred. The results of our study suggest that, especially in the light of the success of blastocyst transfer, the Turkish regulations should be amended to limit the use of DET and encourage the use of single embryo transfer except in exceptional cases and particularly in women under 35 years old.

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Controlled ovarian stimulation should not be preferred for male infertility treated with intrauterine insemination: a retrospective study

Reproductive Biology and Endocrinology ◽

10.1186/s12958-021-00730-3 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Yan Tang ◽

Qian-Dong He ◽

Ting-Ting Zhang ◽

Jing-Jing Wang ◽

Si-Chong Huang ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Pregnancy Rate ◽

Ovarian Stimulation ◽

Intrauterine Insemination ◽

Multiple Pregnancy ◽

Clinical Pregnancy ◽

Male Factor Infertility ◽

Male Factor ◽

Ovulatory Follicles ◽

Multiple Pregnancy Rate

Abstract Background Some studies have stated that intrauterine insemination (IUI) with controlled ovarian stimulation (COS) might increase the pregnancy rate, while others suggest that IUI in the natural cycle (NC) should be the first line of treatment. It remains unclear whether it is necessary to use COS at the same time when IUI is applied to treat isolated male factor infertility. Thus, we aimed to investigate efficacy of IUI with COS for isolated male factor infertility. Methods A total of 601 IUI cycles from 307 couples who sought medical care for isolated male factor infertility between January 2010 and February 2020 were divided into two groups: NC-IUI and COS-IUI. The COS-IUI group was further divided into two subgroups according to the number of pre-ovulatory follicles on the day of HCG: cycles with monofollicular development (one follicle group) and cycles with at least two pre-ovulatory follicles (≥ 2 follicles group). The IUI outcomes, including clinical pregnancy, live birth, spontaneous abortion, ectopic pregnancy, and multiple pregnancy rates were compared. Results The clinical pregnancy, live birth, spontaneous abortion, and ectopic pregnancy rates were comparable between the NC-IUI and COS-IUI group. Similar results were also observed among the NC-IUI, one follicle, and ≥ 2 follicles groups. However, with respect to the multiple pregnancy rate, a trend toward higher multiple pregnancy rate was observed in the COS-IUI group compared to the NC-IUI group (8.7% vs. 0, P = 0.091), and a significant difference was found between the NC-IUI and ≥ 2 follicles group (0 vs. 16.7%, P = 0.033). Conclusion In COS cycles, especially in those with at least two pre-ovulatory follicles, the multiple pregnancy rate increased without a substantial gain in overall pregnancy rate; thus, COS should not be preferred in IUI for isolated male factor infertility. If COS is required, one stimulated follicle and one healthy baby should be the goal considering the safety of both mothers and foetuses.

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The effect of air bubble position on ART outcome in frozen-thawed blastocyst transfer

10.21203/rs.3.rs-1059586/v1 ◽

2021 ◽

Author(s):

Tingting Yang ◽

Bo Chen ◽

Xiaoyan Sun ◽

Qingyang Li ◽

Qiumei Li ◽

...

Keyword(s):

Pregnancy Rate ◽

Live Birth ◽

Birth Rate ◽

Live Birth Rate ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Blastocyst Transfer ◽

Ultrasound Guided ◽

Air Bubble ◽

Art Outcome

Abstract Background So far, only few literatures have studied the relationship between blastocyst transfer position and ART outcomes, and the conclusions are still controversial. Our study is to evaluate the effect of air bubble position on ART outcome and to find the optimal embryo transfer position in frozen-thawed blastocyst transfer. Methods This study included a retrospective cohort analysis of 399 frozen-thawed single blastocyst transfers ultrasound-guided performed between June 1, 2017 and November 30, 2020. All of the women scheduled for frozen-thawed single blastocyst transfers ultrasound-guided. The primary outcome is clinical pregnancy rate and the secondary outcome is live birth rate. Statistical analyses were conducted using One-way Anova, Kruscal Whallis H test, chi-square test and Smooth curve fitting. Results When BFD was less than 19 mm, there was no significant change in clinical pregnancy rate as BFD increased (OR = 0.95, 95% CI: 0.89 to 1.02, P = 0.1373); when BFD was more than 19 mm, the clinical pregnancy rate decreased by 16% for every 1 mm increase in BFD (OR = 0.84, 95% CI: 0.72 to 0.98, P = 0.0363). The effect of BFD on live birth rate were similar to that on clinical pregnancy rate, the inflection point was 19mm, when BFD was more than 19 mm, the live birth rate decreases by 58% for every 1 mm increase in BFD (OR = 0.42, 95% CI: 0.21 to 0.86, P = 0.0174) Conclusions The ideal pregnancy outcome can be achieved within 19mm from uterus fundus after single blastocyst transfer, The clinical pregnancy and live birth at a distance of more 19mm from the uterus fundus have a cliff-like downward trend.

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Single instead of double day-five blastocyst transfer maintains the same clinical pregnancy rate and decreases multiple pregnancy and abortion rates in fresh IVF cycles

Fertility and Sterility ◽

10.1016/j.fertnstert.2018.07.1035 ◽

2018 ◽

Vol 110 (4) ◽

pp. e371

Author(s):

V. Torres Monserrat ◽

I. Moreno ◽

M. Delpiccolo ◽

N. Carizza ◽

E. Navall ◽

...

Keyword(s):

Pregnancy Rate ◽

Multiple Pregnancy ◽

Clinical Pregnancy ◽

Clinical Pregnancy Rate ◽

Blastocyst Transfer

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The effect of Day 3 cell number on pregnancy outcomes in vitrified-thawed single blastocyst transfer cycles

Human Reproduction ◽

10.1093/humrep/deaa209 ◽

2020 ◽

Vol 35 (11) ◽

pp. 2478-2487

Author(s):

Jiayi Wu ◽

Jie Zhang ◽

Yanping Kuang ◽

Qiuju Chen ◽

Yun Wang

Keyword(s):

Pregnancy Rate ◽

Live Birth ◽

Young Women ◽

Pregnancy Outcomes ◽

Cell Number ◽

Blastocyst Transfer ◽

Cell Group ◽

Single Blastocyst Transfer ◽

Significant Difference ◽

Blastomere Number

Abstract STUDY QUESTION Does cell number on Day 3 have an impact on pregnancy outcomes in vitrified-thawed single blastocyst transfer cycles? SUMMARY ANSWER A low Day 3 cell number (≤5 cells) was independently associated with decreased live birth rate (LBR) during single blastocyst transfer cycles in young women. WHAT IS KNOWN ALREADY Day 3 cell number is an effective predictor of IVF success rates when transferring cleavage stage embryos. However, the association between Day 3 blastomere number and pregnancy outcomes after blastocyst transfer is still unknown. STUDY DESIGN, SIZE, DURATION A retrospective cohort study of 3543 patients who underwent frozen-thawed single blastocyst transfers from January 2013 to June 2018 at a tertiary-care academic medical center. PARTICIPANTS/MATERIALS, SETTING, METHODS Patients were grouped into six groups according to the Day 3 cell number: ≤4 cells, 5 cells, 6 cells, 7 cells, 8 cells and >8 cells. The primary outcome measure was LBR. A logistic regression analysis was performed to explore the independent association between Day 3 blastomere number and LBR after adjustment for some potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE In women <35 years old, the LBR varied significantly according to Day 3 cell number, with the rate of 31.2%, 34.4%, 41.9%, 45.1%, 48.1% and 48.2% for the ≤4-cell, 5-cell, 6-cell, 7-cell, 8-cell and >8-cell groups, respectively (P < 0.001). This significant difference was also observed in the high- and low-quality blastocyst subgroups of young women. However, for women ≥35 years old, the rate of live birth was similar between groups. Furthermore, after accounting for confounding factors, the LBR was significantly decreased in the ≤4-cell (adjusted odds ratio (aOR): 0.62, 95% CI: 0.48–0.80, P < 0.001) and 5-cell (aOR: 0.73, 95% CI: 0.57–0.92, P = 0.009) groups as compared to the 8-cell group. Likewise, the blastocysts arising from ≤4-cell (aOR: 0.73, 95% CI: 0.57–0.93, P = 0.010) or 5-cell (aOR: 0.77, 95% CI: 0.61–0.97, P = 0.024) embryos were associated with lower clinical pregnancy rate than those from 8-cell embryos. No significant differences were observed in biochemical pregnancy rate and miscarriage rate. LIMITATIONS, REASONS FOR CAUTION A limitation of the current study was its retrospective design. Future prospective studies are needed to confirm our findings. WIDER IMPLICATIONS OF THE FINDINGS Our observations suggested that a low Day 3 cell number was related to decreased LBR after blastocyst transfer in young women, which provided vital information for clinicians in selecting blastocyst during IVF treatment. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Natural Science Foundation of China (NSFC) (31770989 to Y.W.; 81671520 to Q.C.) and the Shanghai Ninth People’s Hospital Foundation of China (JYLJ030 to Y.W.). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.

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