single blastocyst transfer
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2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110624
Author(s):  
Jinpeng Rao ◽  
Feng Qiu ◽  
Shen Tian ◽  
Ya Yu ◽  
Ying Zhang ◽  
...  

Objective This study aimed to compare the clinical outcomes for transfer of Day 3 (D3) double cleavage-stage embryos and Day 5/6 (D5/6) single blastocysts in the frozen embryo transfer (FET) cycle to formulate a more appropriate embryo transplantation strategy. Methods We retrospectively analyzed 609 FET cycles from 518 women from April 2017 to March 2021. All FETs were assigned to the D3-DET group (transfer of a Day 3 double cleavage-stage embryo), D5-SBT group (transfer of a Day 5 single blastocyst), or D6-SBT group (transfer of a Day 6 single blastocyst). Clinical outcomes were comparatively analyzed. Results There were no significant differences in the biochemical pregnancy rate, clinical pregnancy rate, or ongoing pregnancy rate between the D3-DET and D5-SBT groups, but these rates in the two groups were all significantly higher compared with those in the D6-SBT group. The implantation rate in the D5-SBT group was significantly higher than that in the D3-DET group. The twin pregnancy rate in the D5-SBT and D6-SBT groups was significantly lower than that in the D3-DET group. Conclusion This study suggests that D5-SBT is the preferred option for transplantation. D6-SBT reduces the pregnancy rate, making it a more cautious choice for transfer of such embryos.


2021 ◽  
Author(s):  
jiali Cai ◽  
Lanlan Liu ◽  
Jinghua Chen ◽  
Zhenfang Liu ◽  
Wenjie Wang ◽  
...  

Abstract Background Previous studies arguably associated poor embryo morphology with low birthweight in singletons following single embryo transfer. However, the association between specific morphological features on the cleavage stage and birthweight is still less known. The purpose of the study was to investigate whether embryo morphological features at the cleavage stage affect birthweight following blastocyst transfer Methods The single-center, retrospective cohort study included 4226 singletons derived from fresh single cleavage stage embryo transfer (ET, n=1185), fresh single blastocyst transfer (BT, n=787), or frozen-thawed single blastocyst transfer (FBT, n=2254) between 2016 and 2019. The morphological parameters including early cleavage, day 3 fragmentation, symmetry, blastomere number, and blastocyst morphology were associated with neonatal birthweight and z-score in multivariate regression models. Models were adjusted for maternal age, BMI, parity, peak estradiol level, endometrial thickness, insemination protocol, female etiologies, order of transfer, mode of delivery, and year of treatment. Results Adjusted for confounders, fragmentation was the only morphology feature associated with birthweight and z-score, while early cleavage, symmetry, blastomere number and blastocyst morphology were not. Fragmentation increased the birthweight in both ET group (115.4g, 95% CI: 26.6 to 204.2) and BT group (168.8g, 95%CI: 48.8 to 288.8), but not in FBT group (7.47g, 95%CI: -46.4 to 61.3). The associations of birthweight and morphological parameters were confirmed in analyses for z-score. Adjusted odds of large for gestational age and high birthweight were also significantly greater in singletons following the transfer of fragmented embryos in BT group (OR 3, 95% CI: 1.2 to 7.51, OR 3.65, 95% CI: 1.33 to 10, respectively). The presence of fragmentation at the cleavage stage also affected the association between blastocyst morphology and birthweight. Inner cell mass grades were negatively associated with birthweight in blastocysts with day 3 fragmentation but not in blastocysts without. Conclusions Birthweight following blastocyst transfer is positively associated with fragmentation at the cleavage stage. The data did not support the argument that transferring a poor-looking embryo may increase the risks of low birthweight. However, concerns for LGA infants still remain.


2021 ◽  
Author(s):  
Jinliang Zhu ◽  
Ying Lian ◽  
Xinjie Zhuang ◽  
Shengli Lin ◽  
Xiaoying Zheng ◽  
...  

Abstract Background The correlation between blastocyst quality and birthweight, neonatal outcomes is still controversial. There is a significantly higher male: female ratio among good quality blastocysts (advanced trophoderm morphology) but in the expansion degree, the significance for sex ratio is unclear. Methods A total of 617 and 6803 live singleton births resulting from the transfer of fresh and frozen-thawed single blastocysts in the Reproductive Medicine Center of Peking University Third Hospital from 2009 to 2020 were included. Live singleton births from fresh and frozen-thawed single blastocyst transfer were stratified by inner cell mass/trophoderm morphology and degree of blastocoel expansion. Multivariate linear regression was used to analyze the correlation between expansion, inner cell mass/trophoderm morphology, and birthweight, Z score, gestational weeks. Logistic regression was used to analyze the relationship between expansion, ICM/TE morphology and sex, neonatal outcomes. Results There was no significant correlation between birthweight, neonatal outcomes and blastocyst quality in fresh and frozen-thawed single blastocyst transfer cycles. However, the proportion of male infants in the hatched blastocyst (stage-6) group (67.9% vs. 54.2%; p < 0.001) [OR: 1.76 95% CI (1.34–2.32)] and hatching blastocyst (stage-5) group (61.7% vs. 54.2%; p = 0.001) [OR: 1.36 95 C.I (1.14ཞ1.62)] was significantly higher than that in the expanded blastocyst (stage-4) group. Conclusions The transfer of poor-quality blastocysts is unlikely to affect birthweight and neonatal health; however, transfer of stage-6 blastocysts can result in extremely skewed sex ratio.


PeerJ ◽  
2021 ◽  
Vol 9 ◽  
pp. e11785
Author(s):  
Yingfen Ying ◽  
Xiaosheng Lu ◽  
Huina Zhang ◽  
Samuel Kofi Arhin ◽  
Xiaohong Hou ◽  
...  

Backgroud This study’s objectives were to compare the clinical, perinatal, and obstetrical outcomes of patients with different estradiol (E2) levels in fresh single-blastocyst-transfer (SBT) cycles under an early follicular phase prolonged regimen on the day of trigger. Methods We recruited patients in fresh SBT cycles (n = 771) undergoing early follicular phase prolonged protocols with β-hCG values above 10 IU/L between June 2016 and December 2018. Patients who met the inclusion and exclusion criteria were divided into four groups according to their serum E2 level percentages on the day of trigger: <25th, 25th–50th, 51st–75th, and >75th percentile groups. Results Although the rates of clinical pregnancy (85.57% (166/194)), embryo implantation 86.60% (168/194), ongoing pregnancy (71.13% (138/194)), and live birth (71.13% (138/194)) were lowest in the >75th percentile group, we did not observe any significant differences (all P > 0.05). We used this information to predict the rate of severe ovarian hyperstimulation syndrome (OHSS) area under the curve (AUC) = 72.39%, P = 0.029, cut off value of E2 = 2,893 pg/ml with the 75% sensitivity and 70% specificity. The 51st–75th percentile group had the highest rates of low birth weight infants (11.73% (19/162), P = 0.0408), premature delivery (11.43% (20/175), P = 0.0269), admission to the neonatal intensive care unit (NICU) (10.49% (17/162), P = 0.0029), twin pregnancies (8.57% (15/175), P = 0.0047), and monochorionic diamniotic pregnancies (8.57% (15/175); P = 0.001). We did not observe statistical differences in obstetrics complications, including gestational diabetes mellitus (GDM), gestational hypertension, placenta previa, premature rupture of membranes (PROM), and preterm premature rupture of membranes (PPROM). Conclusion We concluded that serum E2 levels on the day of trigger were not good predictors of live birth rate or perinatal and obstetrical outcomes. However, we found that high E2 levels may not be conducive to persistent pregnancies. The E2 level on the day of trigger can still be used to predict the incidence of early onset severe OHSS in the fresh SBT cycle.


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M L Groendahl ◽  
M. Buhl Borgstrøm ◽  
U. Schiøler Kesmodel

Abstract Study question Do stage and morphology of the competent blastocyst associate with initial hCG rise, gestational age, preterm birth, child birth weight, length, and child sex? Summary answer Higher stage, TE- and ICM-scores associated with higher hCG-rise; ICM- and TE-scores associated with length at birth, and higher stage and TE-score associated with boys. What is known already Many studies have focused on the developmental stage and morphology of the blastocysts in order to find biomarkers of competence to improve the efficacy of assisted reproduction technology treatment. In contrast, the associations between blastocyst assessment score parameters (individually or by combined score) and perinatal outcome have only been reported in few and smaller single center studies, and conflicting results have been presented. In the present study, we focused on the in vitro cultured blastocyst leading to a live birth and how the stage and morphology of these competent blastocysts relate to implantation and birth outcomes. Study design, size, duration Multicenter historical cohort study based on exposure (blastocyst stage (1-6) and morphology (trophectoderm (TE) and inner cell mass (ICM): A,B,C)) and outcome data (serum human chorionic gonadotrophin (hCG), gestational age, preterm birth, child weight, length, and sex) from women undergoing single blastocyst transfer resulting in singleton pregnancy and birth. Data from 16 private and university-based facilities for clinical services and research from 2014 to 2018 was included. Participants/materials, setting, methods 7246 women, who underwent ovarian stimulation or Frozen-thawed-Embryo-Transfer with single blastocyst transfer resulting in singleton pregnancy were identified. Linking to the Danish Medical Birth Registry resulted in a total of 4842 women with live birth being included. Initial serum hCG value (IU/L) (11 days after transfer), gestational age (days), preterm birth (%) child weight (grams), length (cm) and sex. The analyses were adjusted for female age, BMI, smoking, center, diagnosis, parity, gestational age and sex. Main results and the role of chance Higher mean initial hCG was consistently positively associated with higher developmental stage (p &lt; 0.001), TE (p &lt; 0.001) and ICM score (p = 0.02); for stage 6, TE (A) and ICM (A): 508.4, 436.5 and 428.5 IU/L, respectively. No differences between blastocyst morphology (stage, TE, ICM), gestational age (mean 276.6 days), preterm birth (8.3%) and birth weight (mean 3461.7 gram) were statistically significant. While stage showed no association with length at birth (mean 51.6 cm), length at birth between blastocysts with a TE score C and a TE score A were statistically significant (mean difference 0.5 cm (0.07;0.83)) as was the length at birth between blastocysts with an ICM score B and C compared to score A, mean differences respectively 0.2 cm (0.02;0.31) and 0.5 cm (0.03;0.87). Stage and TE, but not ICM were associated with the sex of the child. Blastocysts transferred with stage score 5 compared to blastocysts transferred with score 3 had a 33% increased probability of being a boy (OR 1.33 (1.08;1.64)). Further, TE score B blastocysts compared to TE score A blastocysts had a 28% reduced probability of being a boy (OR 0.72 (0.62;0.82)). Limitations, reasons for caution The assessment scores of the blastocystś stage and morphology were based on subjective evaluation, and information bias may have influenced the results. By adjusting for center, we took the potential variation in scoring between clinics into considerations. Wider implications of the findings Stage and morphology of the competent blastocyst was associated with initial hCG rise suggesting an effect on implantation, which may be used in routine, everyday information to women and couples on the day of blastocyst transfer. Trial registration number j.nr.: VD-2018-282


2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Watanabe ◽  
M Tomida ◽  
S Suzuki ◽  
Y Matsuda ◽  
K Yoshikai ◽  
...  

Abstract Study question When does blastomere exclusion from compaction increase and what effect does it have on the embryo? Summary answer More blastomere were excluded from compaction in embryos with irregular cleavage, resulting in lower blastocyst development rates, but no decrease in pregnancy rates at transfer. What is known already It has been reported that many of the chromosome analysis results of blastomere excluded from compaction were aneuploid, and pointed out that this exclusion may be related to the repair of blastocyst euploidy, but the effect of the number of excluded blastomere has not been reported. Study design, size, duration This is a retrospective study of 578 embryos that developed into morula with time-lapse monitoring by EmbryoScope (Vitrolife) in 2018–2019. Participants/materials, setting, methods The target embryos were classified into two groups: embryos with normal first and second cleavage (normal cleavage group) and embryos with irregular cleavage (dynamics of one cell dividing into three or more cells), called “direct cleavage”, at either cleavage (DC group), and the number of blastomere excluded from compaction during morula formation was recorded and compared. The blastocyst development rate and single blastocyst transfer pregnancy rates of the two groups were compared. Main results and the role of chance There are 286 in the normal cleavage group and 292 in the DC group. The mean number of excluded blastomere was 0.76 and 3.55, respectively, which was significantly higher in the DC group (P &lt; 0.01). Good blastocyst (Gardner classification 4 or higher) development rate was 84.5% (239/283) and 65.8% (181/275), respectively, and high grade blastocyst (Gardner classification BB or higher) development rate was 43.9% (105/239) and 14.9% (27/181) of them, both significantly higher in the normal cleavage group (P &lt; 0.01). The single blastocyst transfer pregnancy rates were 31.6% (25/79) and 32.4% (11/34), and the miscarriage rates were 24.0% (6/25) and 27.3% (3/11), respectively, neither was there a significant difference between the two groups. So, direct cleavage increased the number of blastomere excluded from compaction, decreased the rate of morula to good blastocyst development and reduced blastocyst grade, but did not affect blastocyst transfer pregnancy rate and miscarriage rate. Limitations, reasons for caution Please note that all target embryos must have developed into morula or larger (embryos that did not develop into morula will not be included in the study). Wider implications of the findings: Severe chromosomal aberrant blastomeres formed by direct cleavage were excluded from compaction, and the blastocyst development rate decreased due to a decrease in the amount of viable cells, but it is suggested that this blastomere exclusion mechanism is not related to euploidy after blastocyst development. Trial registration number Not applicable


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