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. Patient(s): Women who have undergone a fresh (n ¼ 570) or frozen (n ¼ 885) transfer of a single blastocyst embryo between December 2013 and December 2018. Intervention(s): None. Main Outcome Measure(s): 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.

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The education received after treatment was considered inadequate. Couples with a long duration of infertility and those conflicted about final embryo disposition may be appropriate targets for further intervention. More written information and/or counseling services after treatment may help patients make informed and timely decisions regarding their surplus embryos.

Advances in the diagnosis and successful treatment of childhood, adolescent, and adult cancers have allowed many young women to lead healthy lives after overcoming their disease. However, life-saving cancer treatment often impairs fertility. Chemotherapy and/or radiation may irreversibly damage the reproductive system. The maturing field of assisted conception, and specifically cryopreservation, has created a unique partnership between oncologists and fertility specialists. Improving assisted conception success and fertility sparing strategies provide options for young women who would like to have children of their own after cancer treatment. This review article focuses on the current practices and developing opportunities for women who wish to preserve their fertility when faced with gonadotoxic cancer treatment.

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