OBJECTIVE: To identify the relationship between the traditional blastocyst morphological evaluation and karyotyping. DESIGN: This is a single center retrospective observational study performed from July to September 2017. A total of 682 embryos derived from 86 patients were included and analyzed by SNP in this study. MATERIALS AND METHODS: Patients with known translocation are recruited in this study. Trophectoderm biopsy and embryo assessment were carried out simultaneously. Biopsy was performed only when the blastocysts were expanded or hatching after the use of laser. Six to eight cells were taken routinely for SNP analysis. The blastocysts were classified into four groups (excellent, good, medium and poor) based on the morphological grading and they were also divided into euploid group and aneuploidy group based on the SNP results. RESULTS: The euploidy rate was 38.4%, 21.0%, 19.5% and 10.3% in the excellent, good, average and poor blastocyst morphology groups, respectively. There was significantly higher euploid rate in excellent group, when compared with other groups (P <0.01). Nevertheless, neither the good and the poor morphology group, nor the medium and the poor morphology group has significant difference in euploid rate (P>0.05, respectively). Regression logistic analysis adjusted for female age and the time of biopsy showed that the blastocyst morphology assessment had a positive effect on the euploidy rate (OR ¼1.713, 95% CI 1.316-2.229; P <0.01). CONCLUSIONS: Although the euploidy rate is decline with the traditional morphological assessment, blastocysts with poor morphological grading should not be discarded and are worth being biopsied as well, given that they have a chance to be euploid, expecially for the patients who have not any other embryos suitable for biopsy.

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We did not find significant differences between the percentage of euploid blastocysts in each category. We also performed a logistic regression model for implantation, in which BMI, type of cycle and standard morphology were included. The model revealed an OR 3.20 (CI95% 1.57-6.50) (p¼0.001) comparing Xtend 1 vs 5 and an OR 2.52 (CI95% 1.23-5.19) (p¼0. 012).CONCLUSIONS: There is a direct correlation between Xtend categories, percentage of viable embryos, blastocyst rate, good morphology blastocyst rate and blastocysts available for biopsy. Regarding the implantation rate total, we observed significant differences between categories, even when we distinguished between fresh and frozen embryos.IMPACT STATEMENT: Retrospective nature of this study may be a reason for caution; nevertheless, it is the largest sample size reported with this test, based in blastocyst transfer with>90% of single-embryo-transfer. Additionally, a multivariable-analysis confirmed the magnitude of the results. It confirms that morphology and automatic time-lapse classifications can be used together to increase success rate in the laboratory.