Obstetric and perinatal outcomes of singletons after single blastocyst transfer: is there any difference according to blastocyst morphology?

Abstract

A strong correlation between blastocyst morphology and implantation has been shown by many studies. The consequences and effects of assisted reproductive techniques on children's short and long-term health have always been a source of discussion. The obstetric and perinatal outcome of singletons according to blastocyst morphology has rarely been evaluated. The aim of this observational study is to determine whether a relationship exists between blastocyst morphology and obstetric and perinatal outcomes. A total of 799 singleton clinical pregnancies were analysed after transfer of a single fresh blastocyst on day 5 between 2006 and 2013. Blastocysts were divided into four groups based on their morphology on day 5: group 1 = good morphology blastocysts; group 2 = fair morphology blastocysts; group 3 = poor morphology blastocysts and group 4 = early (B1/B2) blastocysts. Obstetric and perinatal outcomes were compared between the four groups. After adjustment for some confounding variables, main obstetric and perinatal outcomes after transfer of blastocysts with poor morphological characteristics were not associated with increased adverse obstetric and perinatal events. Sex ratio was significantly higher in group 1 compared with groups 2, 3 and 4, and in Group 2 compared with Group 3 (P < 0.001) even after adjustment (P < 0.05).

Blastocyst culture in the Era of PGS and FreezeAlls: Is a ‘C’ a failing grade?

“…In studies using the newer simplified grading systems, similarly grade 3/C blastocysts are often not frozen or biopsied (Restelli et al , 2014; Stone et al , 2014; Hardarson et al , 2015; Richardson et al , 2015; Fawzy et al , 2017). Since low quality blastocysts can lead to live births (Capalbo et al , 2014; Wirleitner et al , 2016; Irani et al , 2017) with normal obstetric and perinatal outcomes (Bouillon et al , 2017), this bias against freezing grade ‘C’ blastocysts has limited the establishment of a lower threshold for viability.…”

“…Many clinics adhere to a strict grading policy that discards grade ‘C’ blastocysts, yet there are several studies that provide evidence of their potential. The most compelling evidence for freezing low quality blastocysts is that single embryo transfer of expanded blastocysts with grade ‘C’ ICM or grade ‘C’ TE resulted in live births at rates that, while lower than top quality blastocysts (34.1 versus 46.8%), resulted in 109 live births that had similar obstetric and perinatal outcomes compared to grade ‘A’ or ‘B’ blastocysts (Bouillon et al , 2017). With the advent of PGS, clinics are biopsying, freezing and transferring blastocysts that contain ‘C’ ICM or TE, are stage 1 or 2, or develop on Day 7 (Capalbo et al , 2014; Minasi et al , 2016; Christodoulou et al , 2017; Irani et al , 2017).…”

Association Between Morphologic Grading and Implantation Rate of Euploid Blastocyst

“…Elsewhere, poor-quality blastocysts showed a higher miscarriage rate per clinical pregnancy (36.4%) than non-poor-quality blastocysts (13.9%) after euploid SET [19] . However, once the risk of miscarriage is overcome, poor-quality blastocysts go to term apparently without greater obstetrical or perinatal risks [20] .…”

Association Between Morphologic Grading and Implantation Rate of Euploid Blastocyst

“…Elsewhere, poor-quality blastocysts showed a higher miscarriage rate per clinical pregnancy (36.4%) than non-poor-quality blastocysts (13.9%) after euploid SET [20] . However, once the risk of miscarriage is overcome, poor-quality blastocysts go to term apparently without greater obstetrical or perinatal risks [21] .…”