Should we consider day-2 and day-3 embryo morphology before day-5 transfer when blastocysts reach a similar good quality?

Abstract

Clinical outcomes of 291 day-5 blastocyst transfers carried out between January 2012 and March 2016 were retrospectively compared according to their quality at day 2 and 3. Inclusion criteria were female age younger than 37 years; first or second IVF and intracytoplasmic sperm injection cycle; quality of the transferred blastocyst: blastocoele B3 or higher; inner-cell-mass A/B; trophectoderm A/B; and known implantation outcome for each transferred blastocyst. Blastocysts were classified into good-quality and poor-quality embryo groups at day 2 and 3. Implantation (38.7% versus 41.4), clinical pregnancy (40.3% versus 45.9%), miscarriage (22.2% versus 26.7%;) and live birth rates (37.4% versus 38.8%) were comparable in day 2 good and poor-quality embryo groups. No signficiant differences in morphology of transferred blastocysts at day 3 were found. Multivariable analysis highlighted that poor or good embryo quality at day 2 and day 3 were not predictive of the implantation of good-quality blastocysts (at day 2: adjusted odds ratio = 0.82 CI 95% 0.49 to 1.38; at day 3: adjusted odds ratio = 1.39; CI 95% 0.77 to 2.52). Good-quality blastocyst transfer should, therefore, be carried out irrespective of embryo quality at cleavage stage, as it may not compromise success rates in a good-prognosis population.

The Valuable Reference of Live Birth Rate in the Single Vitrified-Warmed BB/BC/CB Blastocyst Transfer: The Cleavage-Stage Embryo Quality and Embryo Development Speed

“…In our study, parameters in cleavage-stage morphology (blastomere number and day 3 grade) had no reference value for cleavage-stage embryo quality on pregnancy outcomes in groups 1 and 2. This is consistent with the results of a previous study (Herbemont et al, 2017). That study concludes that good-quality blastocyst transfer should be carried out irrespective of embryo quality at cleavage stage in a good-prognosis population.…”

“…When blastocysts reach the same grade, it is unclear whether we should be focusing on cleavage-stage embryo quality and embryo development speed before transfer. The success rates of good-quality blastocyst (≥3 BB) transfer appear uncompromised by embryos of different quality at the cleavage stage in a good-prognosis population ( Herbemont et al, 2017 ). However, as far as we know, no study has previously assessed the effects of the detailed cleavage-stage morphology and embryo development speed on single vitrified-warmed blastocyst transfer outcomes, especially in low-quality blastocysts (stages 1 or 2, or ≥3 with a grade “C” ICM or TE) ( Morbeck, 2017 ).…”

Miscarriage Rate Is High With Frozen-Thawed Blastocysts Arising From Poor-Quality Cleavage Stage Embryos

“…Recent research shows that pregnancy outcomes are not influenced by determining good or poor-quality at day 2 or day 3 when good-quality blastocysts are transferred at day 5 ( 6 ), for both fresh and frozen blastocysts transfer cycles being included. Kaartinen et al ( 3 ) analyzed the outcomes of 134 vitrified-warmed blastocyst transfers that originated from PQE at day 2 or day 3.…”

“…Recently, the embryo culture systems have improved the efficiency and reliability of obtaining blastocysts in vitro , and PQE have been reconsidered for further developmental potential. Many findings suggest that embryos with low morphological scores can still grow into the blastocyst stage and have a good clinical outcome ( 3 – 6 ). However, the transfer of a good-quality embryos might improve obstetric and perinatal outcomes ( 5 , 6 ).…”

“…Many findings suggest that embryos with low morphological scores can still grow into the blastocyst stage and have a good clinical outcome ( 3 – 6 ). However, the transfer of a good-quality embryos might improve obstetric and perinatal outcomes ( 5 , 6 ). To the best of our knowledge, few studies have evaluated the possible effects of transferring cryopreserved blastocysts arising from poor-quality cleavage stage embryos on pregnancy and perinatal outcomes.…”