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The influence of morphologic grading and COS protocol on the outcomes of Day 5 versus Day 6 single fresh blastocyst transfers: a retrospective analysis of clinical outcomes from one center experience

Abstract

Introduction

The purpose of this study was to evaluate whether the blastocyst morphologic grading and the protocol of controlled ovarian stimulation (COS) would influence pregnancy outcomes, aiming to provide guidance when choosing blastocyst transfer.

Methods

The clinical data of 612 patients who received single fresh blastocyst transfer for first cycle, as well as the data of 253 patients who had already delivered were analyzed retrospectively. The patients were divided into two groups according to blastocyst formation time (D5 or D6). The following subgroup analyses were performed: (i) the morphologic grading of blastocyst and (ii) the protocol of COS.

Results

We observed that D5 single embryo transfer (SET) were associated with higher clinical pregnancy rate (CPR, 59.04% vs. 31.73%, P < 0.001) and live birth rate (LBR, 43.90% vs. 24.04%, P < 0.001) than D6 SET following fresh cycle. Patients in D5 group experienced more good blastocysts transfer (45.47%vs. 13.46%, P < 0.001) and less poor blastocysts transfer (9.64%vs. 45.19%, P < 0.001) than patients in D6 group. As to early stage and good quality blastocysts, the CPR and LBR were similar between D5 and D6 group. GnRH antagonist protocol had a demonstrable inferiority comparing with the early-follicular-phase long-acting GnRH-agonist long protocol (EFLL) or the mid-luteal-phase long-acting GnRH-agonist long protocol (MLLL) with regard to the CPR and LBR in D6-SET group.

Conclusions

The analysis found that ovarian reserve of patients in D6-SET group was comparatively worse than that of patients in D5-SET group and D6-SET patients represented a subgroup of infertility patients usually having relatively poor embryo quality. The results should be interpreted with caution as the very low numbers in the respective group limited the use of statistical tests and the real significance values.

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Fig. 1

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

AFC:

Antral follicle counting

AMH:

Anti-Müllerian hormone

ART:

Assisted reproductive technology

BMI:

Body mass index

COS:

Controlled ovarian stimulation

CPR:

Clinical pregnancy rate

DBT:

Double blastocyst transfer

EFLL:

Early-follicular-phase long-acting GnRH-agonist long protocol

ET:

Embryo transfer

FET:

Frozen-embryo transfer

GnRH-a:

Gonadotropin releasing hormone agonist

IVF:

In vitro fertilization

ICM:

Inner cell mass

ICSI:

Intracytoplasmic sperm injection

TE:

Trophectoderm cells

LBR:

Live birth rate

MLLL:

Mid-luteal-phase long-acting GnRH-agonist long protocol

OHSS:

Ovarian hyperstimulation syndrome

PN:

Pronucleus

PGT-A:

Preimplantation genetic testing for aneuploidy

RCTs:

Randomized controlled trials

rFSH:

Recombinant follicle-stimulating hormone

SET:

Single embryo transfers (SET)

SBT:

Single blastocyst transfer

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Acknowledgements

The authors are grateful to all staff of the Reproductive Medicine center, Department of Obstetrics and Gynecology, Wuhan Kangjian Maternal and Infant Hospital, Wuhan, Hubei, China for making the project successful.

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Authors and Affiliations

Authors

Contributions

ZC and WL are responsible for the concept and the study design. CX and YL performed the data collection, and WL did the statistical analysis. ZC drafted the manuscript. AG contributed to the critical discussion, interpretation and editing of the manuscript.

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Correspondence to Aidong Gong.

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Chen, Z., Li, W., Xiao, C. et al. The influence of morphologic grading and COS protocol on the outcomes of Day 5 versus Day 6 single fresh blastocyst transfers: a retrospective analysis of clinical outcomes from one center experience. Arch Gynecol Obstet 306, 1739–1752 (2022). https://doi.org/10.1007/s00404-022-06702-1

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Keywords

  • Blastocyst
  • D5
  • D6
  • Fresh blastocyst transfer
  • GnRH antagonist protocol
  • Early-follicular-phase long-acting GnRH-agonist long protocol (EFLL)
  • Mid-luteal-phase long-acting GnRH-agonist long protocol (MLLL)
  • Pregnancy outcomes