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Blastocyst age, expansion, trophectoderm morphology, and number cryopreserved are variables predicting clinical implantation in single blastocyst frozen embryo transfers in freeze-only-IVF

  • Assisted Reproduction Technologies
  • Published:
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Abstract

Purpose

To determine which blastocyst assessment variables predict clinical implantations in single blastocyst frozen embryo transfers (FET) of freeze-only-IVF cycles, following improved vitrified-warmed blastocyst survival and developmental competence preservation.

Method

In this retrospective cohort study performed at a single private IVF center, the pregnancy outcomes of 1795 single blastocyst FET cycles were analyzed, from freeze-only-IVF retrievals performed between January 2017 and January 2020. Stepwise forward logistic regressions with clinical implantation (i.e., normal gestational sac and cardiac activity) as dependent variable were performed to identify the significant predictors. All blastocysts were vitrified using Cryotop technology, with before transfer (post-warming) blastocyst morphology scores used in all analyses.

Result(s)

The 1795 blastocysts transferred were vitrifıed on embryo days 4 (1057), 5 (716), and 6 (22). The overall clinical implantation rate was 50.9%; however, using blastocyst age and blastocyst morphological score the clinical implantation rates increased from 49.0% (day-4 1 and 2) and 25.2% (day-5 1 and 2) to 71.2% (day-4 4AA) and 64.3% (day-5 4AA), respectively. Whereas full (≥3) blastocysts with scores of AA and BA had similar clinical implantation rates (66.2 vs. 66.7%), the rate of full blastocysts with scores of AB was lower (58.9%). In stepwise forward logistic regressions, female age, blastocyst age, blastocyst expansion score, blastocyst trophectoderm score, and number of blastocysts vitrified were significant predictors of clinical implantation.

Conclusion(s)

Using blastocyst age and before transfer blastocyst expansion and trophectoderm morphology scores to select blastocysts, clinical implantation rates greater than 70% could be achieved for top-scoring blastocysts.

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Correspondence to Kevin Coetzee.

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Ethics approval and consent to participate

Standard and accredited procedures were perform in the treatment of all human participants, which were in accordance with the ethical standards of the institutional research committee and the 1964 Helsinki declaration and its amendments. Signed informed consent is obtained from all patients prior to the commencement of IVF treatment, which include the patients involved in this study.

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The authors declare no competing interests.

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Key message

Continuing improvement in frozen embryo transfer pregnancy rates requires blastocyst scoring and selection techniques to be re-evaluated regularly. Despite the limitations of microscopic blastocyst morphology assessment, individual blastocyst morphology scores and supplementary blastocyst variables are predictive of clinical implantation.

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Ozgur, K., Berkkanoglu, M., Bulut, H. et al. Blastocyst age, expansion, trophectoderm morphology, and number cryopreserved are variables predicting clinical implantation in single blastocyst frozen embryo transfers in freeze-only-IVF. J Assist Reprod Genet 38, 1077–1087 (2021). https://doi.org/10.1007/s10815-021-02110-7

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  • DOI: https://doi.org/10.1007/s10815-021-02110-7

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