Delayed blastulation, multinucleation, and expansion grade are independently associated with live-birth rates in frozen blastocyst transfer cycles

Fertil Steril. 2016 Nov;106(6):1370-1378. doi: 10.1016/j.fertnstert.2016.07.1095. Epub 2016 Aug 23.

Abstract

Objective: To identify blastocyst features independently predictive of successful pregnancy and live births with vitrified-warmed blastocysts.

Design: Retrospective study.

Setting: Academic hospital.

Patient(s): Women undergoing a cycle with transfer of blastocysts vitrified using the Rapid-i closed carrier (n = 358).

Intervention(s): None.

Main outcome measure(s): Clinical pregnancy and live-birth rates analyzed using logistic regression analysis.

Result(s): A total of 669 vitrified-warmed blastocysts were assessed. The survival rate was 95%. A mean of 1.7 ± 0.5 embryos were transferred. The clinical pregnancy, live-birth, and implantation rates were 55%, 46%, and 43%, respectively. The odds of clinical pregnancy (odds ratio [OR] 3.08; 95% confidence interval [CI], 1.88-5.12) and live birth (OR 2.93; 95% CI, 1.79-4.85) were three times higher with day-5 blastocysts versus slower-growing day-6 vitrified blastocysts, irrespective of patient age at cryopreservation. Blastocysts from multinucleated embryos were half as likely to result in a live birth (OR 0.46; 95% CI, 0.22-0.91). A four -fold increase in live birth was observed if an expanded blastocyst was available for transfer. The inner cell mass-trophectoderm score correlated to positive outcomes in the univariate analysis. The implantation rate was statistically significantly higher for day-5 versus day-6 vitrified blastocysts (50% vs. 29%, respectively).

Conclusion(s): The blastocyst expansion grade after warming was predictive of successful outcomes independent of the inner cell mass or trophectoderm score. Delayed blastulation and multinucleation were independently associated with lower live-birth rates in frozen cycles. Implantation potential of the frozen blastocysts available should be included in the decision-making process regarding embryo number for transfer.

Keywords: Blastocyst morphology; cryopreservation; live birth; multinucleation; time-lapse; vitrification.

MeSH terms

  • Academic Medical Centers
  • Adult
  • Blastocyst / pathology*
  • Blastula / pathology*
  • Chi-Square Distribution
  • Cryopreservation*
  • Embryo Culture Techniques
  • Embryo Implantation
  • Embryo Transfer* / adverse effects
  • Female
  • Fertility
  • Fertilization in Vitro*
  • Humans
  • Infertility / diagnosis
  • Infertility / physiopathology
  • Infertility / therapy*
  • Live Birth
  • Logistic Models
  • Multivariate Analysis
  • Odds Ratio
  • Pregnancy
  • Pregnancy Rate
  • Retrospective Studies
  • Risk Factors
  • Time Factors
  • Treatment Outcome