Does patient age influence the association between euploidy and day 3 embryo morphology?

Abstract

OBJECTIVE: To assess the influence of patient age on the association between euploidy and day 3 morphology in embryos that develop to blastocyst by day 5. DESIGN: Retrospective cohort. MATERIALS AND METHODS: We included women with in vitro fertilization and a first preimplantation genetic screening (PGS) cycle from January 1, 2006 to December 31, 2007. Nine or 12 chromosomes were analyzed. Embryos were designated high implantation potential (HIP) if they had ≥4 cells on day 2 and 7 to 10 on day 3, with <20% fragmentation and no multinucleation. Repeated measures log-binomial regression adjusting for patient age was used to calculate risk ratios (RR) and 95% confidence intervals (CI) stratified by age. RESULTS: 565 embryos from 132 cycles in 132 women became day 5 blastocysts. In general, euploid embryos were more likely to become HIP. The strength of association between euploidy and HIP morphology decreased, albeit non-significantly (P=0.21), with increasing age: <35, RR 1.29 (95% CI 0.9-1.8); 35 to <38, RR 1.14 (95% CI 0.9-1.4); 38 to <41, RR 1.11 (95% CI 0.9-1.4); ≥41, RR 1.00 (95% CI 0.6-1.7). A similar trend was observed for chromosomes 13, 14, 18, 21, and 22, but not for XY, 8, 15, 16, 17, or 20.Table 1Association Between Euploidy and MorphologyPatient AgeAdjusted RR95% CITrend TestChromosome<3535 to <3838 to <41≥41PXY1.411.871.271.450.630.8-2.30.7-4.80.9-1.80.5-4.181.151.921.041.410.830.7-1.80.9-4.30.8-1.30.6-3.2131.301.181.080.990.380.8-2.20.9-1.60.8-1.50.6-1.7141.771.151.001.180.091.0-3.10.8-1.60.7-1.40.6-2.2151.171.321.071.530.920.7-1.81.0-1.80.8-1.41.0-2.4161.231.061.220.960.540.8-1.80.8-1.50.8-1.80.6-1.4171.171.280.840.880.250.7-2.00.8-2.10.7-1.10.5-1.6181.411.321.270.950.220.9-2.20.9-1.90.9-1.90.6-1.5200.861.051.070.950.790.5-1.30.7-1.60.9-1.30.6-1.5211.471.150.830.920.071.0-2.20.9-1.50.7-1.10.5-1.5221.771.420.980.870.030.9-3.51.0-1.90.8-1.30.6-1.2 Open table in a new tab CONCLUSIONS: Euploidy for some, but not all, chromosomes may predict day 3 morphology. The strength of association appears to diminish with increasing age. These data suggest that PGS may improve selection of euploid embryos, particularly in older women.