Does the inclusion of low quality embryos at the moment of transfer interfere in in vitro fertilization results?

Abstract

Objective: The objective was to verify if the transfer of low quality embryos together with good quality embryos, on third day after in vitro fertilization, affects implantation and pregnancy rate.Design: This was a retrospective study with patients submitted to in vitro fertilization.Materials and Methods: One hundred and six cycles for in vitro fertilization with ICSI were evaluated. All women were 38 years old or less, with endometrial thickness at the moment of transfer (3° day after fertilization) not lower than 9mm. Couples with immunological factor, endometriosis and/or with infertility with unexplained cause were excluded. Group one (GI) was constituted by 53 women that had transferred to the uterus a total of 223 embryos, with 147 embryos of good quality (embryos with or less than 20% citoplasm fragmentation), and 76 embryos of low quality (embryos with more than 20% citoplasm fragmentation). The average of good and bad embryos was 2.8 and 1.4 embryos respectively, in a total of 4.2 embryos/transfer. Group two (GII), also constituted by 53 women, that had transferred only good quality embryos to the uterus. The number and quality of the good embryos were equal in both groups. Data were analysed by Qui-Square and Fisher test, at the p<0.05 level of significancy.Results: Age and endometrial thickness average were 32.8 and 11.2 mm for group I and 32.3 and 11.8 for group II. Pregnancy rate was 49% and 54.7% for groups I and II (NS), with 96.1 and 96.5% of clinical evolution (NS), respectively. Multiple gestation ocurred in 32% and 42.8% for groups I and II (NS). Implantation rate was 16.6% and 27.9% (p=0.009) for groups I and II, respectively. Spontaneous abortion happened in 8% (GI) and 3.6% (GII) (NS). If the low quality embryos were excluded from GI, then the implantation rate was 25.2 for group I versus 27.9% in group II (NS).Conclusion: Implantation rate falls significantly when low quality embryos were transferred, however the pregnancy rate seems not to be affected. Objective: The objective was to verify if the transfer of low quality embryos together with good quality embryos, on third day after in vitro fertilization, affects implantation and pregnancy rate. Design: This was a retrospective study with patients submitted to in vitro fertilization. Materials and Methods: One hundred and six cycles for in vitro fertilization with ICSI were evaluated. All women were 38 years old or less, with endometrial thickness at the moment of transfer (3° day after fertilization) not lower than 9mm. Couples with immunological factor, endometriosis and/or with infertility with unexplained cause were excluded. Group one (GI) was constituted by 53 women that had transferred to the uterus a total of 223 embryos, with 147 embryos of good quality (embryos with or less than 20% citoplasm fragmentation), and 76 embryos of low quality (embryos with more than 20% citoplasm fragmentation). The average of good and bad embryos was 2.8 and 1.4 embryos respectively, in a total of 4.2 embryos/transfer. Group two (GII), also constituted by 53 women, that had transferred only good quality embryos to the uterus. The number and quality of the good embryos were equal in both groups. Data were analysed by Qui-Square and Fisher test, at the p<0.05 level of significancy. Results: Age and endometrial thickness average were 32.8 and 11.2 mm for group I and 32.3 and 11.8 for group II. Pregnancy rate was 49% and 54.7% for groups I and II (NS), with 96.1 and 96.5% of clinical evolution (NS), respectively. Multiple gestation ocurred in 32% and 42.8% for groups I and II (NS). Implantation rate was 16.6% and 27.9% (p=0.009) for groups I and II, respectively. Spontaneous abortion happened in 8% (GI) and 3.6% (GII) (NS). If the low quality embryos were excluded from GI, then the implantation rate was 25.2 for group I versus 27.9% in group II (NS). Conclusion: Implantation rate falls significantly when low quality embryos were transferred, however the pregnancy rate seems not to be affected.