Effect of age and morphology on sustained implantation rate after euploid blastocyst transfer

Michael S Awadalla,Nicole L Vestal,Lynda K Mcginnis,Ali Ahmady,Richard J Paulson

doi:10.1016/j.rbmo.2021.06.008

Michael S Awadalla, Nicole L Vestal + Show 3 more

Open Access

https://doi.org/10.1016/j.rbmo.2021.06.008

Copy DOI

Abstract

Research questionWhat impact does maternal age and embryo morphology have on sustained implantation rates of euploid blastocysts? DesignThis was a retrospective analysis of sustained implantation rates of euploid blastocysts stratified by maternal age and morphology. The primary analysis included 208 embryo transfers with a total of 229 embryos transferred from January 2017 through August 2020. ResultsFor all ages the sustained implantation rates for day 5 good quality blastocysts were higher than for day 5 fair, day 5 poor and day 6 blastocysts. At a maternal age of 36 years the best-fit sustained implantation rates were 86% for day 5 good quality blastocysts, 64% for day 5 fair, 63% for day 5 poor, and 51% for all day 6 blastocysts analysed as one group. When controlling for morphology and day of biopsy, there were higher sustained implantation rates for euploid embryos of younger patients compared with older patients. The best-fit sustained implantation rates for age 33 compared to age 39 years were 86% versus 80% for day 5 good, 71% versus 62% for day 5 fair, 59% versus 55% for day 5 poor, and 81% versus 46% for all day 6. ConclusionsThere was a clinically significant higher sustained implantation rate at all ages for euploid day 5 good quality embryos compared with day 5 fair, day 5 poor and day 6 embryos.

Highlights

There is limited information on how maternal age and the morphology of euploid embryos affects implantation and live birth rates (LBRs)
Out of 229 embryos there were a total of 152 fetal heartbeats detected for an sustained implantation rates (SIRs) rate of 66.4% per euploid blastocyst
There was a higher SIR at all ages for euploid day 5 good quality embryos compared with day 5 fair, day 5 poor and day 6 embryos

Summary

Introduction

There is limited information on how maternal age and the morphology of euploid embryos affects implantation and live birth rates (LBRs). This study was prompted by a need to counsel patients appropriately on their embryo preimplantation genetic testing for aneuploidies (PGT-A) results as well as scientific curiosity. In the authors’ experience some couples take both morphology and sex into consideration when deciding which euploid embryo to transfer. Other couples have considered additional embryo cryopreservation cycles based on the quantity and morphology of their euploid embryos. Information on how the morphology of euploid embryos affects pregnancy rates is needed to design appropriately controlled studies evaluating different embryo transfer protocols. Determining the impact of age, morphology and euploidy on pregnancy rates helps to parse out how much improvement can theoretically be gained by improving embryo or uterine factors. To progress closer to 100% pregnancy rates for a single-embryo transfer, the authors would like to explore how much can be gained by improving the embryo quality and how much can be gained from optimizing the endometrial preparation

Methods

Results

Discussion

Conclusion