Abstract
BackgroundTo assess the predictive value of patient characteristics, controlled ovarian stimulation and embryological parameters on the live birth outcome of single euploid frozen-warmed blastocyst transfer (FBT).MethodsThis was a retrospective cohort study including 707 single FBTs after preimplantation genetic testing for aneuploidy (PGT-A) that were performed from October 1, 2015, to January 1, 2018. The effects of patient-, cycle- and embryology-related parameters on the live birth outcome after FBT were assessed.ResultsIn the subgroup analysis based on live birth, patients who achieved a live birth had a significantly lower body mass index (BMI) than patients who did not achieve a live birth (22.7 (21.5–24.6) kg/m2 vs 27 (24–29.2) kg/m2, p<0.001). The percentage of blastocysts with inner cell mass (ICM) A or B was significantly higher among patients achieving a live birth, at 91.6% vs. 82.6% (p<0.001). Day-5 biopsies were also more prevalent among patients achieving a live birth, at 82.9% vs 68.1% (p<0.001). On the other hand, the mitochondrial DNA (mtDNA) levels were significantly lower among cases with a successful live birth, at 18.7 (15.45–23.68) vs 20.55 (16.43–25.22) (p = 0.001). The logistic regression analysis showed that BMI (p<0.001, OR: 0.789, 95% CI [0.734–0.848]), day of trophectoderm (TE) biopsy (p<0.001, OR: 0.336, 95% CI [0.189–0.598]) and number of previous miscarriages (p = 0.004, OR: 0.733, 95% CI [0.594–0.906]) were significantly correlated with live birth. Patients with elevated BMIs, cycles in which embryos were biopsied on day-6 and a higher number of miscarriages were at increased risks of reduced live birth rates.ConclusionA high BMI, an embryo biopsy on day-6 and a high number of miscarriages negatively affect the live birth rate after single euploid FBT.
Highlights
Chromosomal aneuploidy is present in approximately 50% of embryos throughout preimplantation development and is a consequence of errors occurring during gametogenesis and early mitotic divisions that lead to implantation failure, spontaneous abortion, and the birth of a child with a trisomic condition [1]
The percentage of blastocysts with inner cell mass (ICM) A or B was significantly higher among patients achieving a live birth, at 91.6% vs. 82.6% (p
The mitochondrial DNA levels were significantly lower among cases with a successful live birth, at 18.7 (15.45–23.68) vs 20.55 (16.43–25.22) (p = 0.001)
Summary
Chromosomal aneuploidy is present in approximately 50% of embryos throughout preimplantation development and is a consequence of errors occurring during gametogenesis and early mitotic divisions that lead to implantation failure, spontaneous abortion, and the birth of a child with a trisomic condition [1]. PGT-A has been performed in in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) for different indications, such as advanced maternal age (AMA), repeated implantation failure (RIF), recurrent miscarriage (RM), severe male factor infertility and elective single-embryo transfer (eSET) [2]. After day 3, PGT-A of nucleated blastomeres by fluorescence in situ hybridization (FISH) failed to demonstrate an improvement in clinical outcomes [3,4,5,6,7,8,9,10]. In addition to embryological parameters, clinical variables, such as parameters for controlled ovarian stimulation (COH) and those for endometrial preparation for frozen embryo transfer (FET) are associated with differences in IVF/ICSI outcomes, adding to the complexity of achieving IVF/ICSI success. To assess the predictive value of patient characteristics, controlled ovarian stimulation and embryological parameters on the live birth outcome of single euploid frozen-warmed blastocyst transfer (FBT)
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