Frozen-thawed Single Blastocyst Research Articles

Effect of endometrial thickness changes on clinical pregnancy rates after progesterone administration in a single frozen-thawed euploid blastocyst transfer cycle using natural cycles with luteal support for PGT-SR- and PGT-M-assisted reproduction: a retrospective cohort study

BackgroundTo investigate whether the endometrial thickness change ratio from the progesterone administration day to the blastocyst transfer day is associated with pregnancy outcomes in a single frozen-thawed euploid blastocyst transfer cycle.MethodsAll patients used natural cycles with luteal support for endometrial preparation and selected a single euploid blastocyst for transfer after a biopsy for preimplantation genetic testing. The endometrial thickness was measured by transvaginal ultrasound on the progesterone administration day and the transfer day, the change in endometrial thickness was measured, and the endometrial thickness change ratio was calculated. According to the change rate of endometrial thickness, the patients were divided into three groups: the endometrial thickness compaction group, endometrial thickness non-change group and endometrial thickness expansion group. Among them, the endometrial thickness non-change and expansion groups were combined into the endometrial thickness noncompaction group.ResultsUltrasound images of the endometrium in 219 frozen-thawed euploid blastocyst transfer cycles were evaluated. The clinical pregnancy rate increased with the increase in endometrial thickness change ratio, while the miscarriage rate and live birth rate were comparable among the groups. The multiple logistic regression results showed that in the fully adjusted model a higher endometrial thickness change ratio (per 10%) was associated with a higher clinical pregnancy rate (adjusted odds ratio [aOR] 1.29; 95% confidence interval [CI], 1.01–1.64; P = .040). Similarly, when the patients were divided into three groups according to the change rate of endometrial thickness, the endometrial thickness noncompaction group had a significant positive effect on the clinical pregnancy rate compared with the endometrial thickness compaction group after adjusting for all covariates.ConclusionsIn frozen-thawed euploid blastocyst transfer cycles in which the endometrium was prepared by natural cycles with luteal support, the clinical pregnancy rate was higher in cycles without endometrial compaction after progesterone administration.

P–032 Assessment of embryonic developmental outcome of direct unequal cleavage in patients with non-obstructive azoospermia and/or obstructive azoospermia

Abstract Study question Does direct unequal cleavage (DC) affect embryonic development after ICSI with testicular sperm (TESE-ICSI) in patients with non-obstructive azoospermia (NOA) and/or obstructive azoospermia (OA)? Summary answer The incidence of DC at the first cleavage (DC1) was extremely high and DC1 negatively affected embryonic development in NOA patients. What is known already It has been reported that the blastocyst development of embryos with direct cleavage (DC) was significantly lower than that without DC, but the clinical pregnancy rate after blastocyst transfer was not different with or without DC. The incidence of DC has been reported to be significantly higher after ICSI with testicular sperm (TESE-ICSI) than ICSI with ejaculated sperm (Ej), but to our knowledge, there are few reports investigating that the embryos with DC after TESE-ICSI affect embryonic development. Study design, size, duration We conducted a retrospective cohort study using time-lapse incubators (Geri, Genea Biomedx, Australia) from September 2018 to November 2020. Of 1033 two-pronuclear (2PN) embryos from TESE-ICSI, 486 and 547 embryos were from OA (35.9±5.5 years) and NOA (33.7±5.2 years), respectively. As an age matched control, we chose 581 embryos from ICSI using Ej (36.5±4.4 years). Participants/materials, setting, methods DC embryos were classified as DC1 (DC at first cleavage), DC2 (DC at second cleavage), and non-DC (without DC). The incidences of DC1 or DC2 and blastocyst development rates were compared among OA, NOA and Ej groups. In TESE-ICSI group, we compared blastocyst development rates with or without DC between good and poor quality embryos on day 3. Good quality embryos were defined as 8 cells with G3 or more by the Veeck’s classification. Main results and the role of chance DC1 incidence was significantly higher in NOA (37.3%) than OA (27.8%) and Ej (22.7%) (P < 0.01), whereas DC2 incidence was not statistically different among three groups; NOA (15.7%), OA (15.0%) and Ej (13.4%). Blastocyst development rates in DC1 were 17.8%, 19.5% and 25.8% for NOA, OA and Ej, respectively, which were significantly lower compared to non-DC in corresponding three groups (65.1%, 67.7%, and 68.5%, respectively, P < 0.01). In TESE-ICSI group, good-quality embryo rate on day 3 was significantly lower in DC1 (34.5%, P < 0.01) than DC2 (60.9%) or non-DC (54.2%). Additionally, blastocyst development rates in DC1 and DC2 were significantly lower than non-DC regardless of embryonic grades on day 3 (35.1%, 51.0%, and 81.6% for good-quality embryos on day 3, 10.1%, 27.0%, and 49.1% for poor-quality embryos on day 3, respectively, P < 0.05). When immotile sperm was used for TESE-ICSI, DC1 incidence was 40.0% (6/15), which did not show statistically differences. When performing single frozen-thawed blastocyst transfers, no pregnancies resulted from either DC1 (n = 13) or DC2 (n = 3) embryos in TESE-ICSI group. Limitations, reasons for caution We had a few data about the pregnancy rates after blastocyst transfers with DC, because embryos with DC were seldom transferred due to those lower priority. Although DC might be influenced by the sperm, we did not analyze the incidence of DC by taking the semen factors into account. Wider implications of the findings: The incidence of DC1 was extremely high and DC1 negatively affected embryonic development in NOA patients. Therefore, it is important to observe embryos using time-lapse incubator in order to recognize embryos with/without pregnancy potential, especially for embryos with DC1 in NOA patients. Trial registration number Not applicable

P–264 Clinical relevance of re-expansion after blastocyst thawing

Abstract Study question Are there any differences in clinical outcomes after SET of re-expanded versus non-re-expanded blastocysts? Summary answer The transfer of re-expanded thawed blastocysts is associated with improved clinical outcomes. What is known already Improvements in embryo culture conditions, endometrial receptivity protocols and vitrification as a revolutionary cryopreservation technique have allowed the expansion of blastocyst stage transfers (Lieberman and Tucker, 2006; Stanger et al., 2012; Rienzi et al., 2017), increasing clinical pregnancy and implantation rates in IVF cycles. The re-expansion of thawed blastocyst at the time of transfer has been considered as a good prognosis factor, but not always thawed embryos re-expand. To evaluate the relevance of this event, we compared the clinical results of the re-expanded embryos versus the collapsed ones after their thawing and transfer. Study design, size, duration A total number of 1.125 frozen-thawed blastocyst transfers were included in this retrospective observational study between January 2018 and December 2020. Seven hundred and eighty-six thawed blastocyst were fully expanded at the time of the transfer and 339 thawed blastocysts were non-re-expanded when they were transferred. Participants/materials, setting, methods 1.125 single frozen-thawed blastocyst embryo transfer (SET) cycles (802 from donated and 319 from autologous oocytes) were divided in two groups (re-expanded vs non-re-expanded). Positive beta human chorionic gonadotrophin (bHCG), pregnancy rate (PR), early miscarriage rate (EMR) and live birth rate (LBR) were compared between the two groups. Blastocysts were thawed using an Irvine Scientific® Thaw kit, Irvine Scientific® and were transferring in culture medium (Global® Total® LP, CooperSurgical®). Main results and the role of chance During 2018, 190 re-expanded blastocyst and 94 non-re-expanded were transferred. Statistical significant differences were found in the percentage of positive bHCG (48.4% vs 30.9%, p < 0,0048) and PR (39.5% vs 25.5%, p < 0,0203), respectively. In 2019, statistical differences were found in the LBR between 307 re-expanded blastocyst and 124 non-re-expanded (30.6% vs 12.9%; p < 0,00001). Differences were also found in positive bHCG (50.2% vs 21.8%, p < 0,00001) and PR (40.7% vs 15.3%, p < 0,00001), respectively. Finally, in 2020, 289 re-expanded blastocyst and 121 non-re-expanded were transferred, and significant differences were obtained in the percentage of positive bHCG (46.8% vs 22.3%, p < 0,00001) and PR (32.9% vs 15.7%, p < 0,00001), respectively. Globally, all the variables analysed were statistically significant in favour of the re-expanded embryo group: positive bHCG (48.7% vs 24.5%; p < 0,00001), PR (37.5% vs 18.3%; p < 0,00001) and LBR (20.1% vs 9.5%; p < 0,00001), except for EMR. Limitations, reasons for caution The inherent limitations to a retrospective design. Larger studies are warranted in order to reach robust conclusions on the subject. Wider implications of the findings: Transfer of re-expand blastocyst could be a positive indicator of clinical outcomes. In case of non-re-expand embryos, transfer of two could be reasonable. Trial registration number NONE

Advanced trophectoderm quality increases the risk of a large for gestational age baby in single frozen-thawed blastocyst transfer cycles.

Does trophectoderm (TE) quality affect birthweight after single frozen-thawed blastocyst transfer? Transfer of single blastocyst with advanced TE quality was associated with higher birthweight and increased risk of a large for gestational age (LGA) baby. Transfer of blastocysts with advanced TE quality results in higher ongoing pregnancy rates and a lower miscarriage risk. However, data on the relationship between TE quality and birthweight are still lacking. This retrospective cohort study at a tertiary-care academic medical center included 1548 singleton babies born from single frozen-thawed blastocyst transfer from January 2011 to June 2019. Babies were grouped into four groups according to embryo expansion (Stages 3, 4, 5 and 6), three groups according to inner cell mass (ICM) quality (A, B and C), and three groups according to TE quality (A, B and C). Main outcomes included absolute birthweight, Z-scores adjusted for gestational age and gender, and adverse neonatal outcomes. Multivariable linear and logistic regression analyses were performed to investigate the association of neonatal outcomes with expansion stage, ICM quality and TE quality. As TE quality decreased, birthweight (3468.10 ± 471.52, 3357.69 ± 522.06, and 3288.79 ± 501.90 for A, B and C, respectively, P = 0.002), Z-scores (0.59 ± 1.07, 0.42 ± 1.04, and 0.27 ± 1.06 for A, B and C, respectively, P = 0.002) and incidence of LGA (28.9%, 19.7% and 17.4% for A, B and C, respectively, P = 0.027) decreased correspondingly. After adjusting for confounders, compared with the Grade A group, blastocysts with TE Grade B (standardized coefficients (β): -127.97 g, 95% CI: -234.46 to -21.47, P = 0.019) and blastocysts with TE grade C (β: -200.27 g, 95% CI: -320.69 to -79.86, P = 0.001) resulted in offspring with lower birthweight. Blastocysts with TE grade C brought babies with lower Z-scores than TE Grade A (β: -0.35, 95% CI: -0.59 to -0.10, P = 0.005). Also, embryos with TE Grade B (adjusted odds ratio (aOR):0.91, 95% CI: 0.84 to 0.99, P = 0.033) and embryos with TE Grade C (aOR : 0.89, 95% CI: 0.81 to 0.98, P = 0.016) had lower chance of leading to a LGA baby than those with TE Grade A. No association between neonatal outcomes with embryo expansion stage and ICM was observed (all P > 0.05). The retrospective design, lack of controlling for several unknown confounders, and inter-observer variation limited this study. The study extends our knowledge of the down-stream effect of TE quality on newborn birthweight and the risk of LGA. This study was funded by National Key R&D Program of China (2018YFC1003000), National Natural Science Foundation of China (81771533 to Y.P.K. and 31200825 to L.S.) and Innovative Research Team of High-level Local Universities in Shanghai (SSMU-ZLCX20180401), Shanghai Sailing Program(21YF1423200) and the Fundamental research program funding of Ninth People's Hospital affiliated to Shanghai Jiao Tong university School of Medicine (JYZZ117). The authors declare no conflict of interest in this present study. N/A.

Histological diagnostic criterion for chronic endometritis based on the clinical outcome

BackgroundThe diagnostic criteria of chronic endometritis remain controversial in the treatment for infertile patients.MethodsA prospective observational study was conducted in a single university from June 2014 to September 2017. Patients who underwent single frozen-thawed blastocyst transfer with a hormone replacement cycle after histological examination for the presence of chronic endometritis were enrolled. Four criteria were used to define chronic endometritis according to the number of plasma cells in the same group of patients: 1 or more (≥ 1) plasma cells, 2 or more (≥ 2), 3 or more (≥ 3), or 5 or more (≥ 5) in 10 high-power fields. Pregnancy rates, live birth rates, and miscarriage rates of the non-chronic endometritis and the chronic endometritis groups defined with each criterion were calculated. A logistic regression analysis was performed for live births using eight explanatory variables (seven infertility factors and chronic endometritis). A receiver operating characteristic curve was drawn and the optimal cut-off value was calculated.ResultsA total of 69 patients were registered and 53 patients were finally analyzed after exclusion. When the diagnostic criterion was designated as the presence of ≥ 1 plasma cell in the endometrial stroma per 10 high-power fields, the pregnancy rate, live birth rate, and miscarriage rate were 63.0% vs. 30.8%, 51.9% vs. 7.7%, and 17.7% vs. 75% in the non-chronic and chronic endometritis groups, respectively. This criterion resulted in the highest pregnancy and live birth rates among the non-chronic endometritis and the smallest P values for the pregnancy rates, live birth rates, and miscarriage rates between the non-chronic and chronic endometritis groups. In the logistic regression analysis, chronic endometritis was an explanatory variable negatively affecting the objective variable of live birth only when chronic endometritis was diagnosed with ≥ 1 or ≥ 2 plasma cells per 10 high-power fields. The optimal cut-off value was obtained when one or more plasma cells were found in 10 high-power fields (sensitivity 87.5%, specificity 64.9%).ConclusionsChronic endometritis should be diagnosed as the presence of ≥ 1 plasma cells in 10 high-power fields. According to this diagnostic criterion, chronic endometritis adversely affected the pregnancy rate and the live birth rate.

Monozygotic dichorionic-diamniotic pregnancies following single frozen-thawed blastocyst transfer: a retrospective case series

BackgroundThe primary aim of the study is to report cases of monozygotic dichorionic-diamniotic (DC-DA) pregnancies after single frozen-thawed blastocyst transfer.MethodsThis is a retrospective case series. All single frozen-thawed blastocyst transfer cycles performed between June 2013 and December 2018 at the Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China, were reviewed retrospectively. We included frozen embryo transfer (FET) cycles which clinical pregnancy was confirmed with multiple gestational sacs showed on ultrasonography at around 6 to 7 weeks of gestation. We then conducted an in-depth analysis to further exclude cases which contained newborns of different genders or natural FET cycles.ResultsFive thousand four hundred fifteen frozen-thawed single blastocyst transfer cycles were preformed between June 2013 and December 2018 at the Shanghai Ji Ai Genetics and IVF Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China. Of these, fourteen women underwent a single blastocyst transfer and then achieved clinical pregnancy with an ultrasound diagnosis of multi-chorionic pregnancy. With one natural cycle FET excluded, we finally included thirteen single blastocyst transfer cycles performed in down-regulated controlled FET or hormone replacement FET, in which the possibility of concurrently spontaneous pregnancy was extremely small. These included 13 cases reveal the phenomenon of monozygotic DC-DA twinning after single blastocyst transfer, which challenges the classical theory that only monochorionic pregnancy could happen after 3 days of fertilization.ConclusionThis case series suggest that single blastocyst transfer could result DC-DA pregnancies during IVF treatment.

Ectopic Pregnancy Risk with Assisted Reproductive Technology

To investigate the optimal methods for the reduction of ectopic pregnancy incidence due to assisted reproductive technology (ART). Day five or six blastocyst transfer may decrease ectopic pregnancy rates when compared with day three transfer, similarly, frozen-thawed embryo transfer may lessen the risk of ectopic pregnancy relative to fresh embryo transfer. Single embryo transfers decrease ectopic pregnancy risk and have similar clinical pregnancy outcomes as double embryo transfers. Ectopic pregnancy remains a major cause of maternal morbidity and mortality in the first trimester of pregnancy. Compared with spontaneously conceived pregnancies, pregnancies resulting from in vitro fertilization (IVF) treatments are initially associated with an increased risk of an ectopic implantation. Many risk factors related to ART have been linked to increased ectopic pregnancy risk, though the exact mechanism underlying the link between ectopic pregnancy and ART remains unclear. Tubal factor infertility is the major risk factor for ectopic pregnancy following IVF. Day of transfer, fresh or frozen-thawed cycle single or double transfer are the main controversial factors regarding ectopic pregnancy risk. According to recent data, day 5 blastocyst transfer has decreased ectopic pregnancy risk than day 3, also frozen-thawed cycle has lower risk of ectopic implantation than fresh cycles. Single frozen-thawed blastocyst transfer may thus be the best choice for reducing ectopic pregnancy incidence among IVF patients. Further studies should be done to compare the ectopic pregnancy rates between the single frozen-thawed blastocyst transfer and spontaneous pregnancies.

Higher implantation and live birth rates with laser zona pellucida breaching than thinning in single frozen-thawed blastocyst transfer

While zona pellucida (ZP) breaching of day-3 frozen blastocysts embryos can increase the blastocyst hatching rate, compared with ZP thinning, the pregnancy and implantation rates are similar. The aim of this study was to compare pregnancy outcomes and the risks associated with frozen-thawed blastocysts between laser ZP breaching and laser ZP thinning. For the thinning group, ZP of thawed blastocyst was thinned to a length of 30-40μm using laser between January 2013 and October 2015. On the other hand, for the breaching group, thawed blastocysts were breached with a 60-80μm hole in the ZP using laser between November 2015 and April 2018. The implantation rate of ZP breaching (72.7%) was higher than that of ZP thinning (61.8%). In single frozen blastocyst transfer, the implantation rate, clinical pregnancy rate, and live birth rate of ZP breaching (73.9%, 73.9%, 61.8%, respectively) were significantly higher than those of ZP thinning (60.9%, 60.9%, 46.7%, respectively). The abortion rate, preterm birth rate, congenital malformation, birth defects, and birth weight did not significantly differ between the two groups. In conclusion, laser assisted hatching during single frozen blastocyst transfer using ZP breaching exhibit higher implantation, pregnancy, and live birth rates compared with ZP thinning. No significant differences were observed between the two assisted hatching methods in terms of adverse effects on pregnancy and newborns.

The impact of endometrial thickness change after progesterone administration on pregnancy outcome in patients transferred with single frozen-thawed blastocyst

BackgroundThe aim of this study was to explore the impact of endometrial thickness change after progesterone administration on pregnancy outcome in patients transferred with single frozen-thawed blastocyst.MethodsThis observational cohort study included a total of 3091 patients undergoing their first frozen-thawed embryo transfer (FET) cycles between April 2015 to March 2019. Endometrial thickness was measured by trans-vaginal ultrasound twice for each patient: on day of progesterone administration, and on day of embryo transfer. The change of endometrial thickness was recorded.ResultsRegardless of endometrial preparation protocol (estrogen-progesterone/natural cycle), female age, body mass index (BMI), and infertility diagnosis were comparable between patients with an increasing endometrium on day of embryo transfer and those without. However, clinical pregnancy rate increases with increasing ratio of endometrial thickness. Compared with patients with Non-increase endometrium, those with an increasing endometrium on day of embryo transfer resulted in significantly higher clinical pregnancy rate (56.21% vs 47.13%, P = 0.00 in estrogen-progesterone cycle; 55.15% vs 49.55%, P = 0.00 in natural cycle).ConclusionsIn most patients, endometrial thickness on day of embryo transfer (after progesterone administration) increased or kept being stable compared with that on day of progesterone administration. An increased endometrium after progesterone administration was associated with better pregnancy outcome.

Developments and pregnancies of direct cleavage embryos

The introduction of time-lapse imaging has enabled dynamic embryo observations such as cleavage-type and development-speed determinations in addition to the conventional morphological assessments. Direct cleavage (DC) represents a chromosomal abnormality rather than a normal cleavage (NC) and reportedly affects embryo development. This study aimed to investigate whether DC embryos influence the outcomes of embryonic development and single frozen-thawed embryo transfer (SFET). A retrospective study. We targeted 2614 embryos in 670 cycles from patients who underwent conventional in vitro fertilization or intracytoplasmic sperm injection between January and April 2017. After insemination, embryos were incubated in an EmbryoScope+ system (Vitrolife, Sweden). DC embryos were classified into four groups as follows: group A, abnormal embryos between the one- and three-cell stages; group B, abnormal embryos between the one-cell stage and four-cell or later stages in the first cleavage division; group C, abnormal embryos between the two- and five-cell stages; and group D, abnormal embryos between the two-cell stage and six-cell or later stages in the second cleavage division. We compared the day 3 good-quality embryo, day 5 blastocyst formation, day 5 good-quality blastocyst, and pregnancy and abortion rates after single-cycle, freeze-thawed blastocyst transfer between the DC and NC groups. The proportion of DC embryos was 24.8%. The day 3 good-quality embryo, day 5 blastocyst, day 5 good-quality blastocyst rates were respectively 74.3%, 70.9%, and 47.1% for the NC groups; 50.5%, 32.8%, and 11.1% for group A; 25.3%, 11.9%, and 0.7% for group B; 74.8%, 51.5%, and 15.8% for group C; and 48.6%, 23.9%, and 1.5% for group D. The day 3 good-quality embryo rate was significantly lower in groups A, B, and D than in the NC groups. The day 5 blastocyst rate was significantly lower in group B than in the other groups. The day 5 good-quality blastocyst rate was significantly lower in the 4 DC groups than in the NC groups. The pregnancy and abortion rates after single frozen-thawed blastocyst transfer were respectively 35.0% and 23.7% for the NC groups, 13.2% and 0% for group A, 0% and 0% for group B, 13.2% and 20.0% for group C, and 7.9% and 66.7% for group D. These parameters showed no significant differences. This study showed that the DC embryos had significantly lower day 5 blastocyst and good-quality blastocyst rates than the NC embryos. However, the DC embryos had the potential of blastocyst development and pregnancy. Thus, we suggest that DC embryos developing into blastocysts could be selected for transfer.

Prolonged estrogen (E2) treatment prior to frozen-blastocyst transfer decreases the live birth rate.

How does the duration of estrogen (E2) treatment prior to frozen-blastocyst transfers affect the live birth rate (LBR)? Prolonged E2 exposure as part of artificial endometrial preparation (AEP) significantly decreases the LBR after autologous frozen-thawed blastocyst transfer. One effective method for endometrial preparation prior to frozen embryo transfer is AEP, a sequential regimen with E2 and progesterone, which aims to mimic the endocrine exposure of the endometrium in a normal cycle. Nevertheless, the optimal duration of E2 administration prior to transfer remains unknown. An observational cohort study was conducted in a tertiary care university hospital between 01/07/2012 and 31/12/2015. The main inclusion criteria was having a single frozen-thawed blastocyst transfer with an AEP using exogenous E2. A total of 1377 frozen-thawed blastocyst transfers were assigned to four groups according to the duration of the E2 administration prior to the embryo transfers. These comprised a '≤21 days' group (n = 330), a '22-28 days' group (n = 665), a '29-35 days' group (n = 289) and a '36-48 days' group (n = 93). The '≤21 days' group' was taken as the reference group. The main measured outcome was the LBR following frozen-thawed blastocyst transfers. Statistical analysis was conducted using univariate and multivariate logistic regression models. LBR significantly decreased when the E2 exposure prior to the frozen-thawed blastocyst transfer exceeded 28 days: OR = 0.66; 95% CI [0.46-0.95]; P = 0.026 and OR = 0.49 [0.27-0.89]; P = 0.018, respectively, for the '29 to 35 days' group and for the '36 to 48 days' group compared to the reference group. Early pregnancy loss rates significantly increased when the E2 exposure lasted more than 35 days prior to the frozen-thawed blastocyst transfer (OR = 2.37 [1.12-5.05]; P = 0.025 vs. the reference group). After multivariate logistic regression, E2 exposure lasting more than 28 days prior to the frozen-thawed blastocyst transfer was associated with a decrease in the LBR, for the '29-35 days' group (OR = 0.65; [0.45-0.95]; P = 0.044) as for the '36-48 days' group (OR = 0.49; [0.26-0.92]; P = 0.035), vs. the reference group. One limitation is linked to the observational design of this study. In order to give patients the best chance to obtain a live birth after frozen-thawed blastocyst transfer, the length of E2 exposure prior to the frozen-blastocyst transfer should not exceed 28 days. This study provides new insight in regard to endometrial preparation using AEP prior to frozen-blastocyst transfer. No funding and no competing interest.

Should sexual intercourse be avoided during the embryo transfer cycle? Life-threatening ruptured heterotopic pregnancy after single thawed embryo transfer: case report and review of the literature

To report the life-threatening complication of a raptured heterotopic pregnancy occurring from thawed single embryo transfer. A 33-year-old woman underwent in vitro fertilization (IVF) under a step-up regimen. After oocyte collection, blastocysts were frozen, and a single frozen-thawed blastocyst was then transferred according to the natural cycle. On day 17 after embryo transfer, an intrauterine pregnancy was confirmed. On day 28, she complained of sudden abdominal pain and ultrasonography revealed marked fluid retention in the peritoneal cavity. Emergency laparoscopy was performed, revealing hemoperitoneum and a ruptured interstitial heterotopic pregnancy (HP), which was then resected laparoscopically. Because sexual intercourse had occurred shortly before the transfer, a HP comprising a spontaneous pregnancy and a pregnancy achieved by assisted reproductive technology was assumed. The fetus in the uterus survived and was delivered. In this case, however, despite the single embryo transfer during the natural-cycle frozen-thawed embryo transfer process, the risk of life-threatening complication as a HP as a consequence of spontaneous pregnancy after sexual intercourse remained.

Effect of blastocyst quality on the strategy of single blastocyst transfer in frozen-thawed cycles

To investigate the effect of blastocyst quality on the strategy of single blastocyst transfer in frozen-thawed cycles. A retrospective analysis was performed in Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region on clinical data of single frozen-thawed blastocyst transfer cycles from January 2008 to December 2013. All cycles were divided into four groups (AA, AB/BA, BB, BC/CB) according to the blastocyst score, then the clinical outcomes were compared between groups. And on this basis, the clinical outcomes were further explored when the group of outcomes with single blastocyst transfer wasn't ideal, which would diverted to transfer two blastocyst. In single frozen blastocyst transfer cycles, the clinical pregnancy rate of each group with the blastocyst scored AA, AB/BA, BB, BC/CB were 61.4% (470/765), 51.2% (330/645), 40.5% (407/1 005), 22.9% (60/262), live births rate in each group were 52.2% (399/765), 41.2% (266/645), 30.4% (306/1 005), 13.7% (36/262), and the abortion rate were 13.6% (64/470), 16.7% (55/330), 21.4% (87/407), 35.0%(21/60), separately. This showed that the clinical pregnancy rate and live births rate decreased significantly with the decline of blastocyst quality (P<0.01), but the abortion rate showed significant upward trend (P<0.01). When single blastocyst scored ≥BB grade transferred, an acceptable clinical pregnancy rate (>40%) and live births rate (>30%) could be obtained, however, the clinical pregnancy rate of 22.9% and live births rate of 13.7% could only be acquired when blastocyst scored BC/CB only transferred one embryo, which significant lower than those of each group scored ≥BB grade (P<0.01). So, after that, the blastocyst scored BC/CB were further divided into two groups (single blastocyst transferred versus two blastocyst transferred) to investigate, then the result showed that the clinical pregnancy rate [22.9% versus 38.5%(67/174),P<0.01] and live births rate [13.7% versus 30.5%(16/67),P<0.01] were significantly increased in the group of two blastocyst transferred compared with the group of one blastocyst transferred, and the abortion rate was also significantly decreased from 35.0% to 17.9% (12/67;P<0.05). So when two blastocyst scored BC/CB were transferred, the clinical outcomes were similar to the group of one blastocyst scored BB transferred (P>0.05). Of single blastocyst transfer in frozen-thawed cycles, the clinical pregnancy rate and liver births rate showed significant upward trend, but the abortion rate showed significant downward trend, with the decline of blastocyst quality. When the blastocyst scored ≥BB grade, the single blastocyst transfer could be considered to be performed.

A retrospective study of single frozen-thawed blastocyst transfer.

ObjectiveTo study the clinical outcomes of single frozen-thawed blastocyst transfer cycles according to the hatching status of frozen-thawed blastocysts.MethodsFrozen-thawed blastocysts were divided into three groups according to their hatching status as follows: less-than-expanded blastocyst (≤EdB), hatching blastocyst (HgB), and hatched blastocyst (HdB). The female age and infertility factors of each group were evaluated. The quality of the single frozen-thawed blastocyst was also graded as grade A, tightly packed inner cell mass (ICM) and many cells organized in the trophectoderm epithelium (TE); grade B, several and loose ICM and TE; and grade C, very few ICM and a few cells in the TE. The clinical pregnancy and implantation rate were compared between each group. The data were analyzed by either t-test or chi-square analysis.ResultsThere were no statistically significant differences in average female ages, infertility factors, or the distribution of blastocyst grades A, B, and C in each group. There was no significant difference in the clinical pregnancy and implantation rate of each group according to their blastocyst grade. However, there was a significant difference in the clinical pregnancy and implantation rate between each group. In the HdB group, the clinical pregnancy and implantation rate were similar regardless of the blastocyst quality.ConclusionThere was an effect on the clinical outcomes depending on whether the blastocyst hatched during single frozen-thawed blastocyst transfer. When performing single frozen-thawed blastocyst transfer, the hatching status of the frozen-thawed blastocyst may be a more important parameter for clinical outcomes than the quality of the frozen-thawed blastocyst.

The clinical significance of blastocyst grade at post-thawing: from an analysis of 2,425 single frozen-thawed blastocyst transfer cycles

The clinical significance of blastocyst grade at post-thawing: from an analysis of 2,425 single frozen-thawed blastocyst transfer cycles

Outcome of stimulation of endometrium embryo transfer (SEET): from an analysis of 2,168 single frozen-thawed blastocyst transfer cycles

SEET is a variant method of blastocyst transfer, which is characterized by the injection of the embryo culture supernatant into the uterus before blastocyst transfer. We reported that SEET improved the implantation rate and the pregnancy rate in single frozen-thawed blastocyst transfer cycles (Fertil Steril 2007, 2009). Thereafter, we primarily select SEET method in frozen-thawed blastocyst transfer cycles. In this study, we retrospectively analyzed the outcome of SEET cycles in our ART center. Retrospective analysis. In this study, we collected a total of 2168 cycles of SEET cycles between January 2009 and December 2010. SEET method was performed as previously described (Fertil Steril 2007). We stratified data according to age, previous ART history, and morphological grade of blastocyst, and then investigated the clinical outcome in each group. The average age was 36.3, the average number of previous ART cycles was 2.4, and the total clinical pregnancy rate was 38.4%. The more previous ART cycles led to the lower clinical pregnancy rate (Table1). The clinical pregnancy rates of patients under 37 years of age and above 38 years of age were 45.1% and 27.8%, respectively. The clinical pregnancy rates after high grade blastocyst transfer and low grade blastocyst transfer were 57.0% and 31.9%, respectively.Tabled 1Number of previous ART cycles and Clinical outcome.No. of previous ART12345≤No. of transfer cycles141040016663129Age of patient (y)35.5 ± 4.036.2 ± 3.937.5 ± 3.639.9 ± 3.741.0 ± 3.8No. of chemical pregnancies9342451022650Implantation rate per embryo (%)66.261.361.441.338.8No. of clinical pregnancies582150591526Clinical pregnancy rate per transfer (%)41.337.535.523.820.2No. of pregnancy loss102361836pregnancy loss rate (%)17.52430.52023.1 Open table in a new tab In this study, we showed the good clinical outcome of SEET. SEET is a simple and effective method for single blastocyst transfer.

Prediction of pregnancy and delivery rates by blastocyst morphological score and age, based on 1488 single frozen-thawed blastocyst transfer cycles

OBJECTIVE: To present an estimation of pregnancy and delivery rates after IVF or ICSI stratified by blastocyst (BL) morphology and age. DESIGN: Retrospective analysis. MATERIALS AND METHODS: A total of 1488 single frozen-thawed BL transfer cycles were analyzed. All frozen-thawed BLs used in the study were obtained in the patient's first oocytes retrieval cycles. Viable pregnancy rate (VPR; number of viable pregnancy cycles/number of transfer cycles) and delivery rate (DR; number of delivery cycles/number of transfer cycles) according to BL morphological score (Gardner system) in three different age groups; women aged 22-33, 34-37 and 38-45 years were analyzed. RESULTS: The quality of BLs degraded as age group increased. Within the same BL quality, VPR and DR tended to be lower with increased age.Table 1Viable pregnancy rate and delivery rate by blastocyst quality (BL1-6) and age groups (Age1-3)VPRBL-1(a)BL-2BL-3BL-4BL-5BL-6Age1 (22-33)67.0 (175/261)63.6 (56/88)45.0 (27/60)52.3 (34/65)38.1 (24/63)17.4 (4/23)Age2 (34-37)57.3 (122/213)52.8 (47/89)46.7 (28/60)41.5 (34/82)33.8 (22/65)18.5 (5/27)Age3 (38-45)43.0 (40/93)23.5 (16/68)36.8 (21/57)23.8 (19/80)17.5 (10/57)2.7 (1/37)DR (b)Age1 (22-33)59.9 (148/247)50.6 (40/79)33.9 (20/59)41.9 (26/62)29.5 (18/61)4.5 (1/22)Age2 (34-37)47.8 (96/201)41.0 (34/83)43.1 (25/58)29.5 (23/78)26.6 (17/64)11.1 (3/27)Age3 (38-45)32.6 (29/89)17.2 (11/64)29.8 (17/57)20.0 (16/80)12.3 (7/57)2.7 (1/37)a; BL-1 (G6, G5, and G4AA, 4AB, 4BA by Gardner system), BL-2 (G4 except AA, AB, BA), BL-3 (G3AA, 3AB, 3BA), BL-4 (G3 except AA, AB, BA), BL-5 (G2), and BL-6 (G1). b; Among 685 viable pregnancy cycles, the delivery of 63 cycles could not be confirmed, thus we excluded these cases for calculating the delivery rate. Open table in a new tab a; BL-1 (G6, G5, and G4AA, 4AB, 4BA by Gardner system), BL-2 (G4 except AA, AB, BA), BL-3 (G3AA, 3AB, 3BA), BL-4 (G3 except AA, AB, BA), BL-5 (G2), and BL-6 (G1). b; Among 685 viable pregnancy cycles, the delivery of 63 cycles could not be confirmed, thus we excluded these cases for calculating the delivery rate. CONCLUSION: There was a significant correlation between BL quality and both VPR and DR in addition to the influence of age. The findings may help predict successful pregnancy in single BL transfer.

Prediction of pregnancy rate by blastocyst morphological score and age, based on 1,488 single frozen-thawed blastocyst transfer cycles

To present an estimation of the pregnancy rate after IVF or intracytoplasmic sperm injection stratified by blastocyst morphology and age. Retrospective analysis. Private IVF clinic. A total of 1,488 single frozen-thawed blastocyst transfer cycles. All frozen-thawed blastocysts used in the study were obtained in the patients' first oocytes retrieval cycles. Clinical pregnancy rate (CPR), viable pregnancy rate (VPR), and delivery rate (DR) according to blastocyst morphological score (Gardner and Schoolcraft score) in three different age groups: women aged 22-33 years, 34-37 years, and 38-45 years. The quality of blastocysts degraded as age group increased. The proportions of good-quality blastocysts (grades 4 and above) were 62.3%, 56.3%, and 41.1% in age groups of 22-33 years, 34-37 years, and 38-45 years. Within the same blastocyst quality, CPR, VPR, and DR tended to be lower with increased age. Chances of pregnancy were reduced by 60% or more for women 38 years and older with blastocyst morphology of grades 1 and 2. Significant trends were observed for both age and blastocyst morphology groups. There was a significant correlation between blastocyst quality and CPR, VPR, and DR in addition to the influence of age on the three rates. The findings may help predict successful pregnancy in single-blastocyst transfer.