Abstract Study question What proportion of blastocysts developed from 3PN embryos are diploid, and is this associated with the relative size of the pronuclei? Summary answer Most 3PN blastocysts with even-sized pronuclei are triploid, while most 3PN blastocysts with uneven-sized pronuclei are diploid. What is known already Fertilised oocytes with three pronuclei (3PN, or tripronuclear) are generally considered unsuitable for use due to the high likelihood of triploidy, which is not compatible with an ongoing healthy pregnancy. Recent data on 3PNs with uneven-sized pronuclei (micro-3PN, or 2.1PN) indicates that many may actually be diploid if they form a good quality blastocyst. Study design, size, duration Prospective multi-centre study from October 2020 to December 2023. 81 3PN blastocysts from 69 patients were biopsied. Participants/materials, setting, methods ICSI-inseminated embryos were assessed on Day 1 and pronuclear size at 18 h post insemination was measured using EmbryoViewer software. Biopsy was performed at the blastocyst stage and genetic testing was performed using the Human Karyomap-12 SNP array to ascertain ploidy status. Pronuclei were classified as “Equal”, “Unequal” (smallest pronucleus is 61%-75% of the largest), or “Micro” (smallest pronucleus is < 60% of the largest). Main results and the role of chance 94% of the 3PN blastocysts with equal size pronuclei were triploid, and the remaining 6% were complex aneuploid or had genome wide uniparental disomy (n = 36). Of the 3PN blastocysts with unequal pronuclei (n = 19), 42% were triploid, whereas none of the embryos with a micro pronucleus were triploid (n = 26). Limitations, reasons for caution Only 3PN embryos that formed a good quality expanded blastocyst were biopsied. Only ICSI-inseminated embryos were included, not IVF. No 3PN embryos were transferred in the study, so any additional pregnancy and birth risks from diploid 3PN embryos are unknown. Wider implications of the findings Blastocysts that develop from 3PN oocytes with uneven pronuclei have a greater than 80% chance of diploidy and could be considered for clinical use with PGT. More data is needed to inform clinical guidelines. Trial registration number N/A
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