4.4 Article

Post-warming embryo morphology is associated with live birth: a cohort study of single vitrified-warmed blastocyst transfer cycles

Journal

JOURNAL OF ASSISTED REPRODUCTION AND GENETICS
Volume 39, Issue 2, Pages 417-425

Publisher

SPRINGER/PLENUM PUBLISHERS
DOI: 10.1007/s10815-021-02390-z

Keywords

IVF; Vitrification; Grading; Warming; Blastocyst

Funding

  1. CAUL

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This study found that post-warming re-expansion and high cell survival rate are associated with higher live birth rate. Embryos with fully expanded blastocysts and high cell survival rate have a higher chance of live birth, but embryos with poor post-warming morphology still have a considerable probability of live birth.
Purpose This study aims to examine whether blastocyst morphology post-warming correlates with live birth. Methods In this cohort study, morphological characteristics post-warming were reviewed in all single vitrified-warmed blastocyst transfer cycles performed between November 2016 and May 2017. Immediately before transfer, the degree of blastocoel re-expansion was graded as A, fully expanded; B, partially expanded >= 50%; C, partially expanded < 50%; and D, collapsed. The degree of post-warming cell survival was graded on a scale of 50 to 100% and was then classified into 4 groups: very low 50-70%, low 71-80%, moderate 81-90%, and high 91-100%. Results Overall, 612 cycles were reviewed, of which 196 included PGT-A tested embryos. The live birth rate (LBR) increased from 11.4% in the collapsed blastocysts group to 38.9% in the post-warming full re-expansion group (p < 0.001) and from 6.5% for blastocysts with a very low cell survival rate to 34.7% for blastocysts with high cell survival rate (p = 0.001). LBR was 6.7% for blastocysts with the worst post-warming morphological characteristics, namely, collapsed with very low cell survival rate. On multivariate analyses, partial blastocyst re-expansion >= 50%, full re-expansion, and high cell survival rate remained significantly associated with live birth, after controlling for female age, pre-vitrification morphological grading, and PGT-A. A sub-analysis of cycles using PGT-A tested embryos showed similar results. Conclusion Post-warming re-expansion and high cell survival rate are associated with higher LBR in euploid and untested blastocysts. However, embryos with poor post-warming morphology still demonstrate a considerable probability of live birth, and they should not be discarded.

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