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Journal of Assisted Reproduction and Genetics

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01-09-2018 | Assisted Reproduction Technologies

The association between quality of supernumerary embryos in a cohort and implantation potential of the transferred blastocyst

Authors: Phillip A. Romanski, Randi H. Goldman, Leslie V. Farland, Serene S. Srouji, Catherine Racowsky

Published in: Journal of Assisted Reproduction and Genetics | Issue 9/2018

Abstract

Purpose

Despite studies focused on the association between embryo morphology and implantation potential, it is unknown how the collective quality of the supernumerary embryos in a cohort is associated with the implantation rate (IR) of the transferred embryo. This study tested the hypothesis that a relationship exists between the quality of the supernumerary cohort and IR.

Methods

A retrospective cohort study of first fresh autologous IVF cycles from 05/2012 to 09/2016, with ≥ 3 blastocysts, resulting in a single blastocyst transfer (n = 819) was performed. Cohorts were grouped in two ways: by mean priority score (PS; 1 being best) of supernumerary embryos and by percent supernumerary embryos with low implantation potential. The relationship between cohort quality and IR was assessed using logistic regression.

Results

As mean cohort PS increased, IR of the transferred embryo decreased (test for linear trend, p = 0.05). When ≥ 75% of the supernumerary cohort was predicted to have low implantation potential, IR of the transferred embryo was significantly lower compared to when < 75% of the cohort was predicted to have low implantation potential (OR 0.71; 95% CI (0.53–0.94)). All associations were attenuated when adjusting for PS of the transferred embryo.

Conclusions

Our findings suggest that quality of supernumerary embryos is associated with IR of the transferred embryo, among patients with ≥ 3 blastocysts available on day 5. As cohort quality declines and the proportion of low implantation potential embryos increases, the IR of the transferred embryo declines. These associations are attenuated when controlling for quality of the transferred embryo, suggesting that the relationship between embryo cohort quality and implantation is not independent of the transferred embryo quality.

Beral V, Doyle P, Tan SL, Mason BA, Campbell S. Outcome of pregnancies resulting from assisted conception. Br Med Bull. 1990;46:753–68.CrossRefPubMed

Trounson AO, Leeton JF, Wood C, Webb J, Wood J. Pregnancies in humans by fertilization in vitro and embryo transfer in the controlled ovulatory cycle. Science. 1981;212:681–2.CrossRefPubMed

Puissant F, Van Rysselberge M, Barlow P, Deweze J, Leroy F. Embryo scoring as a prognostic tool in IVF treatment. Hum Reprod. 1987;2:705–8.CrossRefPubMed

Thompson SM, Onwubalili N, Brown K, Jindal SK, PG MG. Blastocyst expansion score and trophectoderm morphology strongly predict successful clinical pregnancy and live birth following elective single embryo blastocyst transfer (eSET): a national study. J Assist Reprod Genet. 2013;30:1577–81. https://doi.org/10.1007/s10815-013-0100-4.CrossRefPubMedPubMedCentral

Hill MJ, Richter KS, Heitmann RJ, Graham JR, Tucker MJ, DeCherney AH, et al. Trophectoderm grade predicts outcomes of single-blastocyst transfers. Fertil Steril. 2013;99:1283–1289.e1. https://doi.org/10.1016/j.fertnstert.2012.12.003.CrossRefPubMed

Steer CV, Mills CL, Tan SL, Campbell S, Edwards RG. The cumulative embryo score: a predictive embryo scoring technique to select the optimal number of embryos to transfer in an in-vitro fertilization and embryo transfer programme. Hum Reprod. 1992;7:117–9.CrossRefPubMed

De Placido G, Wilding M, Strina I, Alviggi E, Alviggi C, Mollo A, et al. High outcome predictability after IVF using a combined score for zygote and embryo morphology and growth rate. Hum Reprod. 2002;17:2402–9.CrossRefPubMed

Visser DS, Fourie FR. The applicability of the cumulative embryo score system for embryo selection and quality control in an in-vitro fertilization/embryo transfer programme. Hum Reprod. 1993;8:1719–22.CrossRefPubMed

Heitmann RJ, Hill MJ, Richter KS, DeCherney AH, Widra EA. The simplified SART embryo scoring system is highly correlated to implantation and live birth in single blastocyst transfers. J Assist Reprod Genet. 2013;30:563–7. https://doi.org/10.1007/s10815-013-9932-1.CrossRefPubMedPubMedCentral

10.

Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000;73:1155–8.CrossRefPubMed

11.

Tesarik J, Junca AM, Hazout A, Aubriot FX, Nathan C, Cohen-Bacrie P, et al. Embryos with high implantation potential after intracytoplasmic sperm injection can be recognized by a simple, non-invasive examination of pronuclear morphology. Hum Reprod. 2000;15:1396–9.CrossRefPubMed

12.

Van Royen E, Mangelschots K, De Neubourg D, Laureys I, Ryckaert G, Gerris J. Calculating the implantation potential of day 3 embryos in women younger than 38 years of age: a new model. Hum Reprod. 2001;16:326–32.CrossRefPubMed

13.

Racowsky C, Stern JE, Gibbons WE, Behr B, Pomeroy KO, Biggers JD. National collection of embryo morphology data into Society for Assisted Reproductive Technology Clinic Outcomes Reporting System: associations among day 3 cell number, fragmentation and blastomere asymmetry, and live birth rate. Fertil Steril. 2011;95:1985–9. https://doi.org/10.1016/j.fertnstert.2011.02.009.CrossRefPubMed

14.

Vernon M, Stern JE, Ball GD, Wininger D, Mayer J, Racowsky C. Utility of the national embryo morphology data collection by the Society for Assisted Reproductive Technologies (SART): correlation between day-3 morphology grade and live-birth outcome. Fertil Steril. 2011;95:2761–3. https://doi.org/10.1016/j.fertnstert.2011.02.008.CrossRefPubMed

15.

Hu Y, Maxson WS, Hoffman DI, Ory SJ, Eager S, Dupre J, et al. Maximizing pregnancy rates and limiting higher-order multiple conceptions by determining the optimal number of embryos to transfer based on quality. Fertil Steril. 1998;69:650–7.CrossRefPubMed

16.

Racowsky C, Jackson KV, Cekleniak NA, Fox JH, Hornstein MD, Ginsburg ES. The number of eight-cell embryos is a key determinant for selecting day 3 or day 5 transfer. Fertil Steril. 2000;73:558–64.CrossRefPubMed

17.

Salha O, Dada T, Levett S, Allgar V, Sharma V. The influence of supernumerary embryos on the clinical outcome of IVF cycles. J Assist Reprod Genet. 2000;17:335–43.CrossRefPubMedPubMedCentral

18.

Wang JG, Douglas NC, Dicken C, Nakhuda GS, Guarnaccia MM, Sauer MV. Cryopreservation of supernumerary high quality embryos predicts favorable outcomes for patients undergoing repeated cycles of in vitro fertilization. Fertil Steril. 2008;89:368–74.CrossRefPubMed

19.

Hill MJ, Richter KS, Heitmann RJ, Lewis TD, DeCherney AH, Graham JR, et al. Number of supernumerary vitrified blastocysts is positively correlated with implantation and live birth in single-blastocyst embryo transfers. Fertil Steril. 2013;99:1631–6. https://doi.org/10.1016/j.fertnstert.2013.01.130.CrossRefPubMedPubMedCentral

20.

Stern JE, Lieberman ES, Macaluso M, Racowsky C. Is cryopreservation of embryos a legitimate surrogate marker of embryo quality in studies of assisted reproductive technology conducted using national databases? Fertil Steril. 2012;97:890–3. https://doi.org/10.1016/j.fertnstert.2011.12.050.CrossRefPubMed

21.

Cheung LP, Lam PM, Lok IH, Chiu TT, Yeung SY, Tjer CC, et al. GnRH antagonist versus long GnRH agonist protocol in poor responders undergoing IVF: a randomized controlled trial. Hum Reprod. 2005;20:616–21.CrossRefPubMed

22.

Dragisic KG, Davis OK, Fasouliotis SJ, Rosenwaks Z. Use of a luteal estradiol patch and a gonadotropin-releasing hormone antagonist suppression protocol before gonadotropin stimulation for in vitro fertilization in poor responders. Fertil Steril. 2005;84:1023–6.CrossRefPubMed

23.

Surrey ES, Bower J, Hill DM, Ramsey J, Surrey MW. Clinical and endocrine effects of a microdose GnRH agonist flare regimen administered to poor responders who are undergoing in vitro fertilization. Fertil Steril. 1998;69:419–24.CrossRefPubMed

24.

Tummon IS, Daniel SA, Kaplan BR, Nisker JA, Yuzpe AA. Randomized, prospective comparison of luteal leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropins in 408 first cycles of in vitro fertilization. Fertil Steril. 1992;58:563–8.CrossRefPubMed

25.

Armstrong S, Arroll N, Cree LM, Jordan V, Farquhar C. Time-lapse systems for embryo incubation and assessment in assisted reproduction. Cochrane Database Syst Rev. 2015;(2):CD011320. https://doi.org/10.1002/14651858.CD011320.pub2.

26.

Racowsky C, Kovacs P, Martins WP. A critical appraisal of time-lapse imaging for embryo selection: where are we and where do we need to go? J Assist Reprod Genet. 2015;32:1025–30. https://doi.org/10.1007/s10815-015-0510-6.CrossRefPubMedPubMedCentral

27.

Ginsburg ES, Baker VL, Racowsky C, Wantman E, Goldfarb J, Stern JE. Use of preimplantation genetic diagnosis and preimplantation genetic screening in the United States: a Society for Assisted Reproductive Technology Writing Group paper. Fertil Steril. 2011;96:865–8. https://doi.org/10.1016/j.fertnstert.2011.07.1139.CrossRefPubMed

28.

Chang J, Boulet SL, Jeng G, Flowers L, Kissin DM. Outcomes of in vitro fertilization with preimplantation genetic diagnosis: an analysis of the United States Assisted Reproductive Technology Surveillance Data, 2011-2012. Fertil Steril. 2016;105:394–400. https://doi.org/10.1016/j.fertnstert.2015.10.018.CrossRefPubMed

29.

Paternot G, Wetzels AM, Thonon F, Vansteenbrugge A, Willemen D, Devroe J, et al. Intra- and interobserver analysis in the morphological assessment of early stage embryos during an IVF procedure: a multicentre study. Reprod Biol Endocrinol. 2011;9:127. https://doi.org/10.1186/1477-7827-9-127.CrossRefPubMedPubMedCentral

30.

Storr A, Venetis CA, Cooke S, Kilani S, Ledger W. Inter-observer and intra-observer agreement between embryologists during selection of a single day 5 embryo for transfer: a multicenter study. Hum Reprod. 2017;32:307–14. https://doi.org/10.1093/humrep/dew330.CrossRefPubMed

31.

Racowsky C, Ohno-Machado L, Kim J, Biggers JD. Is there an advantage in scoring early embryos on more than one day? Hum Reprod. 2009;24:2104–13. https://doi.org/10.1093/humrep/dep198.CrossRefPubMedPubMedCentral

Title: The association between quality of supernumerary embryos in a cohort and implantation potential of the transferred blastocyst
Authors: Phillip A. Romanski
Randi H. Goldman
Leslie V. Farland
Serene S. Srouji
Catherine Racowsky
Publication date: 01-09-2018
Publisher: Springer US
Published in: Journal of Assisted Reproduction and Genetics / Issue 9/2018
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-018-1254-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The association between quality of supernumerary embryos in a cohort and implantation potential of the transferred blastocyst

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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