PCRS 2016 · Poster presentation

Impact of embryo morphology on clinical pregnancy rates in IVF PGS cycles with single embryo transfer

O. O. Barash, K. A. Ivani, M. D. Hinckley, D. S. Wachs, S. P. Willman, E. M. Rosenbluth, F. Rabara, N. Huen, L. N. Weckstein

Reproductive Science Center of the San Francisco Bay Area, USA

Pacific Coast Reproductive Society (PCRS) 2016

569

IVF PGS cycles with SET

Jan 2013 – Jun 2016

3,186

Embryos analyzed

Good 351 · Fair 148 · BL-fair 70

66.4 %

Ongoing PR · good morph.

233/351 · good AA/AB/BA SETs

Age-independent

Good-quality SET

< 35 y.o. 61.9 % · ≥ 41 y.o. 67.4 %

Background

Why this study

Single embryo transfer (SET) is an effective choice for young patients in non-PGS IVF cycles. Recent reports suggest that high pregnancy rates may also be achieved in patients ≥ 38 y.o. when comprehensive chromosomal screening is implemented.

Objective. Compare clinical pregnancy rates after transferring embryos with good, fair, and borderline-fair quality in autologous IVF PGS cycles with SET.

Materials & Methods

Cohort and groups

Design. Retrospective SNP PGS study, January 2013 – June 2016. One euploid embryo transferred per cycle (154 non-elective SETs, 415 elective SETs).
Groups. 351 good (AA/AB/BA, 35.6 ± 4.7 y.o.), 148 fair (BB, 36.0 ± 5.1 y.o.), 70 borderline-fair (at least one B−, 36.1 ± 5.3 y.o.).
Endpoint. Clinical PR by fetal heartbeat at 6–7 weeks.

Results · Morphology

Ongoing PR after SET scales steeply with morphology

Statistically significant difference (p < 0.05, χ² = 23.15) in euploidy rates between good, fair, and borderline-fair embryos in all age groups. In young (< 38 y.o.) patients, euploidy was 67.3 % for good quality, 53.6 % for fair quality, and 46.3 % for borderline-fair.

Ongoing PR after SET: good vs fair vs borderline-fair — 66.4 % (233/351) vs 48.6 % (72/148) vs 42.9 % (30/70), χ² = 13.776, p < 0.05.

Ongoing PR after SET by the morphology of the transferred euploid blastocyst.

Results · Age & elective vs non-elective

When good-quality euploids are transferred, age and cohort size don't matter

Ongoing PR after SET of a good-quality euploid embryo was 61.9 % (60/97) in patients < 35 y.o. and 67.4 % (31/46) in patients ≥ 41 y.o. (χ² = 0.41, p = 0.52).

SETs where only one euploid embryo was available vs those with more to choose from yielded 61.8 % (42/68) and 67.1 % (190/283) — χ² = 0.71, p = 0.4. An increase in initial euploid-embryo count from 1 to 5 did not change SET PR — 58.1 %, 53.6 %, 66.0 %, 52.8 %, and 61.4 % (χ² = 3.11, p = 0.078).

Table 1

Ongoing PR and live-birth rate by transferred blastocyst morphology

Morphology	SETs	+ hCG	− hCG	Biochem.	Miscarr.	Ongoing PR, %	Births 2013–15	Live births	LBR, %
AA	155	128	27	16	12	64.52	99	61	61.62
AB	183	147	36	15	9	67.21	129	78	60.47
BA	13	10	3	0	1	69.23	8	4	50.00
BB	148	110	38	32	5	49.32	108	52	48.15
B−/−B	70	47	23	11	6	42.86	58	25	43.10

Conclusion

Summary of findings

Embryo morphology has a significant impact on clinical outcomes in PGS cycles. Maternal age did not affect clinical PR in IVF PGS cycles when a good-quality euploid embryo was transferred.

References

Cited works

1.Gerris J, De Sutter P, De Neubourg D, et al. A real-life prospective health economic study of elective single embryo transfer versus two-embryo transfer in first IVF/ICSI cycles. Hum Reprod. 2004;19(4):917–923. PubMed
2.Gleicher N, Barad DH. A review of, and commentary on, the ongoing second clinical introduction of preimplantation genetic screening (PGS) to routine IVF practice. J Assist Reprod Genet. 2012;29(11):1159–1166. PubMed
3.Handyside AH. 24-chromosome copy number analysis: a comparison of available technologies. Fertil Steril. 2013;100(3):595–602. PubMed

Reprint requests

Oleksii Barash, Ph.D. · ivfbigdata@gmail.com