Clinical predictors of human blastocyst formation and pregnancy after extended embryo culture and transfer

• Published in: Fertility and sterility Vol. 94; no. 2; pp. 543 - 548
• Main Authors: Thomas, Mika R., M.D, Sparks, Amy E., Ph.D, Ryan, Ginny L., M.D, Van Voorhis, Bradley J., M.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2010; Elsevier
• Subjects: Adult; Biological and medical sciences; Birth control; blastocyst; blastocyst development; blastocyst formation; blastocyst transfer; clinical predictors; Counseling; Cryopreservation; Databases, Factual; Embryo Culture Techniques - methods; Embryo Culture Techniques - standards; embryo quality; Embryo Transfer - methods; Embryo Transfer - standards; extended embryo culture; Female; Fertilization in Vitro - methods; Fertilization in Vitro - standards; Gynecology. Andrology. Obstetrics; Humans; ICSI; Infertility, Female - therapy; Internal Medicine; IVF; Medical sciences; Obstetrics and Gynecology; Predictive Value of Tests; Pregnancy; Pregnancy Outcome; Sterility. Assisted procreation; Young Adult; Zygote - cytology; embryo quality; blastocyst transfer; ICSI; clinical predictors; pregnancy; IVF; blastocyst; blastocyst development; extended embryo culture; blastocyst formation; Human; Embryo; Intracytoplasmic sperm injection; Gynecology; Blastocyst; Assisted procreation; Obstetrics; In vitro fertilization embryo transfer; Pregnancy; Embryo transfer; Quality; Development; Predictive factor; Formation
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/j.fertnstert.2009.03.051

Objective To determine the clinical factors associated with blastocyst development and pregnancy. Design Evaluation of a prospectively collected IVF database. Setting An academic IVF practice. Patient(s) Couples (n = 529) undergoing their first IVF cycle who qualified for extended embryo culture (more than six zygotes) over the past 5 years. Intervention(s) Seven or eight zygotes were cultured for 5 days, assessed for quality, and then transferred with excess zygotes cryopreserved at the pronuclear stage. Main Outcome Measure(s) Clinical predictors of blastocyst development and pregnancy. Result(s) The mean blastocyst development rate was 49.8%, with a median number of total and good-quality blastocysts of 4 and 2, respectively. Clinical factors that were significantly associated with good-quality blastocyst formation were younger female age, increased parity, standard insemination, and lower doses of gonadotropins. Clinical factors that were significantly associated with successful pregnancy were younger female age, higher antral follicle counts, greater numbers of total and good-/excellent-quality blastocysts, and absence of male factor infertility. Conclusion(s) Several clinical factors are associated with the development of good-quality blastocysts after extended embryo culture and successful pregnancy outcome. These patient and cycle characteristics may be very useful in selecting the best candidates for extended embryo culture and single blastocyst transfers, thus optimizing outcomes while reducing the risks associated with multiple pregnancies.