Abstract: P-690

Does a Low-Quality Blastocyst Impair Implantation When it is Transferred Along with a High-Quality One?

Presenter: Evangelos Makrakis


Abstract


OBJECTIVE: Pregnancy depends on interactions between a receptive endometrium and a developmentally competent embryo. The mechanisms that control implantation remain as yet not fully understood posing difficulties on our management of couples with repeated implantation failures during IVF programs. According to recent evidence, developmentally impaired human embryos elicit an endoplasmic stress response in human decidual cells and fail to implant, although signals from developmentally competent embryos activate metabolic enzymes and implantation factors leading to implantation. view more

OBJECTIVE: Pregnancy depends on interactions between a receptive endometrium and a developmentally competent embryo. The mechanisms that control implantation remain as yet not fully understood posing difficulties on our management of couples with repeated implantation failures during IVF programs. According to recent evidence, developmentally impaired human embryos elicit an endoplasmic stress response in human decidual cells and fail to implant, although signals from developmentally competent embryos activate metabolic enzymes and implantation factors leading to implantation. In order to examine whether implantation failure could be associated with inappropriate selectivity of an incompetent embryo, we theorized that transferring a low-quality simultaneously with a high-quality embryo could cause implantation failure of both.
DESIGN: Retrospective study
MATERIALS AND METHODS: All autologous transfers of one or two blastocysts with known implantation outcome from January 2014 through December 2016 were analyzed. A simple grading system (good(G), fair(F), poor(P)) was applied to all embryos according to the developmental stage and the morphology of the inner cell mass and trophectoderm of the blastocysts (Gardner system). In 244 patients were transferred two blastocysts of which we examined only the cases that at least one embryo was of good quality. Three groups were created according to the quality of both embryos: good-good (GG), good-fair (GF) and good-poor (GP). A group of 22 patients had a single embryo transfer with a good quality blastocyst (G).
RESULTS: Demographic and cycle characteristics were similar among the study arms. Patients’ age among different groups with two embryos did not differ significantly (p=0.065). Moreover, mean age of patients transferring single autologous good quality embryo was not significantly different comparing to mean age of patients transferring two embryos (p=0.574). Of 244 patients, in 142 cases only good (GG) quality blastocysts were transferred, in 54 cases good and fair (GF) quality blastocysts were transferred and in 13 cases good and poor (GP) quality blastocysts were transferred. The implantation rate did not differ between groups GG and GF (42.6% vs 38.9%, p=0.503) but was significantly different between groups GG and GP (42.6% vs 11.5%, p=0.002). When we compared GF to G group implantation rate was not significantly different (38.9% and 40.9% respectively, p=0.999), but was statistically significantly different between GP and G group (11.5% and 40.9% respectively, p=0.042).
CONCLUSIONS: Our study offers evidence that transferring just one good blastocyst rather than one good plus one poor has a significant positive impact on implantation rates, along with the obvious benefit of multiple pregnancies’ elimination. In the modern high quality embryology laboratory single embryo transfer of a high quality embryo could be the gold standard.

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