A greater number of euploid blastocysts in a given cohort predicts excellent outcomes in single embryo transfer cycles

Abstract

Purpose This multicentered retrospective study analyzed whether the quantity of euploid blastocysts in a given cohort after comprehensive chromosomal screening can be used to identify candidates for single embryo transfer. Methods Blastocysts from 437 patients underwent trophectoderm biopsy followed by array comparative genomic hybridization. Embryos were then selected for single or double embryo transfer. The number of euploid blastocysts produced and transferred for each patient was recorded, as was clinical pregnancy rate and multiple gestation rate. Results In patients with e3 euploid blastocysts, clinical pregnancy rate was higher in double, compared to single embryo transfers. However, in patients with Q4 euploid blastocysts, clinical pregnancy rate was not reduced with single embryo transfer was performed, whereas the multiple gestation rate was greatly reduced. Conclusions Size of the euploid embryo cohort is a marker for success in single embryo transfer cycles. Patients who produce at least four euploid blastocysts are outstanding candidates for single embryo transer.

A Higher Ovarian Response after Stimulation for IVF Is Related to a Higher Number of Euploid Embryos

“…In fact, in women with ≥4 euploid blastocyst availability, a single embryo transfer offers comparable pregnancy rates to a double embryo transfer, while multiple pregnancy rates significantly lower. In women with ≤3 euploid blastocysts, clinical pregnancy rates were higher when a double embryo transfer was performed [14]. These findings support the hypothesis that euploid embryo cohort size is a prognosis factor in IVF treatments and that the number of euploid embryos has to be taken into account, more importantly than the percentage of euploid/aneuploid embryos, as a prognosis factor, especially if we consider cumulative pregnancy outcome [31].…”

“…In fact, it has been shown that high ovarian response to conventional ovarian stimulation does not increase embryo aneuploidy rates in aCGH-PGS cycles [13]. Besides, the larger the number of available euploid blastocysts, the higher the clinical pregnancy rate observed [14, 15]. …”

Why more is less and less is more when it comes to ovarian stimulation

“…In contradiction to Valbuena et al [16] who concluded that high E 2 levels are deleterious to embryo adhesion, due to a direct toxic effect on the embryo itself at the cleavage stage, Fatemi et al [21] claim that the potential implantation of these embryos is preserved, demonstrated by the fact that the cumulative PRs in high responders are higher than in normal responders. Also, embryo aneuploidies were not increased after moderate ovarian stimulation with respect to nonstimulated cycles in the same patient [22], and higher responses provided more euploid blastocysts [14,23]. Therefore, the whole concept of mild stimulation has not obtained ubiquitous worldwide acceptance by the majority of reproductive endocrinologists and ART practitioners, and after the introduction of GnRH agonist (GnRHa) trigger to minimize OHSS, the idea seems to have lost its momentum.…”

How do patient perceived determinants influence the decision-making process to accept or decline preimplantation genetic screening?

“…To meet the overall goal of providing one healthy child with each pregnancy (14), it is imperative for providers and patients using IVF and PGS to collaboratively make informed decisions with the assistance of a decision-making tool (15). A decision aid generated from this study may prove beneficial for patients in the future as a guide in the decision-making process.…”