Effect of Age and Embryo Morphology on Live Birth Rate After Transfer of Unbiopsied Blastocysts

Effect of age and morphology on sustained implantation rate after euploid blastocyst transfer

“…There is strong biological plausibility that with increasing age the sustained implantation and live birth rates will either remain the same or decrease gradually. Our previous analysis on LBR of cleavage stage embryos and unbiopsied blastocysts is consistent with this (Awadalla et al, 2020b(Awadalla et al, , 2020a). An overfitted model is easy to spot because the outcome rate will increase and decrease with increasing age in a manner that is not biologically plausible.…”

“…Our IVF protocols have been described previously (Awadalla et al, 2020a(Awadalla et al, , 2020bMcDaniel et al, 2020). In brief, we use a combination of GnRH antagonist, GnRH agonist suppression, and GnRH flare ovarian stimulation protocols.…”

“…As a result, there are seven common morphology grades: AA, AB, BA, BB, CB, BC, and CC. Based on live birth rates of unbiopsied blastocysts, our previous analysis found that these seven morphologies best group into overall morphology grades as follows: good (AA/AB/BA), fair (BB/CB), and poor (BC/CC) (Awadalla et al, 2020a).…”

“…We have described our use of linear algebra and moving age groups previously (Awadalla et al, 2020b(Awadalla et al, , 2020a. Although linear algebra is more commonly used in engineering applications than medicine, it is very similar to multiple linear regression.…”

“…Expansion rate can be measured by the degree of expansion observed on a specific day of culture or by the day of culture on which a blastocyst reaches a sufficient degree of expansion required for vitrification or biopsy. Many studies have shown an impact of morphology and expansion rate of unbiopsied blastocysts on pregnancy rates (Ahlstrom et al, 2013;Ahlström et al, 2011;Awadalla et al, 2020a;Bos-Mikich et al, 2016;Desai et al, 2016;Hill et al, 2013;Honnma et al, 2012;Subira et al, 2016;Thompson et al, 2013;Van Den Abbeel et al, 2013). More information is needed to determine if morphology and expansion rate are still associated with pregnancy after euploid embryos have been selected for transfer.…”