title: Graduated Embryo Score and soluble human leukocyte antigen-G expression improve assisted reproductive technology outcomes and suggest a basis for elective single-embryo transfer.
abstract: OBJECTIVE
  To evaluate assisted reproductive technology (ART) outcomes by using Graduated Embryo Score (GES) and soluble human leukocyte antigen-G (sHLA-G) expression to select embryos for transfer on day 3.
  
  
  METHODS
  Prospective cohort.
  
  
  METHODS
  Private practice.
  
  
  METHODS
  Women undergoing fresh ART cycles (n = 209).
  
  
  METHODS
  In vitro fertilization using standard protocols. Embryos scoring GES of > or =70 using were selected for transfer on the basis of sHLA-G expression in the culture media on day 2.
  
  
  METHODS
  Pregnancy, implantation, and multiple-gestation rates.
  
  
  RESULTS
  Ongoing gestations increased with the number of embryos expressing sHLA-G (37%, 42%, 58%, and 56% with 0, 1, 2, or 3 sHLA-G(+), respectively). With at least two sHLA-G(+) embryos, ongoing gestation and implantation rates were higher than those with fewer than two sHLA-G(+). Differences were even higher for women aged < or =37 years. With at least two sHLA-G(+) embryos, the odds ratio (95% confidence interval) was 1.59 (1.51-1.68) for ongoing gestation compared with the case of fewer than two sHLA-G(+). Age was the most important predictor of outcome; the odds ratio (95% confidence interval) was 2.07 (1.98-2.16) for ongoing gestation in women aged < or =37 years with at least two sHLA-G(+) embryos, compared with the case of women aged 38-40 years.
  
  
  CONCLUSIONS
  Day 3 embryo transfer using GES and sHLA-G improves ART outcomes by increasing predictive accuracy. High twin rates suggest that couples with at least two sHLA-G(+) embryos consider elective single-embryo transfer.
authors.affiliation: Sher Institute for Reproductive Medicine, Las Vegas, Nevada 89109, USA. jfisch@sherinstitute.com
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Fisch
authors.forename: Levent
authors.initials: L
authors.lastname: Keskintepe
authors.forename: Michael
authors.initials: M
authors.lastname: Ginsburg
authors.forename: Mark
authors.initials: M
authors.lastname: Adamowicz
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Sher
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D004622:Embryo, Mammalian / Q000166:cytology / Q000276:immunology*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006680:HLA Antigens / Q000032:analysis*; D059951:HLA-G Antigens; D015395:Histocompatibility Antigens Class I / Q000032:analysis*; D006801:Humans; D008423:Maternal Age; D016017:Odds Ratio; D009924:Organ Culture Techniques; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D014427:Twins
chemical_list: D006680:HLA Antigens; D059951:HLA-G Antigens; D015395:Histocompatibility Antigens Class I