Graduated Embryo Score and soluble human leukocyte antigen-G expression improve assisted reproductive technology outcomes and suggest a basis for elective single-embryo transfer.
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.
Fisch
Jeffrey D
JD
Sher Institute for Reproductive Medicine, Las Vegas, Nevada 89109, USA. jfisch@sherinstitute.com
Keskintepe
Levent
L
Ginsburg
Michael
M
Adamowicz
Mark
M
Sher
Geoffrey
G
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
D006680:HLA Antigens; D059951:HLA-G Antigens; D015395:Histocompatibility Antigens Class I