title: Effect of embryo quality on pregnancy outcome following single embryo transfer in women with a diminished egg reserve.
abstract: OBJECTIVE
  To evaluate independently the effect of blastomere number and degree of fragmentation on pregnancy outcome following single ETs in women with a decreased egg reserve.
  
  
  METHODS
  Retrospective cohort analysis.
  
  
  METHODS
  In vitro fertilization center of a university-based practice.
  
  
  METHODS
  Women having a single ET related to a decreased egg reserve. A requirement for inclusion was a day 3 serum FSH >12 mIU/mL and < or =3 antral follicles on ultrasound.
  
  
  METHODS
  Patients received no or minimal stimulation with gonadotropins.
  
  
  METHODS
  Pregnancy rates (PRs) following single ETs were evaluated according to blastomere number (group 1, < or =4 cells; group 2, 5 cells; group 3, 6 cells; group 4, 7 cells; and group 5, > or =8 cells) and fragmentation index (A, no fragmentation; B, 1-25% fragmentation; and C, >25% fragmentation). Embryo transfers and morphologic evaluation were performed on day 3.
  
  
  RESULTS
  The clinical and delivered PRs according to blastomere number showed that 6-8-cell embryos were six times more likely to implant than 4-5-cell embryos (6.6% versus 40.4% clinical). Degree of fragmentation did not predict outcome nearly as well as blastomere number. The overall clinical and delivered PRs per transfer were 27.8% and 24.1%, respectively, and were 14.8% and 12.8% per retrieval, respectively, and were 9.0% and 7.3% per initiated cycle, respectively.
  
  
  CONCLUSIONS
  Six, seven, or eight-cell embryos have equal chances of implanting in women with day 3 elevated serum FSH. The key finding is that these embryos do better than those with <6 blastomeres. These data may be helpful in women with a diminished ovarian reserve in attempting IVF with their own eggs or when choosing donor oocytes.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School at Camden, Camden, New Jersey, USA. laurie@ccivf.com
authors.forename: Jerome H
authors.initials: JH
authors.lastname: Check
authors.forename: Donna
authors.initials: D
authors.lastname: Summers-Chase
authors.forename: Wei
authors.initials: W
authors.lastname: Yuan
authors.forename: Danya
authors.initials: D
authors.lastname: Horwath
authors.forename: Carrie
authors.initials: C
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001757:Blastomeres / Q000502:physiology; D015331:Cohort Studies; D004624:Embryo Transfer; D004622:Embryo, Mammalian / Q000166:cytology*; D004997:Ethinyl Estradiol / Q000494:pharmacology; D005260:Female; D005307:Fertilization in Vitro; D005640:Follicle Stimulating Hormone / Q000097:blood / Q000494:pharmacology; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies
chemical_list: D004997:Ethinyl Estradiol; D005640:Follicle Stimulating Hormone