title: Does IVF cleavage stage embryo quality affect pregnancy complications and neonatal outcomes in singleton gestations after double embryo transfers?
abstract: OBJECTIVE
  Embryo quality is associated with successful implantation and live births. Our retrospective study was carried out to determine whether or not cleavage stage embryo quality affects the miscarriage rate, pregnancy complications and neonatal outcomes of singletons conceived with assisted reproduction technology.
  
  
  METHODS
  The current study included 11,721 In Vitro Fertilization-Embryo Transfer cycles (IVF-ET) between January 2009 (the date at which electronic medical records were implemented at our center) and March 2013. Only women < 40 years of age undergoing their first fresh embryo transfer cycle using non-donor oocytes were included.
  
  
  RESULTS
  Our study indicated that the transfer of poor-quality embryos resulted in higher miscarriage (19.77% vs. 13.28%, p = 0.02) and lower ongoing pregnancy rates (15.33% vs. 48.06%, p < 0.001). Logistic regression analysis performed on data derived from 744 cycles culminating in miscarriages versus 4,333 cycles culminating in live births, suggested that embryo quality (p = 0.04) is significantly associated with miscarriage rate after adjusting for other confounding factors. Moreover, there were no differences in the mean birth weight, low birth weight (<2,500 g), very low birth weight (<1,500 g), gestational age, preterm delivery (<37 weeks), very preterm delivery (<32 weeks), congenital malformations, small-for-gestational-age singletons (SGA), and large-for-gestational-age singleton (LGA) rate (p > 0.05). Similarly, pregnancy complications resulting from poor-quality embryos were not different from good-quality embryos (4.04% vs. 2.57 %, p = 0.33). Finally, logistic regression suggested that embryo quality was not significantly associated with pregnancy complications after adjusting for other confounding factors (p = 0.40).
  
  
  CONCLUSIONS
  Our study suggests that transfer of poor-quality embryos did not increase the risk of adverse outcomes; however, the quality of cleavage stage embryos significantly affected the miscarriage rate and ongoing pregnancies.
authors.affiliation: Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, 100191, Haidian District, Beijing, China.
authors.forename: Jinliang
authors.initials: J
authors.lastname: Zhu
authors.forename: Ying
authors.initials: Y
authors.lastname: Lian
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.forename: Lixue
authors.initials: L
authors.lastname: Chen
authors.forename: Ping
authors.initials: P
authors.lastname: Liu
authors.forename: Jie
authors.initials: J
authors.lastname: Qiao
mesh_terms: D000022:Abortion, Spontaneous / Q000503:physiopathology; D000328:Adult; D001755:Blastocyst / Q000502:physiology; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D018873:Pregnancy Rate; D020554:Sperm Injections, Intracytoplasmic