title: Delayed blastulation, multinucleation, and expansion grade are independently associated with live-birth rates in frozen blastocyst transfer cycles.
abstract: OBJECTIVE
  To identify blastocyst features independently predictive of successful pregnancy and live births with vitrified-warmed blastocysts.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Academic hospital.
  
  
  METHODS
  Women undergoing a cycle with transfer of blastocysts vitrified using the Rapid-i closed carrier (n = 358).
  
  
  METHODS
  None.
  
  
  METHODS
  Clinical pregnancy and live-birth rates analyzed using logistic regression analysis.
  
  
  RESULTS
  A total of 669 vitrified-warmed blastocysts were assessed. The survival rate was 95%. A mean of 1.7 ± 0.5 embryos were transferred. The clinical pregnancy, live-birth, and implantation rates were 55%, 46%, and 43%, respectively. The odds of clinical pregnancy (odds ratio [OR] 3.08; 95% confidence interval [CI], 1.88-5.12) and live birth (OR 2.93; 95% CI, 1.79-4.85) were three times higher with day-5 blastocysts versus slower-growing day-6 vitrified blastocysts, irrespective of patient age at cryopreservation. Blastocysts from multinucleated embryos were half as likely to result in a live birth (OR 0.46; 95% CI, 0.22-0.91). A four -fold increase in live birth was observed if an expanded blastocyst was available for transfer. The inner cell mass-trophectoderm score correlated to positive outcomes in the univariate analysis. The implantation rate was statistically significantly higher for day-5 versus day-6 vitrified blastocysts (50% vs. 29%, respectively).
  
  
  CONCLUSIONS
  The blastocyst expansion grade after warming was predictive of successful outcomes independent of the inner cell mass or trophectoderm score. Delayed blastulation and multinucleation were independently associated with lower live-birth rates in frozen cycles. Implantation potential of the frozen blastocysts available should be included in the decision-making process regarding embryo number for transfer.
authors: Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Fertility Center, Beachwood, Ohio. Electronic address: desain@ccf.org.
authors: Nina
authors: N
authors: Desai
authors: Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Fertility Center, Beachwood, Ohio.
authors: Stephanie
authors: S
authors: Ploskonka
authors: Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Fertility Center, Beachwood, Ohio.
authors: Linnea
authors: L
authors: Goodman
authors: Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Fertility Center, Beachwood, Ohio.
authors: Marjan
authors: M
authors: Attaran
authors: Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Fertility Center, Beachwood, Ohio.
authors: Jeffrey M
authors: JM
authors: Goldberg
authors: Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Fertility Center, Beachwood, Ohio.
authors: Cynthia
authors: C
authors: Austin
authors: Department of Obstetrics and Gynecology, Women's Health Institute, Cleveland Clinic Fertility Center, Beachwood, Ohio.
authors: Tommaso
authors: T
authors: Falcone
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001755:Blastocyst / Q000473:pathology*; D036703:Blastula / Q000473:pathology*; D016009:Chi-Square Distribution; D015925:Cryopreservation; D046149:Embryo Culture Techniques; D010064:Embryo Implantation; D004624:Embryo Transfer / Q000009:adverse effects; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Blastocyst morphology; cryopreservation; live birth; multinucleation; time-lapse; vitrification