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• W1983810439 abstract "By routinely transferring 2 blastocysts on culture day 5, patients are at increased risk of multiple gestation. This analysis was performed to determine if the degree of blastocoel expansion and quality on day 5 were predictive of the clinical pregnancy with multiple gestation. A retrospective analysis of Day 5 transfers January 2000 − December 2003. According to program policy, patients < 38 with ≥7 zygotes were scheduled for a day 5 transfer. After confirmation of fertilization, 7–8 zygotes were cultured in IVC-One with 10% SSS (Irvine Scientific) or SPS (Sage) under oil. Supernumerary zygotes were cryopreserved. Approximately 92 h post-insemination, embryos were moved to 50 μl microdrops of IVC-Three with 10% protein. The 2 embryos or blastocysts that appeared to be most advanced in development and of highest quality at 114 to 120 h post-insemination were transferred. Clinical pregnancies were confirmed by the observation of a gestational sac by ultrasound 6 weeks after transfer. Blastocysts were assigned expansion scores (ES) and quality grades (QG) according to Gardner and Schoolcraft's system. To examine the effect of blastocoel expansion on outcomes, transfers were categorized into the following groups: A) 2 expanded/hatching blastocysts, B) 1 expanded/hatchings1 full or 2 full blastocysts, C) 1 full blastocystsearlier stage embryo/blastocyst, D) 2 early stage blastocysts or embryos. Blastocyst quality was categorized as excellent (AA), good (AB, BA or BB) or fair (BC, CB or CC) based on their trophectoderm and inner cell mass (ICM) quality scores. Embryos that had not reached the blastocyst stage by the time of transfer were categorized as poor. To examine the effect of quality grades on outcomes, cycles were stratified according to the grades of embryos transferred 1) 2 excellent or good blastocysts; 2) 1 excellent or good blastocysts1 fair blastocyst or poor quality embryo; 3) transfer of 2 fair blastocysts or 2 poor quality embryos. Statistical analyses were performed by one-way ANOVA followed by the Bonferroni procedure. Clinical pregnancy rates were similar between ES Groups A (77.5% n=138), B (70% n=70) and C (67.7% n=62) and significantly lower in ES Group D (32.1% n=56) p <.05, but the incidence of multiple gestation was not different between any ES groups. The quality of transferred embryos was predictive of differences in clinical pregnancy rates and the incidence of multiple gestations (Table 1). a,b P<.05; *mean ± se The degree of blastocoel expansion and quality grade in the transfer cohort were associated with clinical pregnancy and implantation rates. The incidence of multiple gestation did not differ between blastocoel expansion groups, but was significantly increased when two good to excellent blastocysts were transferred. For patients under the age of 38, single embryo transfer should be considered when good to excellent quality blastocysts are available." @default.
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• W1983810439 date "2004-09-01" @default.
• W1983810439 modified "2023-09-30" @default.
• W1983810439 title "Day 5 transfers − When are two blastocysts too many?" @default.
• W1983810439 doi "https://doi.org/10.1016/j.fertnstert.2004.07.583" @default.
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