Beyond appearance: Can morphologically low-grade euploid blastocysts yield successful pregnancies?

Abstract

Purpose: The primary objective of this investigation is to evaluate how morphological quality affects the pregnancy outcomes in euploid embryos determined by preimplantation genetic testing for aneuploidies (PGT-A). Concurrently, as a secondary objective, we aim to identify which specific aspects of morphological evaluation exert the most significant impact on these outcomes.

Methods: A retrospective analysis of 451 single euploid embryo transfer cycles at our clinic was conducted. Embryos were evaluated based on the degree of blastocyst expansion, inner cell mass (ICM), trophectoderm (TE) morphology, and the day of blastocyst vitrification. Outcomes between morphologically low-grade and high-grade embryos were compared. Additionally, the study analyzed which morphological factors most influenced pregnancy outcomes.

Results: Pregnancy outcomes were significantly lower in morphologically low-grade blastocysts compared to high-grade ones. Among the morphological evaluations, the ICM assessment was significantly associated with the live birth rate.

Conclusion: Our study indicates that the morphological quality of euploid embryos, particularly the evaluation of the ICM, plays a crucial role in IVF-ET success.

Keywords: blastocyst inner cell mass; fertilization in vitro; live birth; preimplantation diagnosis; single embryo transfer.

FIGURE 1

Enrollment, assignment, and analysis of cycles in which PGT‐A‐tested embryos were transferred.

FIGURE 2

Comparison of pregnancy outcomes between the MHA and ML groups.