Analysis of the correlation between the morphological score of blastocyst and the live birth of frozen-thawed single blastocyst transfer after PGT-SR
Objective To explore the effect of morphological score of blastocyst on the live birth of frozen-thawed single blastocyst transfer after preimplantation genetic testing for chromosome structural rearrangements(PGT-SR).Methods In this retrospective case-control study,the clinical data of 1 412 patients who underwent frozen-thawed single blastocyst transfer after PGT-SR assisted pregnancy in Center for Reproductive Medicine,the First Affiliated Hospital of Zhengzhou University from March 2015 to January 2021 were analyzed.According to whether the live birth was obtained,it was divided into two groups:live birth group(n=634)and non-live birth group(n=778).Blastocysts were graded according to degree of blastocyst expansion,inner cell mass and trophectoderm morphology,and the differences of live birth rate of each morphological parameter were compared.The predictive value of each morphologic parameter to live birth after single blastocyst transfer was evaluated by binary logistic regression.Then it was divided into day 5(D5)blastocyst(n=977)and day 6(D6)blastocyst(n=435)according to the blastocyst development days,and the live birth rate among different blastocyst expansions in D5 and D6 blastocysts was further explored.Results The live birth group had shorter infertility duration[(2.88±2.41)years],higher endometrial thickness[(10.12±2.03)mm]and higher proportion of D5 blastocyst transfer cycle[75.6%(479/634)]compared with the non-live birth group[(3.18±2.67)years,P=0.028;(9.78±1.76)mm,P=0.003;64.0%(498/778),P<0.001].There were significant differences in endometrial preparation protocols,blastocyst expansion and trophoblast cell grade between the two groups(P=0.008,P=0.002,P=0.015).There was no significant difference in the grade of inner cell mass between the two groups(P=0.236).After adjusting the related confounding factors,the results of binary logistic regression showed that the live birth rate in expansion 3 and expansion 4 was significantly higher than that in expansion 1-2(aOR=1.894,95%CI:1.056-3.394,P=0.032;aOR=1.970,95%CI:1.046-3.709,P=0.036),and the inner cell mass and trophectoderm were not independent influencing factors of live birth(aOR=1.480,95%CI:0.790-2.772,P=0.221;aOR=1.242,95%CI:0.952-1.621,P=0.111).Endometrial preparation regimens,blastocyst development days and endometrial thickness were also independent influencing factors of live birth.Compared with hormone replacement therapy regimen,the live birth rate of natural cycle regimen was significantly higher(aOR=1.425,95%CI:1.028-1.975,P=0.033).Compared with D6 blastocyst,the live birth rate of D5 blastocyst was also significantly higher(aOR=1.448,95%CI:1.068-1.963,P=0.017).There was a significant difference in the live birth rate among the different expansion of D5 blastocyst(P=0.002).Compared with the degree of blastocyst expansion 1-2[28.1%(16/57)],the live birth rate in expansion 3,expansion 4 and expansion 6 was significantly higher[51.1%(360/704),50.3%(87/173),58.3%(7/12);all P<0.012 5].Conclusion Higher live birth rate can be obtained by preferentially selecting D5 blastocyst transfer with the degree of expansion 3 and expansion 4 stages and choosing the natural cycle endometrial preparation regimen after PGT-SR assisted pregnancy.
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