Investigating the impact of the timing of blastulation on implantation: management of embryo-endometrial synchrony improves outcomes
| Autor: | K.M. Upham, Eric J. Forman, Marie D. Werner, George Patounakis, Kathleen H. Hong, Nathan R. Treff, Richard T. Scott, Jason M. Franasiak |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
030219 obstetrics & reproductive medicine business.industry blastocyst endometrial receptivity embryo-endometrial synchrony synchrony embryonic competence Retrospective cohort study Embryo culture Embryo Endometrium Cryopreservation Andrology 03 medical and health sciences 030104 developmental biology 0302 clinical medicine medicine.anatomical_structure Private practice embryonic structures medicine Gestation Original Article business Embryo quality |
| Zdroj: | Human Reproduction Open |
| ISSN: | 2399-3529 |
| Popis: | STUDY QUESTION Do embryos with delayed blastulation have inferior reproductive potential or poorer outcomes due in part to embryo and endometrial synchrony? SUMMARY ANSWER Diminished outcomes in embryos with delayed blastulation undergoing fresh embryo transfer (ET) may be attributed to a loss of embryonic-endometrial synchrony. WHAT IS KNOWN ALREADY Embryos that blastulate slowly have lower sustained implantation rates (SIR) than those which blastulate normally on Day 5 (D5). Traditionally this has been attributed to reduced embryo quality; however, dyssynchrony with the endometrium is also a possibility and has not been fully described. This convenient cohort composed of groups that resulted from a practice wide change in laboratory protocol allows for evaluation of embryo and endometrial synchrony as it related to blastocyst expansion. STUDY DESIGN, SIZE, DURATION A retrospective cohort analysis was carried out from January 2009 to February 2013. Three cohorts were identified: D5 ET, D6 ET and frozen ET that comprised 822 patients, 763 patients and 718 patients, respectively. Each of these cohorts had slowly blastulating and normally blastulating embryos identified. PARTICIPANTS/MATERIALS, SETTING, METHODS The study setting was academic affiliated private practice. All first fresh or cryopreserved ETs from 2010 to 2013 were studied. Non-biopsied embryos were classified into two groups on D5: slowly blastulating (Morula-Gardner 1) or normally blastulating (Gardner 2–6). Only single ETs or transfer of two embryos within the same classification group were included. Outcomes were compared between classification groups in embryos undergoing transfer on D5, D6, or after cryopreservation. This assesses the impact of transfer timing in fresh cycles as well as isolating a pure embryonic factor in frozen ET cycles. Sustained implantation was defined as heart beat detection at discharge sonogram at 8 weeks gestation. SIR was defined as the number of embryos transferred meeting criteria for sustained implantation divided by the total number of embryos transferred. MAIN RESULTS AND THE ROLE OF CHANCE In total, 3391 embryos were transferred to 1966 patients. On D5, SIRs were significantly lower with slowly blastulating embryos (44% versus 64% in women |
| Databáze: | OpenAIRE |
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