ISSN: 2320-5407 Int. J. Adv. Res.

12(10), 376-383

Journal Homepage: -www.journalijar.com

Article DOI:10.21474/IJAR01/19649
DOI URL: http://dx.doi.org/10.21474/IJAR01/19649

RESEARCH ARTICLE
IMPACT OF BLASTOCYST GRADES TO IMPLANTATION AND LIVE-BIRTH RATES IN WOMEN
LESS THAN 30 YEARS WITH SINGLE EMBRYO TRANSFERS

Miss Aaryaa Chokshi1 and Dr. Monica Patel2

1. University College London, United Kingdom.
2. ESIC Hospital, Ahmedabad, India.
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Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History Background:Morphological evaluation of blastocysts focusing on key
Received: 15 August 2024 factors such as expansion, inner cell mass (ICM) quality, and
Final Accepted: 18 September 2024 trophectoderm (TE) quality have been most widely used for embryo
Published: October 2024 selection. The study emphasizes the importance of detailed blastocyst
evaluation, highlighting that morphological variations can have
Key words:-
Blastocyst Grading, Implantation Rate, substantial implications for ART outcomes.
Single Fresh-Embryo Transfer Methods:A total of 115women aged less than 30 years undergoing
SET from from January 2023 to June 2023 were included in this
study.The patients were divided into three groups based on their
morphologic grading before embryo transfer: good-quality (n = 53),
average-quality (n = 52) and poor-quality blastocysts (n = 10). The
three morphologic groups' pregnancy outcomes were examined, and the
implantation rate was logistically regressed.
Results:Good-quality blastocysts yielded a statistically significantly
higher implantation rate (77%) than average / poor-quality blastocysts
(44% and 20% respectively). Average-quality blastocysts still yielded
in higher implantation rates (44%) compared to poor-quality
blastocysts (20%). The baseline characteristics were analysed for
significance using the Pearson’s Chi-squared test. A P-value < 0.05 was
considered statistically significant. All the statistical analyses were
performed using the social science statistics website with SPSS
software.
Conclusions:Higher blastocyst morphologic grading was associated
with increased implantation rate for single embryo transfers. These
findings suggest that evaluating blastocyst morphology is critical when
selecting the best blastocyst.

Copyright, IJAR, 2024,. All rights reserved.

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Introduction:-
In vitro fertilisation (IVF) and assisted reproductive technology (ART) have revolutionised the field of reproductive
medicine, offering hope to couples struggling with infertility. IVF involves the fertilisation of an egg outside the
body, followed by the transfer of the resulting embryo into the uterus.

Corresponding Author:-Miss Aaryaa Chokshi

Address:-Student, University College London, United Kingdom.
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ART encompasses a range of techniques, including IVF, intra-cytoplasmic sperm injection (ICSI), and embryo
cryopreservation, aimed at enhancing fertility and increasing the chances of pregnancy. These technologies have
significantly improved reproductive outcomes, making them more effective and accessible.

One of the most important goal of ART is to identify a single potential embryo with high rate of implantation. This
would result in a single healthy live birth.

The selection of the embryo with the highest implantation potential is therefore a critical stage in an ART treatment.
Various approaches can be taken into consideration to achieve this goal. Culturing to the blastocyst stage is one
method that enables the self-selection of embryos with microscopic assessment of morphologic parameters linked to
enhanced viability, such as trophectoderm, inner cell mass (ICM), and blastocoel expansion. Preimplantation genetic
testing for aneuploidy (PGT-A) is another tactic used to lessen the possibility of transferring an aneuploid embryo,
which is the main cause of miscarriage, disturbed embryo development, and unsuccessful implantation. When PGT-
A was first used, it was used to identify embryos in patients who had experienced repeated in vitro fertilisation
(IVF) failure, were elderly, or had experienced repeated pregnancy loss. But embryos might not implant. Failure
causes should be investigated. It has long been believed that a healthy embryo is a key indicator of a successful
implantation and pregnancy.

In terms of embryo selection, standard morphologic examination has been and continues to be the most used
method. Optimal pregnancy outcomes are highly correlated with a greater total blastocyst quality. Therefore, ICM
morphologic grades and trophectoderm are probably useful extra factors to consider when choosing embryos.

There are several factors to take into account that may influence clinical embryo selection in euploid blastocysts.
Because of this, the purpose of this study is to evaluate how a blastocyst's morphologic features affect its ability to
implant.

Methods:-
Study Design
The Banker IVF and women’s hospital approved of this study. The data obtained is for 115 patients from January
2023 to June 2023, all undergoing ICSI (intra-cytoplasmic sperm injection) for conception. The criteria for patient
data included: age of patients (< 30 years), all undergoing single fresh-embryo transfers (SET). All 115 patients
underwent SET.

Ovarian stimulation protocol

The hormones used for ovarian stimulationprotocolweredifferent for every patient depending on their history and
profile. After undergoing a baseline scan on the second or third day of the menstrual period, hormonal injections
were started, the physician adjusted the starting dose according to the patient’s age, body mass index (BMI) and
ovarian reserve. Ovarian follicle development was monitored based on trans-vaginal ultrasonographic
measurements. Oocytes were retrieved trans-vaginal 34–36 h after the hormones are administered. The follicles were
aspirated using a single-lumen needle attached to a syringe under trans-vaginal ultrasound guidance.

Laboratory Protocol
The oocytes were then inseminated via ICSI approximately 4 h after retrieval. Embryos were placed into the
incubator (Benchtop) and cultured at6% CO2, 5% O2, 89% N2 and 37 °C. Fertilisation checks are carried out after
the 19th hour of ICSI. Normal fertilised oocytes should have 2 polar bodies, 2 pronuclei and 3-7 precursor bodies.
Day 3 (pro nucleate stage to day 3,4,5) and blastocyst stage.Embryologists graded the blastocysts on the degree of
expansion and the morphology of ICM and TE according to the classification devised by the ASEBIR scoring
system. This includes four categories (A, B, C, D) for blastocyst grading. The key parameters for the score are
degree of expansion, trophectoderm quality and ICM quality. The trophectoderm condition is the main parameter for
the blastocyst quality.

The trophectoderm was graded as follows:

The blastocoel is found in the trophectoderm, the embryo's outermost layer of cells. Blastocyst grading into the four
ASEBIR categories is made possible by the evaluation of cell quantity, shape, and cohesiveness. The best
trophectoderm has elliptic cells and a homogeneous epithelium (A). The poorest quality has few cells, uneven

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epithelium, and degenerative symptoms (D). Higher implantation and pregnancy rates are associated with high-
quality trophectoderm.

The following grades were part of the degree of expansion:

The degree of blastocoel expansion is influenced by blastocyst collapse and is strongly dependent on the observation
time. In a short time, the blastocoel may enlarge significantly, causing the zona pellucida to thin and eventually
cause hatching to begin. increased blastocyst expansion level.

The following was the ICM's grade:

Oval in shape, the inner cell mass should have compacted cells. ICM mass should be over 1900 mm2 according to
the ASEBIR score. It will be scored A or B depending on compaction, C if the size is below 1900 mm2, and D mass
if degeneration is evident.

The ASEBIR (Asociación para el Estudio de la Biología de la Reproducción) embryo grading criteria is used to
evaluate the quality of embryos in the context of assisted reproductive technologies (ART). The grading system
assesses embryos based on their morphological characteristics at different stages of development. Here follows a
summary of the ASEBIR blastocyst grading criteria in Table 1.0:

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Embryo Transfer and Procedure Outcomes:

Table 2.0:- Data Collection for clinical pregnancy and live birth compared to their corresponding blastocyst grades

Statistical Analysis:
The Pearson's Chi-squared test was used to determine whether the baseline features were significant. The degree of
correlation between two categorical variables is assessed using this test. Clinical pregnancy and live birth are the
two factors being compared to their later embryo morphologic grades. P-values less than 0.05 were regarded as
statistically significant. The social science statistics website using SPSS software was used for all statistical studies.

Results:-
The analyses include 115 patients having single embryo transfers. According to morphologic grading, there were the
following numbers of cycles divided into three groups: good-quality blastocysts (n = 53), average-quality
blastocysts (n = 52), and poor-quality blastocysts (n = 10). The pregnancy and live birth rates in relation to their
respective embryo grades are summarised in table 3.0 below.
Total Clinical Pregnancy rate Live birth Live birth
Patients Pregnancy rate

115 66 57% 44 38%

Grade Good (A + B) 53 41 77% 29 55%

Average (C) 52 23 44% 14 27%

Poor (D) 10 2 20% 1 10%

Table 3.0:- Pregnancy rates and live birth rates compared to their corresponding blastocyst grades.

Primary outcome
The implantation rate of high-quality blastocysts was statistically substantially higher (77%) than that of ordinary or
low-quality blastocysts (44% and 20%, respectively). Averagequality blastocysts still yielded in higher implantation
rates (44%) compared to poor-quality blastocysts (20%). Graph 1.0 summarises these findings.

Secondary Analyses
Subsequent statistical analysis was performed to measure the extent of association between two categorical variables
against their respective blastocyst grades. A chi-squared test for significance was performed at values of P < 0.05
being considered significant shown in Table 4.0 and 5.0.

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Clinical Pregnancy rate (%) Live birth rate (%)

100

80

60

40

20

0
Good Average Poor
Graph 1.0:- Comparison between Clinical pregnancy rates and Live birth rates.

Total Pregnancy rate P-value

Patients

115 57%

Grade Good (A + B) 53 77% (A+B) vs (C) 0.0846

Average (C) 52 44% (A+B) vs (D) 0.0734

Poor (D) 10 20% (C) vs (D) 0.3197

Table 4.0:- P-values of Pregnancy rates to their corresponding blastocyst grades.

Total Live Birth rate P-value

Patients

44 38%

Grade Good (A + B) 29 55% (A+B) vs (C) 0.0594

Average (C) 14 27% (A+B) vs (D) 0.0800

Poor (D) 1 10% (C) vs (D) 0.3473

Table 5.0:- P-values of Live-birth rates to their corresponding blastocyst grades.

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Discussion:-
In summary, the relationships between blastocyst morphologic grades and their implantation rates were discussed in
this study. The primary outcome suggests that good quality (Grade A+B) blastocysts showed higher pregnancy and
implantation rates than average (C-grade) or poor quality (D-grade) blastocysts.

Whereas the secondary analyses consisted of statistical analyses performed to measure the extent of association
between Clinical pregnancy and Live birth rates against their blastocyst grades. The Chi-squared test conducted
determined no statistical significance in the blastocyst grading against pregnancy and implantation rates. The
primary criterion for choosing the most viable embryos for transfer was morphologic grading, even if it is
graphically clear that this criterion is connected with implantation potential. An age-related decrease in embryo
implantation occurs in the older population, despite morphologic grading being one of the most important
determinants of cycle outcome. This supports the idea that other factors also contribute to the age-related drop in
fertility.

This research has several advantages. To choose the optimal embryo for patients who have experienced several
unsuccessful cycles, it was first particularly done to find a linkage. Second, the age range that was selected made it
possible to examine the data in detail. Third, we assessed how embryo selection is influenced by blastocyst growth
and morphology. Fourth, because only one blastocyst was transferred in this trial. Additionally, the embryologists
employed a uniform grading system that included several standardised transfer criteria.

This study includes a number of drawbacks as well. First, the study's sample size was rather modest. Additionally,
since the data was gathered from a single location, bias was unavoidable. Secondly, patients older than 30 years
were excluded due to the possibility that they would not have access to statistics on live birth rates. This can limit
the clinical results' relevance to elderly people whose blastocyst quality is influenced by various circumstances.
Despite investigating blastocyst form and development, the study was unable to yield statistically meaningful data
on the identification of the most viable embryos for successful implantation. Finally, because this study only looked
at single embryo transfers, it cannot be applied to patients having many embryo transfers because it is hard to tell
which embryo was implanted.

Conclusions:-
The correlation between implantation potential and embryo morphologic grade is confirmed by this investigation.
When choosing an embryo for transfer amongst numerous embryos, morphology should be the primary factor taken
into consideration. Nevertheless, it seemed that the relationship between implantation potential and the morphologic
grading of blastocyst quality held true only in younger women, not in older ones.

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References:-
1. Bhattacharya S, Marjoribanks J, Ozturk O, Pandian Z, Serour G. Number of embryos for transfer following in
vitro fertilisation or intra-cytoplasmic sperm injection. The Cochrane database of systematic reviews.
2013;7:CD003416.
2. Gardner DK, Lane M, Meldrum DR, Schlenker T, Schoolcraft WB. Blastocyst culture and transfer: analysis of
results and parameters affecting outcome in two in vitro fertilization programs. FertilSteril. 1999;72(4):604–
609. doi: 10.1016/S0015-0282(99)00311-8.
3. Irani M, O'Neill C, Palermo GD, Qin X, Xu K, Zhang C, et al. Blastocyst development rate influences
implantation and live birth rates of similarly graded euploid blastocysts. FertilSteril. 2018;110(1):95–102.
doi: 10.1016/j.fertnstert.2018.03.032.
4. Davis O, Irani M, Melnick A, Reichman D, Robles A, Zaninovic N, et al. Morphologic grading of euploid
blastocysts influences implantation and ongoing pregnancy rates. FertilSteril. 2017;107(3):664–670.
doi: 10.1016/j.fertnstert.2016.11.012.
5. Lou, H. et al. (2021) Association between morphologic grading and implantation rate of euploid blastocyst,
Journal of ovarian research. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827997/ (Accessed:
09 September 2024).

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