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The hare and the tortoise: extreme mitotic rates and how these affect live birth

Published:October 18, 2020DOI:https://doi.org/10.1016/j.rbmo.2020.10.007

      Abstract

      Research question

      Is live birth of patients with excessive slow (no blastocyst on day 5) and fast mitotic rate (full blastocyst development on day 4) comparable to a matched control standard (blastocyst formation on day 5)?

      Design

      In this retrospective matched (age and anti-Müllerian hormone [AMH]) case-control study rates of fertilization, blastulation, implantation, clinical pregnancy and live birth were compared in couples with male factor indication, prolonged embryo culture and fresh single morula and blastocyst transfer.

      Results

      The rates of implantation, clinical pregnancy and live birth in the slow-developing group were significantly (P < 0.001) lower (17.6%, 13.7%, and 11.8%, respectively) compared with the fast (58.5%, 52.5%, 47.5%) and normal growing counterparts (51.5%, 42.6%, 39.6%). No differences in neonatal outcome could be observed between the three groups. Sex ratio in the fast-growing group was not different from the other cohorts.

      Conclusions

      Extremely slow development, as assessed by the absence of blastulation on day 5, is a negative predictor of pregnancy and live birth. In contrast, the fear that extremely fast-growing embryos may represent an aneuploid cohort of embryos is unsubstantiated. Day-4 full blastocysts can preferentially be considered for transfer.

      KEYWORDS

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      Biography

      Thomas Ebner, PhD, graduated from the Paris Lodron University of Salzburg, Austria, in 1992. He has published more than 160 papers and book chapters as first and co-author. Research interests include non-invasive IVF selection processes, andrology, vitrification, culture media and time-lapse imaging. He is currently executive board member of ESHRE.
      Key message
      Patients with slow-cleaving embryos (no blastocyst on day 5) showed a significantly lower live birth rate compared with normal-cleaving-matched controls (blastocyst formation on day 5). In contrast, extremely fast-growing embryos (full blastocyst development on day 4) were of good prognosis. The fear that extremely fast-growing embryos may represent an aneuploid cohort of embryos seems unsubstantiated.