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Prioritized single vitrified blastocyst to be warmed between grades 3 or 4 blastocyst on day 5 transfer cycles

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Selecting the optimal blastocyst to implant during cryopreservation and warming is critial for in vitro fertilization success. Therefore, the aim of this study was to explore which blastocyst should be prioritized to be thawed when facing a single vitrified blastocyst on day 5 transfer.

Methods

A retrospective study including 1,976 single vitrified-warmed blastocyst transfer cycles was conducted from January 2016 to December 2020.

Results

We found that grade 4 vitrified blastocyst had a higher clinical pregnancy (60.64% vs. 49.48%, P < 0.001) and live birth rates (50.12% vs 39.59%, P < 0.001) than the grade 3 vitrified blastocyst. However, no statistical difference was found between groups in miscarriage rate, birth weight, or gestational age. Besides, the grade 4 vitrified–thawed blastocyst had significant potential to develop into grade 6 blastocyst after further culturing for 16 h (73.68% vs. 48.60%, P < 0.001). The grade 6 transferred blastocyst was markedly higher in both clinical pregnancy rate (61.88% vs. 51.53%, P < 0.001) and live birth rate (50.91% vs. 40.46%, P < 0.001) compared to grade 5 transferred blastocyst.

Conclusions

Grade 4 vitrified blastocyst is recommended when facing single vitrified blastocyst on day 5 transfer. More importantly, the “embryonic escape hypothesis” was firstly proposed to reveal the findings.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors thank all the clinicians and embryologists in the Department of Reproductive Medicine, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital.

Funding

This research was supported by the National Natural Science Foundation of China (grant nos. 81601271, 81871210, 81771536 and 31401225) and the State Key Laboratory of Reproductive Medicine (grant nos. SKLRMK201806).

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Author notes

  1. Joint first authors: Juan Ji and Xiufeng Ling.

Authors and Affiliations

  1. Department of Reproductive Medicine, Women’s Hospital of Nanjing Medical University, Nanjing Women and Children’s Healthcare Hospital, 123 Tianfeixiang, Mochou Road, Nanjing, 210004, Jiangsu, China

    Juan Ji, Xiufeng Ling, Qiao Zhou, Lin Zhou, Hui Ji, Xun Wu, Juanqiang Zhang & Shanren Cao

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Contributions

JJ participated in the study design and drafted the article. XL performed the analysis and wrote the manuscript. QZ and LZ participated in the acquisition and analysis of data. HJ and XW reviewed the final article and made appropriate corrections and suggestions to improve it. SC and JZ are corresponding authors and they participated in the study design, did the final proof reading and confirmed the final version. All authors approved the final manuscript.

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Correspondence to Shanren Cao.

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Ji, J., Ling, X., Zhou, Q. et al. Prioritized single vitrified blastocyst to be warmed between grades 3 or 4 blastocyst on day 5 transfer cycles. Arch Gynecol Obstet 309, 1629–1641 (2024). https://doi.org/10.1007/s00404-023-07336-7

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