To determine if sonographically observed factors predict birthweight and prematurity.
Abstract Study question Are objective measurements and subjective assessments of blastocysts predictive of aneuploidy? Summary answer Aneuploidy was predicted equally well by lower trophectoderm cell count (objectively measured morphometry) or by a lower subjective trophectoderm grade. What is known already Blastocyst morphological grade has been reported to be moderately predictive of embryo ploidy. However, due to its subjective nature, morphological grade may be significantly more difficult to code into artificial intelligence algorithms when compared to objective measurements. Study design, size, duration This retrospective cohort study included all 1409 blastocysts that were subject to pre-implantation genetic testing (PGT) in a 30-month study period. Participants/materials, setting, methods Per clinic routine, embryos from oocyte were cultured to the blastocyst stage following conventional ovarian stimulation, oocyte retrieval, and intracytoplasmic sperm injection. If the patients opted for PGT, a laser was used to open the zona at the cleavage stage, trophectoderm biopsies were collected at the blastocyst stage, and biopsies were analyzed by next-generation sequencing. Inner cell mass sizes were measured by ocular micrometer and trophectoderm cells were counted in one plane of focus. Main results and the role of chance The mean patient age (including oocyte donors) was 31.9±6.4 years and the mean number of collected oocytes was 23.0±12.9. In multivariable logistic regression, greater patient age was the best available predictor of blastocyst aneuploidy (P < 0.0001). Along with age in the model, the observation of fewer trophectoderm cells (P = 0.0019) was also predictive of aneuploidy. Alternatively, the failure to have an A-grade trophectoderm (P = 0.0007) was also predictive of aneuploidy, also with age in the model. Neither the objectively measured inner cell mass size nor subjective inner cell mass grade were significant predictors of ploidy. Overall, objectively measured blastocyst morphometry was about equally predictive of ploidy as was subjective blastocyst grading, and area under the receiver operating characteristic curve was 0.62 for each model. Limitations, reasons for caution This study was retrospective, allowing the possibility of selection bias among patients and among embryos chosen for biopsy. Wider implications of the findings Artificial intelligence algorithms assessing embryos might benefit from the similar performance of subjective grading and objective measurements, because it is much easier to code objective measurements into the algorithms. Trial registration number None.
To determine if the change in endometrial thickness following exogenous progesterone (P) initiation correlates with outcome following autologous transfer of a single thawed blastocyst. The study is a retrospective observational cohort study conducted at a private fertility center. Patients scheduled for thawed blastocyst transfer received artificial endometrial preparation (artificial cycle FET) and underwent serial ultrasonography. The main outcomes were the rate of ongoing pregnancy (fetal heart motion at 12 weeks of gestation) and early pregnancy loss. Logistic regression was used to test for correlations between these outcomes and the change in endometrial thickness while adjusting for potential confounders (patient age, embryo quality, and the use of genetic testing). There were 232 qualifying autologous single-blastocyst transfers in the 20-month study period ending 31 December 2019. Mean endometrial thicknesses were 3.8 mm, 10.0 mm, and 11.2 mm at baseline, P initiation, and at transfer, respectively. The change in endometrial thickness after exogenous P exposure ranged from − 5 to + 9 mm and negatively correlated with ongoing pregnancy in logistic regression analyses. Specifically, ongoing pregnancy rates per transfer were 63.2% in 19 cases where endometria compacted by 10% or more, 64.2% in 95 cases where there was unchanged endometrial thickness, and 52.5% in 118 cases where endometria expanded. The change in endometrial thickness after P initiation was associated with the probability of ongoing pregnancy but not with early pregnancy loss. Ongoing pregnancy rates were greater in endometria with negative growth (compaction) when compared to endometria that grew (expanded) after P exposure.
