Trophectoderm morphology significantly affects the rates of ongoing pregnancy and miscarriage in frozen-thawed single-blastocyst transfer cycle in vitro fertilization


      To determine which parameter of blastocyst morphology is the most important predictor of ongoing pregnancy or miscarriage.


      Retrospective analysis.


      One in vitro fertilization (IVF) center.


      Women who underwent a total of 1,087 frozen-thawed single-blastocyst transfer cycles.


      First IVF treatment with blastocysts after frozen-thawed cycle.

      Main Outcome Measure(s)

      Ongoing pregnancy and miscarriage rates as related to blastocyst morphology (blastocyst expansion, inner cell mass, and trophectoderm), and interaction tests in unadjusted logistic regression models to assess clinical factors affecting outcomes.


      After adjustment for trophectoderm, inner cell mass, and age as confounders, trophectoderm was determined to be statistically significantly related to the rate of ongoing pregnancy. Trophectoderm was also statistically significantly related to the miscarriage rate. By contrast, neither inner cell mass nor blastocyst expansion was statistically significantly related.


      In frozen-thawed embryo transfer cycles, trophectoderm morphology is statistically significantly related to the rates of ongoing pregnancy and miscarriage after adjusting for confounders. Trophectoderm morphology may be the most important parameter when selecting a single blastocyst for transfer.

      Key Words

      To read this article in full you will need to make a payment


        • Gardner D.K.
        • Vella P.
        • Lane M.
        • Wagley L.
        • Schlenker T.
        • Schoolcraft W.B.
        Culture and transfer of human blastocysts increases implantation rates and reduces the need for multiple embryo transfers.
        Fertil Steril. 1998; 69: 84-88
        • Veeck L.L.
        • Bodine R.
        • Clarke R.N.
        • Berrios R.
        • Libraro J.
        • Moschini R.M.
        • et al.
        High pregnancy rates can be achieved after freezing and thawing human blastocysts.
        Fertil Steril. 2004; 82: 1418-1427
        • Schoolcraft W.B.
        • Gardner D.K.
        • Lane M.
        • Schlenker T.
        • Hamilton F.
        • Meldrum D.R.
        Blastocyst culture and transfer: analysis of results and parameters affecting outcome in two in vitro fertilization programs.
        Fertil Steril. 1999; 72: 604-609
        • Zaninovic N.
        • Berrios R.
        • Clarke R.N.
        • Bodine R.
        • Ye Z.
        • Veeck L.L.
        Blastocyst expansion, inner cell mass (ICM) formation, and trophectoderm (TM) quality: is one more important for implantation?.
        Fertil Steril. 2001; 76: S8
        • Ahlstrom A.
        • Westin C.
        • Reismer E.
        • Wikland M.
        • Hardarson T.
        Trophectoderm morphology: an important parameter for predicting live birth after single blastocyst transfer.
        Hum Reprod. 2011; 26: 3289-3296
        • Balaban B.
        • Urman B.
        • Sertac A.
        • Alatas C.
        • Aksoy S.
        • Mercan R.
        Blastocyst quality affects the success of blastocyst-stage embryo transfer.
        Fertil Steril. 2000; 74: 282-287
        • Richter K.S.
        • Harris D.C.
        • Daneshmand S.T.
        • Shapiro B.S.
        Quantitative grading of a human blastocyst: optimal inner cell mass size and shape.
        Fertil Steril. 2001; 76: 1157-1167
        • Kovacic B.
        • Vlaisavljevic V.
        • Reljic M.
        • Cizek-Sajko M.
        Developmental capacity of different morphological types of day 5 human morulae and blastocysts.
        Reprod Biomed Online. 2004; 8: 687-694
        • Marek D.E.
        • Langley M.T.
        • Weiand L.A.
        • Nackley A.C.
        • Doody K.M.
        • Doody K.J.
        Blastocyst inner cell mass grade predicts outcome for single embryo transfer in fresh cycles.
        Fertil Steril. 2004; 82: S219
        • Goto S.
        • Kadowaki T.
        • Tanaka S.
        • Hashimoto H.
        • Kokeguchi S.
        • Shiotani M.
        Prediction of pregnancy rate by blastocyst morphological score and age, based on 1,488 single frozen-thawed blastocyst transfer cycles.
        Fertil Steril. 2011; 95: 948-952
        • Magli M.C.
        • Gianaroli L.
        • Ferraretti A.P.
        • Lappi M.
        • Ruberti A.
        • Farfalli V.
        Embryo morphology and development are dependent on the chromosomal complement.
        Fertil Steril. 2007; 87: 534-541
        • Alfarawati S.
        • Fragouli E.
        • Colls P.
        • Stevens J.
        • Gutierrez-Mateo C.
        • Schoolcraft W.B.
        • et al.
        The relationship between blastocyst morphology, chromosomal abnormality, and embryo gender.
        Fertil Steril. 2011; 95: 520-524
        • Endo T.
        • Honnma H.
        • Hayashi T.
        • Chida M.
        • Yamazaki K.
        • Kitajima Y.
        • et al.
        Continuation of GnRH agonist administration for 1 week, after hCG injection, prevents ovarian hyperstimulation syndrome following elective cryopreservation of all pronucleate embryos.
        Hum Reprod. 2002; 17: 2548-2551
        • Kini S.
        • Li H.W.
        • Morrell D.
        • Pickering S.
        • Thong K.J.
        Anti-mullerian hormone and cumulative pregnancy outcome in in-vitro fertilization.
        J Assist Reprod Genet. 2010; 27: 449-456
        • Shapiro B.S.
        • Daneshmand S.T.
        • Garner F.C.
        • Aguirre M.
        • Hudson C.
        • Thomas S.
        Evidence of impaired endometrial receptivity after ovarian stimulation for in vitro fertilization: a prospective randomized trial comparing fresh and frozen-thawed embryo transfers in high responders.
        Fertil Steril. 2011; 96: 516-518
        • Honnma H.
        • Baba T.
        • Sasaki M.
        • Hashiba Y.
        • Oguri H.
        • Fukunaga T.
        • et al.
        Different ovarian response by age in an anti-müllerian hormone-matched group undergoing in vitro fertilization.
        J Assist Reprod Genet. 2012; 29: 117-125
        • Honnma H.
        • Hashiba Y.
        • Asada Y.
        • Endo T.
        Failure of triggering oocyte maturation with a GnRH agonist in polycystic ovary syndrome: two case reports.
        Eur J Obstet Gynecol Reprod Biol. 2011; 157: 239-240
        • Kuwayama M.
        • Vajta G.
        • Kato O.
        • Leibo S.P.
        Highly efficient vitrification method for cryopreservation of human oocytes.
        Reprod Biomed Online. 2005; 11: 300-308
        • Parks J.C.
        • McCallie B.R.
        • Janesch A.M.
        • Schoolcraft W.B.
        • Katz-Jaffe M.G.
        Blastocyst gene expression correlates with implantation potential.
        Fertil Steril. 2011; 95: 1367-1372