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Reproductive outcomes with delayed blastocyst development: the clinical value of day 7 euploid blastocysts in frozen embryo transfer cycles

Published online by Cambridge University Press:  13 November 2023

Andrea Abdala*
ART Fertility Clinics, Abu Dhabi, United Arab Emirates
Ibrahim Elkhatib
ART Fertility Clinics, Abu Dhabi, United Arab Emirates
Aşina Bayram
ART Fertility Clinics, Abu Dhabi, United Arab Emirates
Ahmed El-Damen
ART Fertility Clinics, Abu Dhabi, United Arab Emirates
Laura Melado
ART Fertility Clinics, Abu Dhabi, United Arab Emirates
Daniela Nogueira
ART Fertility Clinics, Abu Dhabi, United Arab Emirates
Barbara Lawrenz
ART Fertility Clinics, Abu Dhabi, United Arab Emirates Department of Reproductive Medicine, UZ Ghent, Ghent, Belgium
Human M. Fatemi
ART Fertility Clinics, Abu Dhabi, United Arab Emirates
Corresponding author: Andrea Abdala; Email:


Embryos of optimal development reach blastocyst stage 116 ± 2 h after insemination. Usable D7 blastocysts represent nearly 5% of embryos in IVF with acceptable pregnancy and live birth rates, however data are still limited. Therefore, this study aimed to analyze the ongoing pregnancy rate (OPR) of D7 blastocysts in single euploid frozen embryo transfer (FET) cycles. An observational study was performed including 1527 FET cycles with blastocysts biopsied on D5 (N = 855), D6 (N = 636) and D7 (N = 36). Blastocysts were classified as good (AA/AB/BA), fair (BB) or poor (AC/BC/CC/CA/CB) (Gardner scoring). FETs were performed in natural cycles (NC) or hormone replacement therapy (HRT) cycles. Patient’s age differed significantly between D5, D6 and D7 blastocysts FET cycles (33.2 ± 5.6, 34.4 ± 5.3 and 35.9 ± 5.2, P < 0.001). OPRs were higher when D5 euploid blastocysts were transferred compared with D6 and D7 (56.0% vs. 45.3% and 11.1%, P < 0.001). Poor quality blastocysts were predominant in D7 blastocyst FET cycles (good quality: 35.4%, 27.2%, 5.6%; fair quality: 52.1%, 38.5%, 11.1%; poor quality: 12.5%, 34.3%, 83.3%, P < 0.001 for D5, D6 and D7 blastocysts; respectively). OPR was significantly reduced by D7 blastocyst FETs (OR = 0.23 [0.08;0.62], P = 0.004), patient’s BMI (OR = 0.96 [0.94;0.98], P < 0.001), HRT cycles (OR = 0.70 [0.56;0.88], P = 0.002) and poor quality blastocysts (OR = 0.33 [0.24;0.45], P < 0.001). OPR is significantly reduced with D7 compared with D5/D6 euploid blastocysts in FET cycles. The older the patient, the more likely they are to have an FET cycle with blastocysts biopsied on D7, therefore culturing embryos until D7 can be a strategy to increase OPR outcomes in patients ≥38 years.

Research Article
© ART FERTILITY CLINICS LLC, 2023. Published by Cambridge University Press

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