Clinical and experimental reproductive medicine · 2026
Relationships between morphological score changes during embryonic development and pregnancy outcomes.
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Gan Qiuying, Ma Wenhong, Liu Lidan, Huang Qianyi, Lu Fang, Qin Lang, Ren Liang, Deng Zhibing, Yang Chao, Liu Bo, Yang Yihua
Аннотация
OBJECTIVE: This study investigated whether changes in embryonic morphological scores can predict pregnancy outcomes to support optimal blastocyst selection.
METHODS: This retrospective dual-center study analyzed 1,492 single blastocyst transfers. Blastocysts were categorized according to day 3 and day 5 scores (excellent, good, or poor) and their day 3-5 morphological changes (improvement, stability, or deterioration). The primary outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR).
RESULTS: No statistically significant differences were observed in CPR or LBR among the Excellent-D3, Good-D3, and Poor-D3 embryo-quality groups. However, both CPR and LBR were significantly higher in the Excellent-D5 group compared with the Poor-D5 group (CPR: 58.64% vs. 46.34%, p=0.014; LBR: 45.97% vs. 33.54%, p=0.012). Temporal trends in developmental outcomes from day 3 to day 5 showed no significant differences across the improvement, stability, and deterioration groups for either CPR (57.95%, 55.28%, and 55.87%; p=0.615) or LBR (43.74%, 44.54%, and 40.84%; p=0.648). In stratified analysis, Poor-D3 embryos that reached Excellent-D5 status had a significantly lower LBR than Excellent-D5 embryos (40.52% vs. 48.81%: odds ratio, 0.714; 95% confidence interval, 0.513 to 0.994; p=0.046). No other subgroup comparisons demonstrated significant differences in clinical outcomes.
CONCLUSION: Day 5 morphology is the primary predictor of CPR and LBR, with Excellent-D5 embryos demonstrating superior outcomes. Although day 3-5 morphological changes were not associated with CPR or LBR, day 3 quality contributed supplemental predictive value for distinguishing among top-tier day 5 embryos, thereby aiding embryo selection.
METHODS: This retrospective dual-center study analyzed 1,492 single blastocyst transfers. Blastocysts were categorized according to day 3 and day 5 scores (excellent, good, or poor) and their day 3-5 morphological changes (improvement, stability, or deterioration). The primary outcomes were clinical pregnancy rate (CPR) and live birth rate (LBR).
RESULTS: No statistically significant differences were observed in CPR or LBR among the Excellent-D3, Good-D3, and Poor-D3 embryo-quality groups. However, both CPR and LBR were significantly higher in the Excellent-D5 group compared with the Poor-D5 group (CPR: 58.64% vs. 46.34%, p=0.014; LBR: 45.97% vs. 33.54%, p=0.012). Temporal trends in developmental outcomes from day 3 to day 5 showed no significant differences across the improvement, stability, and deterioration groups for either CPR (57.95%, 55.28%, and 55.87%; p=0.615) or LBR (43.74%, 44.54%, and 40.84%; p=0.648). In stratified analysis, Poor-D3 embryos that reached Excellent-D5 status had a significantly lower LBR than Excellent-D5 embryos (40.52% vs. 48.81%: odds ratio, 0.714; 95% confidence interval, 0.513 to 0.994; p=0.046). No other subgroup comparisons demonstrated significant differences in clinical outcomes.
CONCLUSION: Day 5 morphology is the primary predictor of CPR and LBR, with Excellent-D5 embryos demonstrating superior outcomes. Although day 3-5 morphological changes were not associated with CPR or LBR, day 3 quality contributed supplemental predictive value for distinguishing among top-tier day 5 embryos, thereby aiding embryo selection.