Objective: To determine if Day 7 blastocysts merit biopsy, vitrification and transfer consideration by contrasting their aneuploidy and implantation rates to Day 5 and 6 blastocysts.
Methods: A total of 1,925 blastocysts were biopsied from 402 PGT-A cycles over a 12 to 16 month interval. All embryos were cultured under tri-gas, humidified conditions (37ºC) for up to 7 days (168 hours post-insemination). Biopsied blastocysts were vitrified and trophectoderm samples analyzed using NextGen sequencing. Single euploid embryo transfers were performed (n=254) using either a Day 5 (n=145), Day 6 (n=92) or a Day 7 blastocyst (n=16) post-warming. Euploidy rates and pregnancy outcomes were subsequently assessed and differences determined by day of development and blastocyst quality grade.
Results: No differences were observed in implantation, pregnancy loss or ongoing pregnancy rates between Day 5 and Day 6 blastocysts. Development to Day 7 accounted for 6.6% of all blastocysts. Euploidy rates were higher in Day 5 blastocysts (53.5%; p<0.05) compared to Day 6 (40.4%) and Day 7 (35.9%). High implantation potential (56.3% to 79.3%) of vitrified-warmed euploid blastocyst occurred independent to the day of development. However, miscarriage/loss rates increased (22.2% vs. 2%; p<0.05) with Day 7 blastocysts, resulting in lower (p<0.05) live birth rates (43.8% vs. 67.4-77.2%).
Conclusion: Culturing blastocysts to Day 7 has proven beneficial by achieving viable euploid embryos that would have otherwise been discarded. An extra Day of embryo growth allows select patients additional opportunities for in vitro development and possible healthy term live births.
Keywords: Day 7; PGT; biopsy; blastocyst; embryo culture.