Blastocyst Transfer After Extended Culture of Cryopreserved Cleavage Embryos Improves in Vitro Fertilization Cycle Outcomes

Cryopreserved blastocyst embryo transfer has been reported to result in better pregnancy outcomes than those by cleavage embryo transfer. Women who had previously failed in the cleavage-stage embryo transfer, underwent extended culture of their warmed cleavage embryos to the blastocyst stage, thereby improving cryopreserved embryo transfer (CET) outcomes, although the ability of embryos to reach the extended blastocyst as well as the value of the prolonged culture was limited. This study aimed to investigate the effectiveness of blastocyst transfer by extending the culture of vitrified-warmed cleavage embryos. CET cycles were collected from January 2018 to June 2020. Pregnancy outcomes were analyzed and compared between three groups: day 2 embryo transfer using cryopreserved embryos (D2 CET), blastocyst transfer (D5 CET), and extended culture vitrified day 2 embryo transfer (D2-5 CET). A total of 52.77% of vitrified-warmed cleavage embryos developed into blastocysts in D2-5 CET group. Although D2-5 CET had a lower number of transferred embryos and grade A embryos, the pregnancy outcomes were significantly better than those in D2 CET, with respect to hCG positivity, clinical pregnancy and implantation rates (59.62% vs. 24.64%, 46.15% vs. 21.71%, 27.18% vs. 9.09%, respectively, P < 0.05). There were no significant different outcomes between the D2-5 CET and D5 CET groups. This study demonstrated a way of achieving better pregnancy outcomes in 8CET cycles by means of extended culture to blastocysts in patients with vitrified cleavage embryo failure.