ArticleFrontiers in endocrinology2026
Impact of rapidly cleaving embryos on blastocyst formation and single-blastocyst transfer outcomes.
Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Clarifying the impact of day-3 cell number on blastulation and subsequent pregnancy outcomes is essential for optimizing blastocyst selection criteria and refining embryo assessment protocols. While slow cleavage on day 3 is well-recognized as detrimental, the prognostic value of rapid cleavage (>8 cells) remains ambiguous. Methods: This retrospective cohort study (January 2015-April 2024) included 64,853 embryos undergoing blastocyst culture (Cohort 1) and 2,669 single-blastocyst frozen embryo transfer (FET) cycles (Cohort 2) at a large tertiary assisted reproduction center. Cohort 1 examined the association between day-3 cell number and blastulation potential. Cohort 2 evaluated clinical pregnancy, live birth, and miscarriage rates following single-blastocyst transfer using multivariable logistic regression adjusted for confounders. Embryos were stratified by maternal age (<35 or ≥35 years) and blastocyst grade (top-quality [≥4BB on day-5] or non-top-quality [≥3BC on day-5/6, excluding ≥4BB on day-5]). Results: In Cohort 1, compared to 8-cell embryos, 9- and 10-cell embryos had lower usable blastocyst rates (aORs [95% CI]: 0.77 [0.72-0.82] and 0.84 [0.77-0.91]); 11- and 12-cell embryos had comparable usable rates (0.96 [0.85-1.09] and 1.08 [0.93-1.24]) but higher top-quality rates (1.59 [1.37-1.85] and 2.17 [1.85-2.54]); and embryos with ≥13 cells had higher rates for both usable and top-quality blastocysts (all aORs > 1.4; 95% CIs excluded 1). This pattern was consistent across female age subgroups. In Cohort 2, however, the advantage of 11-16-cell embryos translated into superior pregnancy and live birth rates only in younger women receiving top-quality blastocysts versus 8-cell embryos (76.5% Conclusion: Day-3 cell number serves as a context-dependent prognostic indicator for optimizing blastocyst selection. For young women with top-quality blastocysts, ≥11-cell embryos are the strongest candidates; conversely, 8-cell embryos appear optimal for older women with non-top-quality blastocysts.
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