ArticleFrontiers in endocrinology2026
Transfer strategy performance varies with embryo morphokinetic quality in good prognosis IVF/ICSI cycles.
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
Whether embryo morphokinetic quality influences the clinical efficacy of different embryo transfer (ET) strategies in good prognosis ICSI/IVF cycles remains an open question. This study evaluated the impact of early morphokinetic selection on clinical outcomes following fresh cleavage-stage single embryo transfers (FC-SETs) versus cryopreserved blastocyst single embryo transfers (CB-SETs). We conducted a retrospective cohort study analyzing 925 single embryo transfers, which included 565 FC-SETs and 360 CB-SETs. Embryos were ranked using an in-house Kinetic Evolution algorithm (KINEVO), whose performance was assessed through the relationship between KINEVO scores and live birth rates (LBR) following FC-SETs. Subsequently, clinical outcomes were compared across three distinct embryo cohorts: overall (n=925), top-quality (n=610) and non-top-quality (n=315). Pregnancy and live birth rates following FC-SETs were 57% and 51% higher (p ≤ 0.001) in A-score embryos as compared to non-A embryos. Multivariate analysis confirmed that the KINEVO score (OR = 1.62; p=0.015) and maternal age (OR = 0.88; p<0.0001) were independently associated with live birth. Overall, CB-SETs provided a higher clinical pregnancy rate (47.5% vs. 35.6%; p<0.0001) but a significantly higher miscarriage rate (21.6% vs. 9.5%; p=0.001) compared to FC-SETs. When a top-quality embryo was transferred, CB-SETs provided a numerically higher CPR (47.5% vs. 41.4%; p = 0.082) but a significantly higher miscarriage rate (21.4% vs. 10.5%; p = 0.011) as compared to FC-SETs, resulting in comparable live birth rates (37.4% vs. 36.5%; p = 0.46). Conversely, non-top-quality embryos achieved a 52% higher live birth rate (36.8% vs. 24.1%; p = 0.017) through CB-SETs as compared to FC-SETs. In conclusion, embryo quality must be controlled when alternative ET strategies are compared. FC-SETs can benefit patients and laboratory logistics when a top-quality embryo is produced, whereas a freeze-all strategy with CB-SETs may favor patients producing only sub-optimal embryos.
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