Evaluation of the In Vitro Fertilization Success Rate in Transfer of Top-Quality Embryo Versus Poor-Quality Embryos: A Cohort Study

Objectives: To evaluate the in vitro fertilization success rate by transferring top- versus low-quality embryos. Materials and Methods: This prospective cohort study was conducted on 199 infertile women. Ninety-nine patients underwent an agonist cycle (70 fresh embryo transfer [ET] and 29 frozen ET), and 100 patients received an antagonist cycle (28 fresh ET and 72 frozen ET) in the infertility department of a tertiary university-based hospital between May 2019 and March 2020. The blastocysts classified as AA, AB, and BB, as well as AC, BC, and CC were considered as top- and poor-quality embryos (TQE and PQE). The study outcomes were biochemical and clinical and determined the rate of pregnancy. Results: The average age of the participants was 32.44±5.25 years old. Women with TQE were significantly younger than those with PQE (31.35±4.97 vs. 34.09±5.27, P<0.001). In addition, the duration of women’s infertility was significantly (P<0.001) correlated with the embryo’s top quality. A positive β-human chorionic gonadotropin was detected in 12.6% (n=25) of women while clinical pregnancy was investigated in 8% (n=16) of them. The fetal heart rate was detected in 7.5% (n=15). Eventually, the clinical (P=0.020) and determined (P=0.030) pregnancy rates significantly differed between two study groups with a higher level in the TQE group. Conclusions: It seems that TQP transfer should be the first recommendation for infertile women, but when the double-embryo transfer (DET) is needed according to the patient’s condition, she should be informed that the quality of the second embryo may have an adverse impact on pregnancy consequences.