ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Reproduction
Volume 16 - 2025 | doi: 10.3389/fendo.2025.1644773
Impact of euploid blastocyst developmental stage and morphological grading on pregnancy outcomes in young recurrent pregnancy loss patients: Association with parental chromosomal status
Provisionally accepted
- 1Reproductive Medicine Center, Henan Provincial People's Hospital, Zhengzhou, China
- 2Reproductive Medicine Center, People’s Hospital of Zhengzhou University, Zhengzhou, China
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Objective: This study investigated the impact of blastocyst developmental stage and morphological grading on pregnancy outcomes following single euploid frozen-thawed blastocyst transfer (SE-FBT) in young patients with recurrent pregnancy loss (RPL) and balanced chromosomal translocations (BCTs), compared to patients with normal karyotypes. Methods: A retrospective cohort analysis was performed on 449 SE-FBT cycles (2017–2023), comprising 177 cycles from patients with BCT and 272 cycles from patients with normal karyotypes. Blastocysts were categorized according to their developmental stage (day 5 [D5] versus day 6 [D6]) and morphological grading (good versus poor). Multivariable logistic regression models were used to adjust for potential confounders. Results: Among BCT carriers, D5 blastocysts exhibited significantly higher clinical pregnancy rates (CPR: 83.33% vs. 62.86%; adjusted odds ratio [aOR] = 2.90, P = 0.005) and live birth rates (LBR: 75.00% vs. 51.43%; aOR = 2.6, P = 0.010) compared to D6 blastocysts, whereas morphological grading showed no significant association after adjustment. Among normokaryotypic patients, however, blastocyst morphological grading was the primary prognostic factor, with good-grade blastocysts yielding superior CPR (74.13% vs. 54.26%, aOR = 2.46, P = 0.001) and LBR (56.64% vs. 40.31%, aOR = 1.76, P = 0.039), while developmental stage had no significant effect. Conclusions: These findings suggest that the developmental stage of the blastocyst is the primary determinant of successful outcomes in BCT-associated RPL, whereas embryo morphological grading predominantly influences pregnancy outcomes in RPL patients with normal karyotypes. These results highlight the importance of personalized embryo selection strategies based on parental chromosomal status and embryological characteristics to optimize reproductive outcomes in distinct RPL populations.
Keywords: Recurrent pregnancy loss, Developmental Stage, morphological grading, euploid blastocyst transfer, Pregnancy Outcome, preimplantation genetic testing
Received: 10 Jun 2025; Accepted: 04 Sep 2025.
Copyright: © 2025 Zhang, Luo, Cui and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Cuilian Zhang, Reproductive Medicine Center, Henan Provincial People's Hospital, Zhengzhou, China
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