Published: 2022-08-29

Transfer or not to transfer? a medical dilemma

Neeta Singh, Garima Patel, Monika Saini, Ankita Sethi


Morphological assessment predominantly determines the quality of embryos although, several methods are available for it. Dilemma to transfer arises when clinicians are left with mere poor grade embryos. This case report encompasses a case of 37 years primary infertile female managed with GnRH antagonist cycle for tubal factor infertility. Post ovarian stimulation and ovum pickup, only two 4 celled grade-C embryos were available for transfer. Reluctantly the embryo was transferred, but fortunately resulted in a healthy live intrauterine pregnancy. This case report questions the aptness of the current methods to determine embryo quality and also enlightens whether the ethical or medical conundrum holds true regarding relation between embryo quality and chances of a fruitful pregnancy.


Poor grade embryo, Embryo transfer, Pregnancy outcome

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Nasiri N, Eftekhari-Yazdi P. An Overview of The Available Methods for Morphological Scoring of Pre-Implantation Embryos in In Vitro Fertilization. Cell J. 2015;16(4):392-405.

Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Hum Reprod. 2011;26(6):1270-83.

Zaninovic N, Irani M, Meseguer M. Assessment of embryo morphology and developmental dynamics by time-lapse microscopy: is there a relation to implantation and ploidy? Fertil Steril. 2017;108(5):722-9.

Oron G, Son WY, Buckett W, Tulandi T, Holzer H. The association between embryo quality and perinatal outcome of singletons born after single embryo transfers: a pilot study. Hum Reprod. 2014;29(7):1444-51.

Scott L, Finn A, O’Leary T, McLellan S, Hill J. Morphologic parameters of early cleavage-stage embryos that correlate with fetal development and delivery: prospective and applied data for increased pregnancy rates. Hum Reprod. 2007;22(1):230-40.

Bradley CK, Peura T, Dumevska B, Jovasevic A, Chami O, Schmidt U et al. Cell lines from morphologically abnormal discarded IVF embryos are typically euploid and unaccompanied by intrachromosomal aberrations. Reprod Biomed Online. 2014;28(6):780-8.

Kaartinen N, Das P, Kananen K, Huhtala H, Tinkanen H. Can repeated IVF-ICSI-cycles be avoided by using blastocysts developing from poor-quality cleavage stage embryos? Reprod Biomed Online. 2015;30(3):241-7.

Poulain M, Hesters L, Sanglier T, de Bantel A, Fanchin R, Frydman N et al. Is it acceptable to destroy or include human embryos before day 5 in research programmes? Reprod Biomed Online. 2014;28(4):522-9.

Kirillova A, Lysenkov S, Farmakovskaya M, Kiseleva Y, Martazanova B, Mishieva N et al. Should we transfer poor quality embryos? Fertil Res and Pract. 2020;6(1):2.

Oatway C, Gunby J, Daya S. Day three versus day two embryo transfer following in vitro fertilization or intracytoplasmic sperm injection. Cochrane Database Syst Rev. 2004;(2):CD004378.

Carrillo AJ, Lane B, Pridman DD, Risch PP, Pool TB, Silverman IH et al. Improved clinical outcomes for in vitro fertilization with delay of embryo transfer from 48 to 72 hours after oocyte retrieval: use of glucose- and phosphate-free media. Fertil Steril. 1998;69(2):329-34.

Lee J-W, Cha J-H, Shin S-H, Kim Y-J, Lee S-K, Park C et al. Efficacy of embryo transfer on day 2 versus day 3 according to maternal age in patients with normal ovarian response. Clin Exp Reproduct Med. 2017;44(3):141.

Mendoza R, Perez S, de Los Santos MJ, Larreategui Z, Ayerdi F, Expósito A et al. Congenital malformations, chromosomal abnormalities and perinatal results in IVF/ICSI newborns resulting from very poor-quality embryos: a case-control study. Gynecol Obstet Invest. 2015;79(2):83-9.

Alfarawati S, Fragouli E, Colls P, Stevens J, Gutiérrez-Mateo C, Schoolcraft WB et al. The relationship between blastocyst morphology, chromosomal abnormality, and embryo gender. Fertil Steril. 2011;95(2):520-4.

Fragouli E, Alfarawati S, Spath K, Wells D. Morphological and cytogenetic assessment of cleavage and blastocyst stage embryos. Mol Hum Reprod. 2014;20(2):117-26.

Munné S, Chen S, Fischer J, Colls P, Zheng X, Stevens J et al. Preimplantation genetic diagnosis reduces pregnancy loss in women aged 35 years and older with a history of recurrent miscarriages. Fertil Steril. 2005;84(2):331-5.

Minasi MG, Colasante A, Riccio T, Ruberti A, Casciani V, Scarselli F et al. Correlation between aneuploidy, standard morphology evaluation and morphokinetic development in 1730 biopsied blastocysts: a consecutive case series study. Hum Reprod. 2016;31(10):2245-54.

Shahine LK, Kuppermann M, Davis G, Creasman J, Cedars MI. Patient willingness to participate in a clinical trial with preimplantation genetic diagnosis. Fertil Steril. 2008;89(4):879-84.

Scott RT, Upham KM, Forman EJ, Zhao T, Treff NR. Cleavage-stage biopsy significantly impairs human embryonic implantation potential while blastocyst biopsy does not: a randomized and paired clinical trial. Fertil Steril. 2013;100(3):624-30.

Bielanska M, Tan SL, Ao A. Chromosomal mosaicism throughout human preimplantation development in vitro: incidence, type, and relevance to embryo outcome. Hum Reprod. 2002;17(2):413-9.

Cohen J, Wells D, Munné S. Removal of 2 cells from cleavage stage embryos is likely to reduce the efficacy of chromosomal tests that are used to enhance implantation rates. Fertil Steril. 2007;87(3):496-503.

Harton GL, Magli MC, Lundin K, Montag M, Lemmen J, Harper JC et al. ESHRE PGD Consortium/Embryology Special Interest Group--best practice guidelines for polar body and embryo biopsy for preimplantation genetic diagnosis/screening (PGD/PGS). Hum Reprod. 2011;26(1):41-6.