The Impact of Blastocyst Grade on Singleton Birthweight in Fresh Transplanted Cycles

The Impact of Blastocyst Grade on Singleton Birthweight in Fresh Transplanted Cycles | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Impact of Blastocyst Grade on Singleton Birthweight in Fresh Transplanted Cycles Qiongyao Shi, Senlin Shi, Wenyan Song, Feifei Zhao, Haixia Jin, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-726950/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: A retrospectively cohort study was performed to compare the birth weight of different blastocyst grades in fresh transplantation cycle and explore the related factors affecting the birth weight. Methods: The 1301 fresh cycles of single blastocyst transplantation and single live birth profile were analyzed,four groups were divided according to the grade of transplanted blastocyst. There are 170 cycles in group A with AA blastocyst grade, 312 cycles in group B with AB/BA blastocyst grade, 559 cycles in group C with BB/CA/AC blastocyst grade and 260 cycles in group D with BC/CB blastocyst grade. Comparison were made among four groups of birth weight, general conditions, fertilization rate, embryo rate, cleavage rate and D5,D6 blastocyst formation rate and other laboratory indicators. And then comparison were performed among the birth weight of different groups which were divided by the degree of blastocyst expansion, and the classification of inner cell mass(ICM) and the trophectoderm(TE). Results: The study shows that the birth weight of group A is significantly higher than that of the other three groups (P < 0.05). And the high quality embryo rate and blastocyst rate of group A are significantly higher than those of the other three groups (P < 0.05). What’s more, the clinical pregnancy rate, implantation rate and live birth rate of high grade blastocyst are higher, but there are no significant difference in abortion rate. The birth weight of the degree of blastocyst expansion in grade 3 and below is significantly lower than that of those with grade 3 and above (P < 0.05). The birth weight of grade A of ICM is significantly higher than that of grade B (P < 0.05). The birth weight of grade B of TE is significantly heavier than that of grade C (P < 0.05). Conclusions: Our results indicate that high grade blastocyst transplantation can achieve better pregnancy outcome. Different blastocyst grades affect birth weight, and low grade blastocyst transplantation is associated with a single birth weight loss. Maternal & Fetal Medicine Sexual & Reproductive Medicine Blastocyst transplantation blastocyst grade birth weight Fresh transplantation Pregnancy outcome Background With the development of assisted reproductive technology(ART), there are more than 5 million babies born by this way. However, in the process of in vitro fertilization and embryo transplantation(IVF-ET), even singletons live births can also increase the risk of adverse perinatal outcomes, including premature delivery, low birth weight and small gestational age problems, compared to their naturally conceived peer ( 1 – 3 ). In previous studies, more attention has been paid to the complications of infants born with ART, such as neonatal asphyxia, respiratory distress syndrome, intracranial hemorrhage, sepsis, etc ( 4 ), but there is a lack of information on birth weight around the world. Although the positive correlation between embryo quality and pregnancy outcomes has been well confirmed in many studies ( 5 , 6 ), few studies research the impact of embryo quality on neonatal weight, especially the fresh transplanted blastocysts. Therefore, this study aims to compare the birth weight of different blastocyst grades in the fresh transplantation cycle of ART to explore the related factors affecting the birth weight of infants. Methods 1. Study object The patients who received single blastocyst transplantation in the reproductive center of the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019 were selected as the research subjects, both couples have normal chromosomes; Exclusion of female uterine malformation, endometriosis, ovarian dysfunction and other related factors of female infertility. According to the level of transplanted blastocyst, it was divided into four groups: 170 cycles in group A with AA blastocyst grade, 312 cycles in group B with AB/BA blastocyst grade, 559 cycles in group C with BB/CA/AC blastocyst grade and 260 cycles in group D with BC/CB blastocyst grade. Four groups were compared with laboratory indexes such as birth weight, general conditions, fertilization rate, embryo rate, cleavage rate, D5 blastocyst formation rate and D6 blastocyst formation rate. Then blastocysts were divided into different groups according to the degree of blastocyst expansion, inner cell mass(ICM) development and trophectoderm(TE) appearance to compare the difference in birth weight. 2. Ovulation induction program and oocyte collection Controlled hyperovulation was performed with gonadotropin (GN), then oocyte retrieval was preformed by transvaginal ultrasound-guided puncture 36-37 hours after HCG injection, and the ovum crown-cumulus complex (OCCC) was identified under an autopsy microscope and collected in G-MOPS Plus culture medium (Vitrolife, Sweden). When OCCC of one side ovary were collected, washing three times with G-IVF Plus (Vitrolife, Sweden) medium and placing in a petri dish with G-IVF Plus. Then it was put into a three-gas incubator at 37℃, 6% CO 2 and 5% O 2 for further cultured and matured. 3. Blastocyst culture and transplantation Petri dishes for blastocyst culture were made the day before, D3 normal fertilized embryos, except for frozen embryos, were transferred to medium containing 50ul of G-2plus (Vitrolife, Sweden) for further culture, one embryo per droplet was cultured in a three-gas incubator until blastocyst stage. The blastocyst formation was observed and recorded at day 5 and 6. Blastocyst score was made according to Gardner scoring system, which was based on the grade of blastocyst expansion, as well as morphology of ICM and TE, the number of trophoblast cells and the density of the structure. Blastocyst grading: grade 1: early blastocyst, that is, blastocyst cavity volume is less than half of the total volume of blastocyst; Grade 2: blastocyst cavity volume is more than half of total blastocyst volume; Grade 3: blastocyst in complete dilated stage, the blastocyst cavity almost occupies the whole blastocyst; Grade 4: the expanded blastocyst, the volume of the blastocyst cavity was significantly larger than that of the early blastocyst, and the zona pellucida was thinner. Grade 5: Inhatching blastocysts, which are breaking out of the zona pellucida; Grade 6: The blastocyst has completely emerged from the zona pellucida. ICM: A indicates a large number of cells and a close bound; B indicates that the number of cells is small and the combination is loose; C means very few cells. Trophoblast cells: A denotes a large number of cells that distributed around the blastocyst; B refers to a small number of cells and a loose combination of cells; C means very few cells. 4. Blastocyst transfer Fresh blastocysts were transferred to ET dishes (G-2 plus Vitrolife, Sweden) for transfer within day 5. Before transplantation, blastocysts were transferred to another dish filled with 1ml Embryoglue (Vitrolife, Sweden). On the 35th day after transplantation, B-ultrasonography of the gestational sac was performed to determine whether a clinical pregnancy was possible. 5. Statistical analysis SPSS 21.0 software was used for statistical analysis. The independent sample t test was used for statistical analysis of the general data of patients, represented by means ± SDs. The laboratory indicators of embryo development and pregnancy outcome were tested by chi-square test, and the datas were represented by rate. P<0.05 was considered statistically significant. Results 1. General situation and birth weight of different grades of blastocyst group A total of 170,312,559 and 260 infants respectively with the grade of AA、AB/BA、BB/AC/CA、BC/CB blastocysts were transplanted in this study.There were no differences in female age, infertility years, Body mass index (BMI), Follicle-stimulating hormone(FSH),Luteinizing hormone( LH), Anti-Mu¨ llerian Hormone(AMH), intimal thickness on transplantation day, gestational age and birth sex among the four groups, but the grade of blastocyst transplant to AA’s birth weight of infants is significantly higher than the other three groups, and infants of low birth weight in group A and group B were significantly lower than that of group C and D, the difference is statistically significant. Relevant data are shown in Table 1 . Table 1 General situation and birth weight of different grades of blastocyst group Fresh A B C D χ 2 p cycle number(n) 170 312 559 260 Female age(years) 29.14 ± 3.78 29.40 ± 3.36 29.25 ± 3.92 29.43 ± 3.87 1.597 0.188 Infertility duration(years) 3.73 ± 2.78 3.41 ± 2.67 3.53 ± 2.38 3.83 ± 2.85 1.240 0.294 Female BMI(kg/m2) 23.24 ± 3.29 23.25 ± 3.24 23.45 ± 3.31 23.43 ± 3.39 1.060 0.365 Female FSH(mIU/ml) 6.13 ± 1.46 5.77 ± 1.57 6.11 ± 1.57 6.16 ± 1.86 2.508 0.057 Female LH(mIU/ml) 6.57 ± 4.54 6.66 ± 4.79 6.42 ± 4.25 7.68 ± 3.96 2.368 0.069 Female AMH(ng/ml) 5.64 ± 3.37 5.86 ± 3.13 5.48 ± 3.29 5.45 ± 3.50 0.475 0.700 Endometrial thickness(mm) 12.40 ± 2.69 12.54 ± 2.33 12.45 ± 2.55 12.47 ± 2.41 0.120 0.948 Gestational age(weeks) 38.94 ± 1.45 38.82 ± 1.37 38.83 ± 1.33 38.63 ± 1.42 1.976 0.116 Percentage of male births(%) 57.65(98/170) 59.94(187/312) 57.96(324/559) 59.23(154/260) 0.113 0.990 Birthweight(g) 3512.69 ± 506.76 B,C.D 3401.24 ± 521.99 3395.26 ± 528.62 3343.58 ± 522.09 5.584 0.001 Birthweight༜2500g(%) 1.18(2/170) C.D 1.92(6/312) C.D 5.90(33/559) 6.15(16/260) 13.710 0.003 Note: B,C,D indicate that difference between the two groups is statistically significant, P < 0.05. 2. Comparison of pregnancy outcomes in different grades of blastocyst The number of embryo transplantation(ET) cycles at AA、AB/BA、BB/AC/CA、BC/CB blastocyst grade are 300,581,1073 and 567 respectively, there are significant difference in clinical pregnancy rate, implant rate, live birth rate among four groups, P 0.05. Datas are shown in Table 2 . After abortion, Single-nucleotide polymorphism (SNP) detection cycle was counted, a total of 75 cycles, and 42 cycles is abnormal. Statistical analysis showed that there was no significant difference in the distribution of abnormal embryonic karyotype between different groups. The data showed that 30 cases were trisomy, 2 cases were triploid, 6 cases were monomers and 4 cases were structural abnormality. Details were shown in Table 3 . Table 2 Comparison of pregnancy outcomes between different levels of blastocyst Fresh A B C D χ 2 p ET cycles(n) 300 581 1073 567 - - Clinical pregnancy rate[n(%)] 196(65.33) 377(64.89) 675(62.91) 319(56.26) 11.766 0.008 Planting rate[n(%)] 192(64) 369(63.51) 665(61.98) 313(55.20) 11.117 0.011 Live birth rate[n(%)] 170(56.67) 312(53.70) 559(52.10) 260(45.86) 11.709 0.008 Abortion rate[n(%)] 20(10.2) 54(14.32) 89(13.19) 48(15.05) 2.758 0.431 Table 3 Analysis of abnormal SNP of different levels of blastocyst abortion Abortion A B C D cycles[n(%)] 8 21 30 16 Trisome [n(%)] 3(37.5) 10(47.6) 12(40.0) 5(31.3) Triploid[n(%)] 0(0.0) 1(4.8) 0(0.0) 1(6.3) Monosome[n(%)] 1(12.5) 0(0.0) 5(16.7) 0(0.0) 3. Comparison of laboratory conditions of different grades of blastocysts groups 2PN fertilization rate in group A is significantly higher than that in group D (P < 0.000); 2PN cleavage rate in group A is significantly higher than that in group D (P < 0.001); The high quality embryo rate and D6 blastocyst formation rate in group A are significantly higher than those in the other three groups (P < 0.000). The blastocyst formation rate of group A, B and C are significantly higher than that of group D (P < 0.000). The ratio of high quality blastocysts and D5 high quality blastocysts are significantly different between the groups (P < 0.000). Dates are shown in Table 4 . Table 4 Comparison of laboratory conditions of different grades of blastocysts groups Fresh A B C D χ 2 p cycle number(n) 170 312 559 260 2PN fertilization rate [n(%)] 2378(82.54) D 3972(81.79) 6880(80.94) 2889(78.99) 15.982 0.001 2PN cleavage rate [n(%)] 2362(99.33) d 3919(98.67) 6804(98.90) 2841(98.34) 11.921 0.008 Quality embryo rate [n(%)] 1920(81.29) B,C,D 3062(77.09) 5205(76.50) 1948(68.57) 125.528 0.000 blastocyst formation rate[n(%)] 1359(71.64) 2188(71.36) 3601(68.37) 1297(61.53) A,B,C 67.774 0.000 D5 blastocyst formation rate[n(%)] 920(48.50) 1928(62.88) 3138(59.58) 1023(48.53) 125.378 0.000 D6 blastocyst formation rate[n(%)] 439(23.14) 260(8.48) 463(8.79) 274(13.00) 319.152 0.000 Quality embryo ratio [n(%)] 756(39.85) 1056(34.44) 1334(25.33) 80(3.80) 841.012 0.000 * D5 quality embryo ratio [n(%)] 715(37.69) 996(32.49) 1255(23.83) 0 156.139 0.000 * D6 quality embryo ratio [n(%)] 41(2.16) 60(1.96) 79(1.50) 80(3.80) A,B,C 38.891 0.000 Note: *: There were significant differences between groups, after correction P < 0.000; “A”,”B”,”C”,”D” indicate that significant differences were detected between the two groups,after correction P < 0.000; “d” indicate that significant differences were detected between the two groups,after correction P < 0.001; 4. Relationship between the grade of blastocyst expansion, ICM, TE level and birth weight The birth weight of infants with blastocysts grade 3 and below is significantly lower than that of infants with blastocysts grade 3 and above (P < 0.05), while the former is significantly higher than the later in low birth weight, (P < 0.05). The birth weight of infants with level A of ICM is significantly higher than that of blastocysts with level B, and the incidence rate of low birth weight infants of group A is significantly lower than that of group B, with statistical significance (P < 0.05). The birth weight of infants with level B of TE is significantly higher than that of level C, P 3 A B A B C n 289 1012 - - 476 825 - - 153 866 282 - - Birthweight(g) 3365.10 ± 571.65 3427.96± 533.57 1.738 0.041 3470.21 ± 515.02 3381.37 ± 526.74 8.727 0.003 3402.68 ± 492.13 3441.52 ± 526.13 C 3335.04 ± 527.88 4.455 0.012 Birthweight༜2500g 6.57(19/289) 2.87(29/1010) 8.659 0.003 1.26(6/476) 4.48(37/825) 9.819 0.002 2.61(4/153) 3.0(26/866) 4.61(13/282) 1.979 0.372 Note : C: There was significant difference between group B and group C. P < 0.05. Discussion Our study suggests that the grade of transplanted blastocysts is related to the birth weight of infants, and the birth weight of the grade AA blastocysts is significantly higher than that of other grades, and the incidence of low birth weight infants is significantly lower than that of other grades of blastocysts. At the same time, the grade of blastocyst expansion, ICM development and TE appearance all have a certain influence on the birth weight of infants, especially the blastocyst level above 3, the ICM level of the A blastocyst can better avoid the birth of low birth weight infants, this is consistent with previous research results ( 7 ). However, Ebner et al. believe that TE is the only relevant parameter that significantly affects the outcome of pregnancy, and is related to the birth weight by affecting the growth and development of the placenta ( 8 ). We believe that this difference may be due to the different grouping standards used in different studies, and the differences in the ratings of embryos by operators of different proficiency. In addition, the effect of transplanted blastocyst quality on pregnancy outcomes is different ( 5 , 9 ). The results of this study suggests that high-grade blastocyst transplantation can obtain better pregnancy outcome, but it has no significant effect on abortion rate. Previous studies have shown that multiple pregnancy rate was obviously reduced by single blastocyst transplant ( 5 , 10 ), thereby complications during pregnancy and the negative impacts of perinatal outcome were reduced ( 11 ), meanwhile, the clinical pregnancy rate and singletons live birth rate were improved ( 12 ), therefore, the proportion of blastocyst embryo transfer is increasing. Many studies have shown that high quality blastocyst transfer can achieve a better clinical pregnancy rate and live birth rate ( 13 ). Akamine Kozue et al, however, think that blastocyst quality has no significant effect on neonatal outcome, including birth weight ( 14 ). This difference may be related to its small sample size and single. Studies have suggested that the selection of transplanted blastocysts is very important for single blastocyst transplantation without affecting the embryo implantation rate, clinical pregnancy rate, live birth rate and other indicators ( 15 , 16 ). The causes of low grade blastocysts leading to birth weight loss are unclear. Some studies believe that the changes in deoxyribonucleic acid(DNA) methylation of poor quality embryos are uncontrollable ( 17 ), so epigenetic changes may play an important role. In addition, multiple exposures were involved in the in vitro culture stage of ART, such as changes in DNA methylation caused by embryo operation, culture and implantation, which may also had adverse effects on placenta development and fetal growth ( 17 , 18 ). Studies have also shown that when embryos are damaged in development, they are more active in metabolism, stress and other aspects than normal embryos, producing more reactive oxygen species and adenosine triphosphate(ATP). Therefore, metabolic disorder and imbalance in vivo may also be the reason why low grade blastocyst transplantation leads to lower birth weight ( 19 ). Another cause of birth weight loss due to low grade blastocyst transplantation may be related to maternal uterine factors, In vitro studies have shown that the endometrium has the function of a biosensor to identify embryo quality ( 20 ), that is, after embryo implantation, it can actively transmit information to facilitate implantation by improving the internal uterine environment, decuvialized endometrium stromal cells can receive and identify high quality and inferior embryos, and respond to them by producing different growth factors or cytokines, but the response to inferior embryos is greater than that of high quality embryos, more energy is required to participate in the repair of developmental damage. These reactions and changes may have an impact on the uterine environment of embryo implantation, thus affecting placenta formation and subsequent embryo development and fetal growth ( 21 ). Conclusions this study believes that in the fresh transfer cycle, the blastocyst level has a greater impact on the pregnancy outcome and the birth weight. The blastocyst grade is also related to laboratory indicators such as the rate of high quality embryos and the rate of high quality blastocysts. In the selection process of blastocyst transplant, paying attention to the size of the blastocyst cavity and ICM is beneficial to reduce the birth of low birth weight infants. Abbreviations ICM: Inner cell mass TE: Trophectoderm ART: Assisted reproductive technology IVF-ET: In vitro fertilization and embryo transplantation GN: Gonadotropin OCCC: Ovum crown-cumulus complex G-IVF: CO 2 : O 2 : BMI: body mass index FSH: Follicle-stimulating hormone LH: Luteinizing hormone AMH: Anti-Mullerian Hormone ET: embryo transplantation SNP: Single-nucleotide polymorphism DNA: Deoxyribonucleic acid ATP: Adenosine triphosphate Declarations Ethics approval and content to participate All study participants gave verbal informed consent, this study was approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University as it was a retrospective study and no interventions was given to the participants. Approval Number: 2019-KY-39. This manuscript reported adherence to Declaration of Helsinki. Consent for publication All authors gave their consent for publication. Availability of data and materials The datasets used during the current study are available from the corresponding author on reasonable request. Competing Interests The authors declare that they have no competing interests. Funding The study was supported by grants from National Natural Science Foundation of China(81701527 to Senlin Shi, 81571409 to Yihong Guo) and Youth Program of National Natural Science Foundation of China(82001529 to Feifei Zhao). Author Contributions SSL and GYH designed the study. SWY, ZFF, JHX, YGD and LY were responsible for the study subjects’ enrollment and the collection of data. SQY, and SH analyzed the data and SQY was a major contributor in writing the manuscript. All authors read and approved the final manuscript. Acknowledgements Not applicable References Berntsen S, Soderstrom-Anttila V, Wennerholm U. B, Laivuori H, Loft A, Oldereid N. B. et al. The health of children conceived by ART: 'the chicken or the egg?'. 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Journal of Genetics and Genomics. 2017;44:475–81. doi: 10.1016/j.jgg.2017.09.001 . Mani S, Ghosh J, Coutifaris C, Sapienza C, Mainigi M. Epigenetic changes and assisted reproductive technologies. Epigenetics. 2020;15:12–25.doi: 10.1080/15592294.2019.1646572 . Leese H. J, Sturmey R. G, Baumann C. G, McEvoy T. G. Embryo viability and metabolism: obeying the quiet rules. Hum Reprod. 2007;22:3047–50. doi: 10.1093/humrep/dem253 . Macklon N. S, Brosens J. J. The human endometrium as a sensor of embryo quality. Biol Reprod. 2014;91:98.doi: 10.1095/biolreprod.114.122846 . Brosens J. J, Salker M. S, Teklenburg G, Nautiyal J, Salter S, Lucas E. S. et al. Uterine selection of human embryos at implantation. Scientific reports. 201; 4:3894. doi: 10.1038/srep03894 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-726950","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":42632583,"identity":"a8b0aba1-15ad-4740-96bc-a1eef074dcb8","order_by":0,"name":"Qiongyao Shi","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qiongyao","middleName":"","lastName":"Shi","suffix":""},{"id":42632584,"identity":"9db7cf51-873c-4070-967b-0ec5b1f53868","order_by":1,"name":"Senlin Shi","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Senlin","middleName":"","lastName":"Shi","suffix":""},{"id":42632585,"identity":"60000f55-d392-4903-87ce-e3e9d1e44a58","order_by":2,"name":"Wenyan Song","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wenyan","middleName":"","lastName":"Song","suffix":""},{"id":42632586,"identity":"8cff0ef7-1a1d-42a9-80c6-86e6a523356e","order_by":3,"name":"Feifei Zhao","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Feifei","middleName":"","lastName":"Zhao","suffix":""},{"id":42632587,"identity":"500938af-8764-4bc7-9894-13a37b7fb978","order_by":4,"name":"Haixia Jin","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Haixia","middleName":"","lastName":"Jin","suffix":""},{"id":42632588,"identity":"48ff4d16-aabb-47a2-9a51-d84669d120ae","order_by":5,"name":"Hao Shi","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hao","middleName":"","lastName":"Shi","suffix":""},{"id":42632589,"identity":"d0b092e0-95b0-45e3-a6ea-124fa19d8d54","order_by":6,"name":"Guidong Yao","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Guidong","middleName":"","lastName":"Yao","suffix":""},{"id":42632590,"identity":"d92177ac-1830-4335-a7b4-aadedc15669c","order_by":7,"name":"Yan Liu","email":"","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Liu","suffix":""},{"id":42632591,"identity":"528183f9-d27f-41b6-8a7b-da89e2ecfba6","order_by":8,"name":"Yihong Guo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIie3RoQ7CMBCA4VsuqRrMloSA4AWqUARepQvJFCTIignIyBBAsDwGElloMkwBi0AMg2YOycBC6HCIfrp/rtcCWNYfIl4kNzfRaneUM0q5CM1JmSa+ojrowg4VS3ViTmrQa8hSvHWGRxJULmMscDHQIKmW6ERuU/hDAt5kyr8nOJdyIM5lRLd58tdVoHq/Mkw58HzKFckr0QQY7ZuSHst3Uc4sTwZ+jD8kSyQBFEtowl+PzBAV5TpxjbvUF5HKnl/JvM0ou4uw5k3m35M37m/HLcuyrI8eqDtNNjE+ySMAAAAASUVORK5CYII=","orcid":"","institution":"First Affiliated Hospital of Zhengzhou University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yihong","middleName":"","lastName":"Guo","suffix":""}],"badges":[],"createdAt":"2021-07-17 03:59:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-726950/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-726950/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":15017196,"identity":"e0e80bcd-754a-416b-a890-22318e6c7c70","added_by":"auto","created_at":"2021-10-29 08:46:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":380614,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-726950/v1/c8400ef0-818b-4276-9fa7-6890a3de2fa1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eThe Impact of Blastocyst Grade on Singleton Birthweight in Fresh Transplanted Cycles\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003e \u003cem\u003eWith the development of assisted reproductive technology(ART), there are more than 5\u0026nbsp;million babies born by this way. However, in the process of in vitro fertilization and embryo transplantation(IVF-ET), even singletons live births can also increase the risk of adverse perinatal outcomes, including premature delivery, low birth weight and small gestational age problems, compared to their naturally conceived peer\u003c/em\u003e(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). \u003cem\u003eIn previous studies, more attention has been paid to the complications of infants born with ART, such as neonatal asphyxia, respiratory distress syndrome, intracranial hemorrhage, sepsis, etc\u003c/em\u003e(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), \u003cem\u003ebut there is a lack of information on birth weight around the world. Although the positive correlation between embryo quality and pregnancy outcomes has been well confirmed in many studies\u003c/em\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), \u003cem\u003efew studies research the impact of embryo quality on neonatal weight, especially the fresh transplanted blastocysts. Therefore, this study aims to compare the birth weight of different blastocyst grades in the fresh transplantation cycle of ART to explore the related factors affecting the birth weight of infants.\u003c/em\u003e\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003e\u003cem\u003e1. Study object\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eThe patients who received single blastocyst transplantation in the reproductive center of the First Affiliated Hospital of Zhengzhou University from January 2016 to December 2019 were selected as the research subjects, both couples have normal chromosomes; Exclusion of female uterine malformation, endometriosis, ovarian dysfunction and other related factors of female infertility. According to the level of transplanted blastocyst, it was divided into four groups: 170 cycles in group A with AA blastocyst grade, 312 cycles in group B with AB/BA blastocyst grade, 559 cycles in group C with BB/CA/AC blastocyst grade and 260 cycles in group D with BC/CB blastocyst grade. Four groups were compared with laboratory indexes such as birth weight, general conditions, fertilization rate, embryo rate, cleavage rate, D5 blastocyst formation rate and D6 blastocyst formation rate. Then blastocysts were divided into different groups according to the degree of blastocyst expansion, inner cell mass(ICM) development and\u0026nbsp;\u003c/em\u003e\u003cem\u003etrophectoderm(TE) appearance to compare\u003c/em\u003e\u003cem\u003e\u0026nbsp;the difference in birth weight.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003e2. Ovulation induction program and oocyte collection\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eControlled hyperovulation was performed with gonadotropin (GN), then oocyte retrieval was preformed by transvaginal ultrasound-guided puncture 36-37 hours after HCG injection, and the ovum crown-cumulus complex (OCCC) was identified under an autopsy microscope and collected in G-MOPS Plus culture medium (Vitrolife, Sweden). When OCCC of one side ovary were collected, washing three times with G-IVF Plus (Vitrolife, Sweden) medium and placing in a petri dish with G-IVF Plus. Then it was put into a three-gas incubator at 37℃, 6% CO\u003csub\u003e2\u003c/sub\u003e and 5% O\u003csub\u003e2\u003c/sub\u003e for further cultured and matured.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003e3. Blastocyst culture and transplantation\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003ePetri dishes for blastocyst culture were made the day before, D3 normal fertilized embryos, except for frozen embryos, were transferred to medium containing 50ul of G-2plus (Vitrolife, Sweden) for further culture, one embryo per droplet was cultured in a three-gas incubator until blastocyst stage. The blastocyst formation was observed and recorded at day 5 and 6. Blastocyst score was made according to Gardner scoring system, which was based on the grade of blastocyst expansion, as well as morphology of ICM and TE, the number of trophoblast cells and the density of the structure. Blastocyst grading: grade 1: early blastocyst, that is, blastocyst cavity volume is less than half of the total volume of blastocyst; Grade 2: blastocyst cavity volume is more than half of total blastocyst volume; Grade 3: blastocyst in complete dilated stage, the blastocyst cavity almost occupies the whole blastocyst; Grade 4: the expanded blastocyst, the volume of the blastocyst cavity was significantly larger than that of the early blastocyst, and the zona pellucida was thinner. Grade 5: Inhatching blastocysts, which are breaking out of the zona pellucida; Grade 6: The blastocyst has completely emerged from the zona pellucida. ICM: A indicates a large number of cells and a close bound; B indicates that the number of cells is small and the combination is loose; C means very few cells. Trophoblast cells: A denotes a large number of cells that distributed around the blastocyst; B refers to a small number of cells and a loose combination of cells; C means very few cells.\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003e4. Blastocyst transfer\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eFresh blastocysts were transferred to ET dishes (G-2 plus Vitrolife, Sweden) for transfer within day 5. Before transplantation, blastocysts were transferred to another dish filled with 1ml Embryoglue (Vitrolife, Sweden). On the 35th day after transplantation, B-ultrasonography of the gestational sac was performed to determine whether a clinical pregnancy was possible.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003e5. Statistical analysis\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eSPSS 21.0 software was used for statistical analysis. The independent sample t test was used for statistical analysis of the general data of patients, represented by means\u003c/em\u003e\u003cem\u003e\u0026plusmn;\u003c/em\u003e\u003cem\u003eSDs. The laboratory indicators of embryo development and pregnancy outcome were tested by chi-square test, and the datas were represented by rate. P\u0026lt;0.05 was considered statistically significant.\u003c/em\u003e\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec9\"\u003e\n \u003ch2\u003e\u003cem\u003e1. General situation and birth weight of different grades of blastocyst group\u003c/em\u003e\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eA total of 170,312,559 and 260 infants respectively with the grade of AA、AB/BA、BB/AC/CA、BC/CB blastocysts were transplanted in this study.There were no differences in female age, infertility years, Body mass index\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e(BMI), Follicle-stimulating hormone(FSH),Luteinizing hormone( LH), Anti-Mu\u0026uml; llerian Hormone(AMH), intimal thickness on transplantation day, gestational age and birth sex among the four groups, but the grade of blastocyst transplant to AA\u0026rsquo;s birth weight of infants is significantly higher than the other three groups, and infants of low birth weight in group A and group B were significantly lower than that of group C and D, the difference is statistically significant. Relevant data are shown in\u003c/em\u003e Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGeneral situation and birth weight of different grades of blastocyst group\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFresh\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eA\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eC\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eD\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ecycle number(n)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e170\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e312\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e559\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e260\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFemale age(years)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e29.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e29.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.36\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e29.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.92\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e29.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e1.597\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.188\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eInfertility duration(years)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.78\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.67\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3.53\u0026thinsp;\u0026plusmn;\u0026thinsp;2.38\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e1.240\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.294\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFemale BMI(kg/m2)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e23.24\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e23.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.24\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e23.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e23.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e1.060\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.365\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFemale FSH(mIU/ml)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.46\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5.77\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e2.508\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.057\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFemale LH(mIU/ml)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.57\u0026thinsp;\u0026plusmn;\u0026thinsp;4.54\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.66\u0026thinsp;\u0026plusmn;\u0026thinsp;4.79\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.42\u0026thinsp;\u0026plusmn;\u0026thinsp;4.25\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e7.68\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e2.368\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.069\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFemale AMH(ng/ml)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5.64\u0026thinsp;\u0026plusmn;\u0026thinsp;3.37\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5.86\u0026thinsp;\u0026plusmn;\u0026thinsp;3.13\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5.48\u0026thinsp;\u0026plusmn;\u0026thinsp;3.29\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5.45\u0026thinsp;\u0026plusmn;\u0026thinsp;3.50\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.475\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.700\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eEndometrial thickness(mm)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e12.40\u0026thinsp;\u0026plusmn;\u0026thinsp;2.69\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e12.54\u0026thinsp;\u0026plusmn;\u0026thinsp;2.33\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e12.45\u0026thinsp;\u0026plusmn;\u0026thinsp;2.55\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e12.47\u0026thinsp;\u0026plusmn;\u0026thinsp;2.41\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.120\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.948\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eGestational age(weeks)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e38.94\u0026thinsp;\u0026plusmn;\u0026thinsp;1.45\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e38.82\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e38.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.33\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e38.63\u0026thinsp;\u0026plusmn;\u0026thinsp;1.42\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e1.976\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.116\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ePercentage of male births(%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e57.65(98/170)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e59.94(187/312)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e57.96(324/559)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e59.23(154/260)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.113\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.990\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBirthweight(g)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3512.69\u0026thinsp;\u0026plusmn;\u0026thinsp;506.76\u003c/em\u003e\u003csup\u003e\u003cem\u003eB,C.D\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3401.24\u0026thinsp;\u0026plusmn;\u0026thinsp;521.99\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3395.26\u0026thinsp;\u0026plusmn;\u0026thinsp;528.62\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3343.58\u0026thinsp;\u0026plusmn;\u0026thinsp;522.09\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e5.584\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBirthweight༜2500g(%)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.18(2/170)\u003c/em\u003e\u003csup\u003e\u003cem\u003eC.D\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.92(6/312)\u003c/em\u003e\u003csup\u003e\u003cem\u003eC.D\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5.90(33/559)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.15(16/260)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e13.710\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cem\u003eNote: B,C,D indicate that difference between the two groups is statistically significant, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch2\u003e\u003cem\u003e2. Comparison of pregnancy outcomes in different grades of blastocyst\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eThe number of embryo transplantation(ET) cycles at AA、AB/BA、BB/AC/CA、BC/CB blastocyst grade are 300,581,1073 and 567 respectively, there are significant difference in clinical pregnancy rate, implant rate, live birth rate among four groups, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05; while no difference observed on abortion rate between the four groups, P\u0026thinsp;\u0026gt;\u0026thinsp;0.05. Datas are shown in\u003c/em\u003e Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. \u003cem\u003eAfter abortion, Single-nucleotide polymorphism (SNP) detection cycle was counted, a total of 75 cycles, and 42 cycles is abnormal. Statistical analysis showed that there was no significant difference in the distribution of abnormal embryonic karyotype between different groups. The data showed that 30 cases were trisomy, 2 cases were triploid, 6 cases were monomers and 4 cases were structural abnormality. Details were shown in\u003c/em\u003e Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of pregnancy outcomes between different levels of blastocyst\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFresh\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eA\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eC\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eD\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eET cycles(n)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e300\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e581\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1073\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e567\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eClinical pregnancy rate[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e196(65.33)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e377(64.89)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e675(62.91)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e319(56.26)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e11.766\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.008\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ePlanting rate[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e192(64)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e369(63.51)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e665(61.98)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e313(55.20)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e11.117\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.011\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eLive birth rate[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e170(56.67)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e312(53.70)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e559(52.10)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e260(45.86)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e11.709\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.008\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eAbortion rate[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e20(10.2)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e54(14.32)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e89(13.19)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e48(15.05)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2.758\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.431\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab3\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAnalysis of abnormal SNP of different levels of blastocyst abortion\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eAbortion\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eA\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eC\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eD\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ecycles[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e8\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e21\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e30\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e16\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eTrisome [n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3(37.5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e10(47.6)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e12(40.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5(31.3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eTriploid[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0(0.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1(4.8)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0(0.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1(6.3)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eMonosome[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1(12.5)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0(0.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5(16.7)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0(0.0)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cspan class=\"BoldItalic\" name=\"Emphasis\" type=\"BoldItalic\"\u003e\u003cem\u003e3. Comparison of laboratory conditions of different grades of blastocysts groups\u003c/em\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003e2PN fertilization rate in group A is significantly higher than that in group D (P\u0026thinsp;\u0026lt;\u0026thinsp;0.000); 2PN cleavage rate in group A is significantly higher than that in group D (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001); The high quality embryo rate and D6 blastocyst formation rate in group A are significantly higher than those in the other three groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.000). The blastocyst formation rate of group A, B and C are significantly higher than that of group D (P\u0026thinsp;\u0026lt;\u0026thinsp;0.000). The ratio of high quality blastocysts and D5 high quality blastocysts are significantly different between the groups (P\u0026thinsp;\u0026lt;\u0026thinsp;0.000). Dates are shown in\u003c/em\u003e Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable border=\"1\" id=\"Tab4\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of laboratory conditions of different grades of blastocysts groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eFresh\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eA\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eC\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eD\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ecycle number(n)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e170\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e312\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e559\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e260\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2PN fertilization rate\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2378(82.54)\u003c/em\u003e\u003csup\u003e\u003cem\u003eD\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3972(81.79)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6880(80.94)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2889(78.99)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e15.982\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.001\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2PN cleavage rate\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2362(99.33)\u003c/em\u003e\u003csup\u003e\u003cem\u003ed\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3919(98.67)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6804(98.90)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2841(98.34)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e11.921\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.008\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eQuality embryo rate\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1920(81.29)\u003c/em\u003e\u003csup\u003e\u003cem\u003eB,C,D\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3062(77.09)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e5205(76.50)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1948(68.57)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e125.528\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eblastocyst formation rate[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1359(71.64)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2188(71.36)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3601(68.37)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1297(61.53)\u003c/em\u003e\u003csup\u003e\u003cem\u003eA,B,C\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e67.774\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eD5 blastocyst formation rate[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e920(48.50)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1928(62.88)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3138(59.58)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1023(48.53)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e125.378\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eD6 blastocyst formation rate[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e439(23.14)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e260(8.48)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e463(8.79)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e274(13.00)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e319.152\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eQuality embryo ratio\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e756(39.85)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1056(34.44)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1334(25.33)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e80(3.80)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e841.012\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003csup\u003e\u003cem\u003e*\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eD5 quality embryo ratio\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e715(37.69)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e996(32.49)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1255(23.83)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e156.139\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003csup\u003e\u003cem\u003e*\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eD6 quality embryo ratio\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e[n(%)]\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e41(2.16)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e60(1.96)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e79(1.50)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e80(3.80)\u003c/em\u003e\u003csup\u003e\u003cem\u003eA,B,C\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e38.891\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e0.000\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003e\u003cem\u003eNote: *: There were significant differences between groups, after correction P\u0026thinsp;\u0026lt;\u0026thinsp;0.000;\u003c/em\u003e\u003cbr\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;A\u0026rdquo;,\u0026rdquo;B\u0026rdquo;,\u0026rdquo;C\u0026rdquo;,\u0026rdquo;D\u0026rdquo; indicate that significant differences were detected between the two groups,after correction P\u0026thinsp;\u0026lt;\u0026thinsp;0.000;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;d\u0026rdquo; indicate that significant differences were detected between the two groups,after correction P\u0026thinsp;\u0026lt;\u0026thinsp;0.001;\u003c/em\u003e\u003c/p\u003e\u003cbr\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cspan class=\"BoldItalic\" name=\"Emphasis\" type=\"BoldItalic\"\u003e\u003cem\u003e4. Relationship between the grade of blastocyst expansion, ICM, TE level and birth weight\u003c/em\u003e\u003c/span\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eThe birth weight of infants with blastocysts grade 3 and below is significantly lower than that of infants with blastocysts grade 3 and above (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), while the former is significantly higher than the later in low birth weight, (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The birth weight of infants with level A of ICM is significantly higher than that of blastocysts with level B, and the incidence rate of low birth weight infants of group A is significantly lower than that of group B, with statistical significance (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The birth weight of infants with level B of TE is significantly higher than that of level C, P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Seen\u003c/em\u003e Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u0026nbsp;\u003c/p\u003e\u0026nbsp;\u003ctable border=\"1\" id=\"Tab5\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRelationship between cystic cavity expansion, endocytic cell mass, ectodermal trophoblast cell level and birth weight\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eFresh\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eblastocyst level\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eICM\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003e\u003cem\u003eTE\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026chi;\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026le;\u0026thinsp;3\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026gt;3\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eA\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eA\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eC\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e289\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1012\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e476\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e825\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e153\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e866\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e282\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003e-\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBirthweight(g)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3365.10\u0026thinsp;\u0026plusmn;\u0026thinsp;571.65\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3427.96\u0026plusmn;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e533.57\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.738\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.041\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3470.21\u0026thinsp;\u0026plusmn;\u0026thinsp;515.02\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3381.37\u0026thinsp;\u0026plusmn;\u0026thinsp;526.74\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e8.727\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3402.68\u0026thinsp;\u0026plusmn;\u0026thinsp;492.13\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3441.52\u0026thinsp;\u0026plusmn;\u0026thinsp;526.13\u003c/em\u003e\u003csup\u003e\u003cem\u003eC\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3335.04\u0026thinsp;\u0026plusmn;\u0026thinsp;527.88\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e4.455\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.012\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBirthweight༜2500g\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e6.57(19/289)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2.87(29/1010)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e8.659\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.003\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.26(6/476)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e4.48(37/825)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e9.819\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.002\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e2.61(4/153)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e3.0(26/866)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e4.61(13/282)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e1.979\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e0.372\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"15\"\u003e\u003cem\u003eNote : C: There was significant difference between group B and group C. P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cem\u003eOur study suggests that the grade of transplanted blastocysts is related to the birth weight of infants, and the birth weight of the grade AA blastocysts is significantly higher than that of other grades, and the incidence of low birth weight infants is significantly lower than that of other grades of blastocysts. At the same time, the grade of blastocyst expansion, ICM development and TE appearance all have a certain influence on the birth weight of infants, especially the blastocyst level above 3, the ICM level of the A blastocyst can better avoid the birth of low birth weight infants, this is consistent with previous research results\u003c/em\u003e(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). \u003cem\u003eHowever, Ebner et al. believe that TE is the only relevant parameter that significantly affects the outcome of pregnancy, and is related to the birth weight by affecting the growth and development of the placenta\u003c/em\u003e(\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). \u003cem\u003eWe believe that this difference may be due to the different grouping standards used in different studies, and the differences in the ratings of embryos by operators of different proficiency. In addition, the effect of transplanted blastocyst quality on pregnancy outcomes is different\u003c/em\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). \u003cem\u003eThe results of this study suggests that high-grade blastocyst transplantation can obtain better pregnancy outcome, but it has no significant effect on abortion rate.\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003ePrevious studies have shown that multiple pregnancy rate was obviously reduced by single blastocyst transplant\u003c/em\u003e(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), \u003cem\u003ethereby complications during pregnancy and the negative impacts of perinatal outcome were reduced\u003c/em\u003e(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), \u003cem\u003emeanwhile, the clinical pregnancy rate and singletons live birth rate were improved\u003c/em\u003e(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), \u003cem\u003etherefore, the proportion of blastocyst embryo transfer is increasing. Many studies have shown that high quality blastocyst transfer can achieve a better clinical pregnancy rate and live birth rate\u003c/em\u003e(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). \u003cem\u003eAkamine Kozue et al, however, think that blastocyst quality has no significant effect on neonatal outcome, including birth weight\u003c/em\u003e(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). \u003cem\u003eThis difference may be related to its small sample size and single. Studies have suggested that the selection of transplanted blastocysts is very important for single blastocyst transplantation without affecting the embryo implantation rate, clinical pregnancy rate, live birth rate and other indicators\u003c/em\u003e(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003eThe causes of low grade blastocysts leading to birth weight loss are unclear. Some studies believe that the changes in deoxyribonucleic acid(DNA) methylation of poor quality embryos are uncontrollable\u003c/em\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), \u003cem\u003eso epigenetic changes may play an important role. In addition, multiple exposures were involved in the in vitro culture stage of ART, such as changes in DNA methylation caused by embryo operation, culture and implantation, which may also had adverse effects on placenta development and fetal growth\u003c/em\u003e(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). \u003cem\u003eStudies have also shown that when embryos are damaged in development, they are more active in metabolism, stress and other aspects than normal embryos, producing more reactive oxygen species and adenosine triphosphate(ATP). Therefore, metabolic disorder and imbalance in vivo may also be the reason why low grade blastocyst transplantation leads to lower birth weight\u003c/em\u003e(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). \u003cem\u003eAnother cause of birth weight loss due to low grade blastocyst transplantation may be related to maternal uterine factors, In vitro studies have shown that the endometrium has the function of a biosensor to identify embryo quality\u003c/em\u003e(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), \u003cem\u003ethat is, after embryo implantation, it can actively transmit information to facilitate implantation by improving the internal uterine environment, decuvialized endometrium stromal cells can receive and identify high quality and inferior embryos, and respond to them by producing different growth factors or cytokines, but the response to inferior embryos is greater than that of high quality embryos, more energy is required to participate in the repair of developmental damage. These reactions and changes may have an impact on the uterine environment of embryo implantation, thus affecting placenta formation and subsequent embryo development and fetal growth\u003c/em\u003e(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e \u003cem\u003ethis study believes that in the fresh transfer cycle, the blastocyst level has a greater impact on the pregnancy outcome and the birth weight. The blastocyst grade is also related to laboratory indicators such as the rate of high quality embryos and the rate of high quality blastocysts. In the selection process of blastocyst transplant, paying attention to the size of the blastocyst cavity and ICM is beneficial to reduce the birth of low birth weight infants.\u003c/em\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cem\u003eICM: Inner cell mass\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTE: Trophectoderm\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eART: Assisted reproductive technology\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eIVF-ET: In vitro fertilization and embryo transplantation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eGN: Gonadotropin\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eOCCC: Ovum crown-cumulus complex\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eG-IVF:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCO\u003csub\u003e2\u003c/sub\u003e:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eO\u003csub\u003e2\u003c/sub\u003e:\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eBMI: body mass index\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFSH: Follicle-stimulating hormone\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLH: Luteinizing hormone\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAMH: Anti-Mullerian Hormone\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eET: embryo transplantation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eSNP: Single-nucleotide polymorphism\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDNA: Deoxyribonucleic acid\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eATP: Adenosine triphosphate\u003c/em\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cem\u003eEthics approval and content to participate\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eAll study participants gave verbal informed consent, this study\u0026nbsp;\u003c/em\u003e\u003cem\u003ewas approved by the Ethics Committee of the First Affiliated Hospital of Zhengzhou University\u0026nbsp;\u003c/em\u003e\u003cem\u003eas it was a retrospective study and no interventions was given to the participants.\u0026nbsp;\u003c/em\u003e\u003cem\u003eApproval Number: 2019-KY-39.\u003c/em\u003e\u003cem\u003e\u0026nbsp;This manuscript reported adherence to Declaration of Helsinki.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eConsent for publication\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eAll authors gave their consent for publication.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eThe datasets used during the current study are available from the corresponding author on reasonable request.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eCompeting Interests\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eThe authors declare that they have no competing interests.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eFunding\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eThe study was supported by grants from National Natural Science Foundation of China(81701527 to Senlin Shi, 81571409 to Yihong Guo) and Youth Program of National Natural Science Foundation of China(82001529 to Feifei Zhao).\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAuthor Contributions\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eSSL and GYH designed the study. SWY, ZFF, JHX, YGD and LY were responsible for the study subjects\u0026rsquo; enrollment and the collection of data. SQY, and SH analyzed the data and SQY was a major contributor in writing the manuscript. All authors read and approved the final manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003ch2\u003e\u003cem\u003eAcknowledgements\u0026nbsp;\u003c/em\u003e\u003c/h2\u003e\n\u003cp\u003e\u003cem\u003eNot applicable\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e \u003cli\u003e\u003cspan\u003eBerntsen S, Soderstrom-Anttila V, Wennerholm U. B, Laivuori H, Loft A, Oldereid N. B. et al. The health of children conceived by ART: 'the chicken or the egg?'. 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Chin Med J (Engl).2018;131:1261-7. doi:l10.4103/0366-6999.232808.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkamine K, Mekaru K, Gibo K, Nagata C, Oishi S, Miyagi M. et al. Comparative study of obstetric and neonatal outcomes of live births between poor- and good-quality embryo transfers. Reprod Med Biol. 2018;17:188\u0026ndash;94. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/rmb2.12090\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYiqun J, Dong L, Shanshan W, un C. L, Jianbin S, Ningyuan Z. Influence of overall blastocyst quality on pregnancy and neonate outcome after single frozen blastocyst transfer. Journal of Reproductive Medicine. 2019;8. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3969/j.issn.1004-3845.2019.08.009\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBakkensen J. B, Brady P, Carusi D, Romanski P, Thomas A. M, Racowsky C. Association between blastocyst morphology and pregnancy and perinatal outcomes following fresh and cryopreserved embryo transfer. J Assist Reprod Genet. 2019;36:2315\u0026ndash;24. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10815-019-01580-0\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi G, Yu Y, Fan Y, Li C, Xu X, Duan J. et al. Genome wide abnormal DNA methylome of human blastocyst in assisted reproductive technology. Journal of Genetics and Genomics. 2017;44:475\u0026ndash;81. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jgg.2017.09.001\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMani S, Ghosh J, Coutifaris C, Sapienza C, Mainigi M. Epigenetic changes and assisted reproductive technologies. Epigenetics. 2020;15:12\u0026ndash;25.doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/15592294.2019.1646572\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeese H. J, Sturmey R. G, Baumann C. G, McEvoy T. G. Embryo viability and metabolism: obeying the quiet rules. Hum Reprod. 2007;22:3047\u0026ndash;50. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/humrep/dem253\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacklon N. S, Brosens J. J. The human endometrium as a sensor of embryo quality. Biol Reprod. 2014;91:98.doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1095/biolreprod.114.122846\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrosens J. J, Salker M. S, Teklenburg G, Nautiyal J, Salter S, Lucas E. S. et al. Uterine selection of human embryos at implantation. Scientific reports. 201; 4:3894. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1038/srep03894\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Blastocyst transplantation, blastocyst grade, birth weight, Fresh transplantation, Pregnancy outcome","lastPublishedDoi":"10.21203/rs.3.rs-726950/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-726950/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBackground:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e A retrospectively cohort study was performed to compare the birth weight of different blastocyst grades in fresh transplantation cycle and explore the related factors affecting the birth weight. \u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eMethods:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e The 1301 fresh cycles of single blastocyst transplantation and single live birth profile were analyzed,four groups were divided according to the grade of transplanted blastocyst. There are 170 cycles in group A with AA blastocyst grade, 312 cycles in group B with AB/BA blastocyst grade, 559 cycles in group C with BB/CA/AC blastocyst grade and 260 cycles in group D with BC/CB blastocyst grade. Comparison were made among four groups of birth weight, general conditions, fertilization rate, embryo rate, cleavage rate and D5,D6 blastocyst formation rate and other laboratory indicators. And then comparison were performed among the birth weight of different groups which were divided by the degree of blastocyst expansion, and the classification of\u003c/em\u003e\u003cstrong\u003e\u003cem\u003e \u003c/em\u003e\u003c/strong\u003e\u003cem\u003einner cell mass(ICM) and the trophectoderm(TE). \u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eResults:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e The study shows that the birth weight of group A is significantly higher than that of the other three groups (P \u0026lt; 0.05). And the high quality embryo rate and blastocyst rate of group A are significantly higher than those of the other three groups (P \u0026lt; 0.05). What’s more, the clinical pregnancy rate, implantation rate and live birth rate of high grade blastocyst are higher, but there are no significant difference in abortion rate. The birth weight of the degree of blastocyst expansion in grade 3 and below is significantly lower than that of those with grade 3 and above (P \u0026lt; 0.05). The birth weight of grade A of ICM is significantly higher than that of grade B (P \u0026lt; 0.05). The birth weight of grade B of TE is significantly heavier than that of grade C (P \u0026lt; 0.05). \u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConclusions:\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e Our results indicate that high grade blastocyst transplantation can achieve better pregnancy outcome. Different blastocyst grades affect birth weight, and low grade blastocyst transplantation is associated with a single birth weight loss.\u003c/em\u003e\u003c/p\u003e","manuscriptTitle":"The Impact of Blastocyst Grade on Singleton Birthweight in Fresh Transplanted Cycles","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-08-02 14:37:05","doi":"10.21203/rs.3.rs-726950/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4842d880-c195-4f95-94e7-edfc4e0c8347","owner":[],"postedDate":"August 2nd, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":6150334,"name":"Maternal \u0026 Fetal Medicine"},{"id":6150335,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2021-10-29T08:45:56+00:00","versionOfRecord":[],"versionCreatedAt":"2021-08-02 14:37:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-726950","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-726950","identity":"rs-726950","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}