Association between women's age and stage, morphology, and implantation of the competent blastocyst: a multicenter cohort study

Objective: To study if the age of women undergoing assisted reproductive technology treatment associates with stage, morphology, and implantation of the competent blastocyst. Design: Multicenter historical cohort study based on exposure (age) and outcome data (blastocyst stage and morphology and initial human chorionic gonadotrophin [hCG] rise) from women undergoing single blastocyst transfer resulting in singleton pregnancy/birth. Setting: Sixteen private and university-based facilities. Patient(s): In this study, 7,246 women who, between 2014 and 2018, underwent controlled ovarian stimulation (COS) or frozen-thawed embryo transfer (FET) with a single blastocyst transfer resulting in singleton pregnancy were identified. Linking data to the Danish Medical Birth Registry resulted in a total of 4,842 women with a live birth being included. Intervention(s): None. Main Outcome Measure(s): The competent blastocyst development stage (1–6), inner cell mass (A, B, C), trophectoderm (A, B, C), and initial serum hCG value. Result(s): Adjusted analysis of age and stage in COS treatments showed that for every 1-year increase in age there was a 5% reduced probability of the competent blastocyst assessed as being in a high stage at transfer. Comparison between hCG values in women 18–24 years and 25–29 years in both COS and FET showed significantly lower levels in the youngest women. Conclusion(s): The initial hCG rise was influenced by the age of the woman, with an identical pattern for hCG values in COS and FET treatments. In COS, the competent blastocyst had a reduced stage with increasing women's age.