Original Articles

Clinical Pregnancy After Elimination of Embryo Fragments Before Fresh Cleavage-stage Embryo Transfer


Objective: To determine if the elimination of fragments in cleavage-stage embryos, before fresh transfer, improves pregnancy rates in in vitro fertilization cycles.
Materials and methods: This is a Prospective observational case-control study carried out at a University Reproductive Center. We included Twenty-six infertile patients divided into two groups. Group one: 13 patients with embryos classified as grade B and C (embryos with fragments) according to the Hill classification, and Group two: 13 patients with grade A embryos (embryos with no fragments). Embryo Defragmentation was performed in embryos of group one 65 to 68 hours after conventional fertilization. Fresh embryo transfer was made after two hours post fragments removal. Reproductive results were evaluated and compared between both groups.
Results: The total number of clinical pregnancies was nine. In group one there were 5 (38.5 %); in group two, there were 4 (30.8%). The difference was not statistically significant (p = 0.68). Two abortions were reported in the study, both in group one; were fragment elimination was performed. This represents an abortion rate of 40% in patients who got pregnant in this group. These patients had twice the probability of suffering an abortion (OR 2.1; 95% CI 1.4-3.37). Ongoing pregnancies were similar in both groups.
Conclusion: Removal of fragments in freshly transferred day three embryos could be an alternative to increase clinical pregnancy and ongoing pregnancy rates in patients who have only poor-quality embryos. Despite the relationship with a higher abortion rate, this strategy could represent a real alternative for this type of patient.

1. Halvaei I, Khalili MA, Nottola SA. A novel method for transmission electron microscopy study of cytoplasmic fragments from preimplantation human embryos. Microscopy Research and Technique 2016; 79: 459-62.
2. Halvaei I, Khalili M, Esfandiari N,Safari S,Talebi AR,Miglietta S, et al. Ultrastructure of cytoplasmic fragments in human cleavage stage embryos. J Assist Reprod Genet 2016; 33: 1677–84.
3. Safari S, Khalili MA, Barekati Z, Halvaei I, Anvari M, Nottola SA. Cosmetic micromanipulation of vitrified-warmed cleavage stage embryos does not improve ART outcomes: An ultrastructural study of fragments. Reprod Biol 2017; 17: 210-7.
4. Keltz MD, Skorupski JC, Bradley K, Stein D. Predictors of embryo fragmentation and outcome after fragment removal in invitro fertilization. Fertil Steril 2006; 86: 321-4.
5. Kim SG, Kim YY, Park JY, Kwak SJ, Yoo CS, Park IH, et al. Early fragment removal on in vitro fertilization day 2 significantly improves the subsequent development and clinical outcomes of fragmented human embryos.
Clin Exp Reprod Med 2018; 45: 122-8.
6. Gurgan T, Demirol A, Sari T, Benkhalifa M. Effect of embryo fragment removal of day 3 embryos in recurrent implantation failure. Fertil Steril 2005; 84:S284.
7. Alikani M, Cohen J, Tomkin G, Garrisi GJ, Mack C, Scott RT. Human embryo fragmentation an vitro and its implications for pregnancy and implantation. Fertil Steril 1999; 71: 836–42.
8. Check JH, Summer-Chse D, Juan W,Barci H, Brittingham D. The importance of Blastomere Number, Fragmentation and Symmetry as Determined by Evaluation of Outcome of Single Embryo Transfer (ET). Fertili Steril 2005; 83: S28.
9. Hill GA, Freeman M, Bastias MC, Rogers BJ,Herbert CM,Osteen KG,et al. The influence of oocyte maturity and embryo Quality on Pregnancy Rate in a Program for in Vitro Fertilization-Embryo Transfer. Fertil Steril 1989; 52: 801-6.
10. Halvaei I, Ghazali S, Nottola SA, Khalili MA. Cleavage-stage embryo micromanipulation in the clinical setting. Syst Biol Reprod Med 2018; 64: 157-168.
11. Eftekhari-Yazdi P, Rezazadeh valojerdi M, Kazemi Ashtiani S,Baghaban Eslaminejad MR,Karimani L. Effect of fragment removal on blastocyst formation and quality of human embryos. Rep BioMed Online 2006; 13: 823-32.
12. Ebner T, Yaman C, Moser M, Sommergruber M,Polz W,Tews G. Embryo fragmentation in vitro and its impact on treatment and pregnancy outcome. Fertil Steril 2001; 76: 281-5.
13. Plachot M, Junca AM, Mandelbaum J, de Grouchy J, Salat-Baroux J, Cohen J. Chromosome investigations in early life. II. Human preimplantation embryos. Hum Reprod 1987; 2: 29 –35.
14. Munne ́ S, Alikani M, Tomkin G, Grifo J, Cohen J. Embryo morphol- ogy, developmental rates, and maternal age are correlated with chro- mosome abnormalities Fertil Steril 1995; 64: 382–91.
15. Munne ́ S, Cohen J. Chromosomal abnormalities in human embryos. Hum Reprod Update 1998; 4: 842–55.
IssueVol 14, No 3 (September 2020) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/jfrh.v14i3.4674
Embryo Fragment Removal Fresh Embryo Transfer Pregnancy

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How to Cite
Sordia-Hernandez L, Morales Martinez F, Frazer Moreira L, Pineda L, Sordia-Piñeyro M, Valdes Martinez O. Clinical Pregnancy After Elimination of Embryo Fragments Before Fresh Cleavage-stage Embryo Transfer. J Fam Reprod Health. 14(3):198-204.