Is the presence of a non-cleaved embryo on day 3 associated with poorer quality of the remaining embryos in the cohort?

PURPOSE: Morphological evaluation is currently considered the single most important predictive measure for assessing embryo quality. The aim of this study was to investigate whether cycles with at least one non-cleaved embryo (i.e., a 1-cell embryo on day 3) have different outcomes compared with cycles in which all embryos had cleaved by day 3. METHODS: All autologous IVF/ICSI cycles with a fresh day 3 transfer and without using a gestational carrier performed at our center between 1/1/2010 and 12/31/2011 were analyzed retrospectively. Those cycles with at least one non-cleaved embryo on day 3 were compared with all other autologous cycles that had 100% cleaved embryos performed during the study period. RESULTS: Eight hundred and forty two cycles were included. Of them, 144 cycles comprised the non-cleaved group, and 698 cycles comprised the cleaved group. Cycles in the non-cleaved group had more oocytes retrieved (15.4 ± 7.1 vs. 12.5 ± 7.1, p < 0.001), more zygotes obtained (10.0 ± 5.3 vs. 7.9 ± 5.2, p = <0.001), but the embryos exhibited lower cleavage rates and higher rates of fragmentation and asymmetry compared with controls (p < 0.001). However, spontaneous abortion rates, ectopic pregnancies rates as well as delivery rates were similar between the two groups. CONCLUSIONS: Our results show that the presence of a non-cleaved embryo on day 3 is associated with a more exuberant response to controlled ovarian stimulation as reflected by more oocytes retrieved. Despite the significant decrease in quality of the whole cohort in the non-cleaved group, implantation, delivery rates and number of embryos frozen were not adversely affected by the presence of a non-cleaved embryo.