Sci Rep. 2025 Oct 17;15(1):36326. doi: 10.1038/s41598-025-20150-2.
ABSTRACT
The relationship between blastocyst morphological quality and the risk of congenital malformations in assisted reproductive technology (ART) remains poorly understood, limiting clinical decision-making for embryo selection. We conducted a retrospective cohort study of 3986 frozen embryo transfer cycles (January 2014-June 2023) to evaluate whether blastocyst morphological quality influences the risk of congenital malformations. Blastocysts were classified according to Gardner’s grading system, and 1:2 propensity score matching was applied to control for maternal age, BMI, infertility characteristics, and other potential confounders. After matching, 1743 singleton births were analyzed (1162 good-quality vs. 581 poor-quality blastocysts). Baseline characteristics were well balanced between groups. The risk of congenital malformations was similar between good- and poor-quality groups (aOR 1.14, 95% CI 0.54-2.41, P = 0.7310; 1.72% vs. 2.07%), with no significant between-group differences in any ICD-10 organ-specific categories (all P > 0.10). Secondary outcomes showed no significant differences: preterm birth (aOR 0.80, 95% CI 0.57-1.12, P = 0.1976), low birth weight (aOR 1.26, 95% CI 0.72-2.19, P = 0.4172), other neonatal outcomes, and obstetric complications (aOR 0.89, 95% CI 0.64-1.22, P = 0.4629). These findings indicate that blastocyst morphological quality does not influence the risk of congenital malformations, supporting the use of morphologically poor blastocysts when high-quality alternatives are unavailable, which may reduce unnecessary discarding of embryos, alleviate patient anxiety, and improve treatment accessibility.
PMID:41107304 | DOI:10.1038/s41598-025-20150-2
