Graduated Embryo Score and soluble human leukocyte antigen-G expression improve assisted reproductive technology outcomes and suggest a basis for elective single-embryo transfer

Objective: To evaluate assisted reproductive technology (ART) outcomes by using Graduated Embryo Score (GES) and soluble human leukocyte antigen-G (sHLA-G) expression to select embryos for transfer on day 3. Design: Prospective cohort. Setting: Private practice. Patient(s): Women undergoing fresh ART cycles (n = 209). Intervention(s): In vitro fertilization using standard protocols. Embryos scoring GES of >= 70 using were selected for transfer on the basis of sHLA-G expression in the culture media on day 2. Main Outcome Measure(s): Pregnancy, implantation, and multiple-gestation rates. Result(s): Ongoing gestations increased with the number of embryos expressing sHLA-G (37%, 42%, 58%, and 56% with 0, 1, 2, or 3 sHLA-G(+),respectively). With at least two sHLA-G(+) embryos, ongoing gestation and implantation rates were higher than those with fewer than two sHLA-G(+). Differences were even higher for women aged <= 37 years. With at least two sHLA-G(+) embryos, the odds ratio (95% confidence interval) was 1.59 (1.51-1.68) for ongoing gestation compared with the case of fewer than two sHLA-G(+). Age was the most important predictor of outcome; the odds ratio (95% confidence interval) was 2.07 (1.98-2.16) for ongoing gestation in women aged:537 years with at least two sHLA-G(+) embryos, compared with the case of women aged 38-40 years. Conclusion(s): Day 3 embryo transfer using GES and sHLA-G improves ART outcomes by increasing predictive accuracy. High twin rates suggest that couples with at least two sHLA-G(+) embryos consider elective single-embryo transfer.