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

Women’s age and competent blastocyst development stage were associated. Initial human chorionic gonadotrophin (hCG) increase was influenced by age, in both controlled ovarian stimulation and frozen-thawed embryo transfer; the youngest women had the lowest initial hCG.

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VOLUME 115, ISSUE 3, P646-654, MARCH 01, 2021


Maria Buhl Borgstrøm, M.Sc., Marie Louise Grøndahl, D.M.Sc., Tobias Wirenfeldt Klausen, M.Sc., Anne Kjærgaard Danielsen, Ph.D., Thordis Thomsen, Ph.D., Anette Gabrielsen, M.Sc., Anne Zedeler, Ph.D., Betina Boel Povlsen, M.Sc., Christina Hnida, Ph.D., Gitte Juul Almind, Ph.D., Jens Fedder, Ph.D., John Kirk, M.D., Johnny Hindkjær, M.Sc., Josephine G. Lemmen, Ph.D., Karsten Petersen, M.D., Katrine Haahr, M.D., Morten Rønn Petersen, Ph.D., Steen Laursen, Ph.D., Thomas Høst Hansen, Ph.D., Ulla Breth Knudsen, Ph.D., Ursula Bentin-Ley, Ph.D., Thomas Larsen, C.E.O., Ulrik Schiøler Kesmodel, Ph.D.



To study if the age of women undergoing assisted reproductive technology treatment associates with stage, morphology, and implantation of the competent blastocyst.


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.


Sixteen private and university-based facilities.


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.



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.


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.


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.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.