Materials and Methods: This prospective cohort study was conducted on 199 infertile women. Ninety-nine patients underwent an agonist cycle (70 fresh embryo transfer [ET] and 29 frozen ET), and 100 patients received an antagonist cycle (28 fresh ET and 72 frozen ET) in the infertility department of a tertiary university-based hospital between May 2019 and March 2020. The blastocysts classified as AA, AB, and BB, as well as AC, BC, and CC were considered as top- and poor-quality embryos (TQE and PQE). The study outcomes were biochemical and clinical and determined the rate of pregnancy.

Results: The average age of the participants was 32.44 ± 5.25 years old. Women with TQE were significantly younger than those with PQE (31.35 ± 4.97 vs. 34.09 ± 5.27, P < 0.001). In addition, the duration of women’s infertility was significantly (P < 0.001) correlated with the embryo’s top quality. A positive β-human chorionic gonadotropin was detected in 12.6% (n = 25) of women while clinical pregnancy was investigated in 8% (n = 16) of them. The fetal heart rate was detected in 7.5% (n = 15). Eventually, the clinical (P = 0.020) and determined (P = 0.030) pregnancy rates significantly differed between two study groups with a higher level in the TQE group.

Conclusions: It seems that TQP transfer should be the first recommendation for infertile women, but when the double-embryo transfer (DET) is needed according to the patient’s condition, she should be informed that the quality of the second embryo may have an adverse impact on pregnancy consequences.