How compliant are in vitro fertilization member clinics in following embryo transfer guidelines? An analysis of 59,689 fresh first in vitro fertilization autologous cycles from 2011 to 2012

Comparisons of benefits and risks of single embryo transfer versus double embryo transfer: a systematic review and meta-analysis

BACKGROUND

Evidence referring to the trade-offs between the benefits and risks of single embryo transfer (SET) versus double embryo transfer (DET) following assisted reproduction technology are insufficient, especially for those women with a defined embryo quality or advanced age.

METHODS

A systematic review and meta-analysis was conducted according to PRISMA guidelines. PubMed, EMBASE, Cochrane Library and ClinicalTrials.gov were searched based on established search strategy from inception through February 2021. Pre-specified primary outcomes were live birth rate (LBR) and multiple pregnancy rate (MPR). Odds ratio (OR) with 95% confidence interval (CI) were pooled by a random-effects model using R version 4.1.0.

RESULTS

Eighty-five studies (14 randomized controlled trials and 71 observational studies) were eligible. Compared with DET, SET decreased the probability of a live birth (OR = 0.78, 95% CI: 0.71-0.85, P < 0.001, n = 62), and lowered the rate of multiple pregnancy (0.05, 0.04-0.06, P < 0.001, n = 45). In the sub-analyses of age stratification, both the differences of LBR (0.87, 0.54-1.40, P = 0.565, n = 4) and MPR (0.34, 0.06-2.03, P = 0.236, n = 3) between SET and DET groups became insignificant in patients aged ≥40 years. No significant difference in LBR for single GQE versus two embryos of mixed quality [GQE + PQE (non-good quality embryo)] (0.99, 0.77-1.27, P = 0.915, n = 8), nor any difference of MPR in single PQE versus two PQEs (0.23, 0.04-1.49, P = 0.123, n = 6). Moreover, women who conceived through SET were associated with lower risks of poor outcomes, including cesarean section (0.64, 0.43-0.94), antepartum haemorrhage (0.35, 0.15-0.82), preterm birth (0.25, 0.21-0.30), low birth weight (0.20, 0.16-0.25), Apgar1 < 7 rate (0.12, 0.02-0.93) or neonatal intensive care unit admission (0.30, 0.14-0.66) than those following DET.

CONCLUSIONS

In women aged < 40 years or if any GQE is available, SET should be incorporated into clinical practice. While in the absence of GQEs, DET may be preferable. However, for elderly women aged ≥40 years, current evidence is not enough to recommend an appropriate number of embryo transfer. The findings need to be further confirmed.

Predictive Model for the Quality of Life of Infertile Men

Purpose:

This study explores factors influencing the quality of life of infertile men, and attempts to construct a structural model to predict their quality of life.

Methods:

Data was collected via questionnaires from 242 infertile male outpatients from 3 infertile clinics at general hospital urologist departments, with the subjects’ confidentiality was ensured. The self-reported questionnaires were collected for 7 months from February to August 2016 in the outpatient centers. The collected data was analyzed using SPSS/WIN 21.0 Program and Mplus 6.0 Program.

Results:

Hypothesis test of the quality of life as the endogenous variable identified infertility-related stress (β=-0.79, t=-9.41), depression (β=-0.20, t=-2.58), and spirituality (β=0.21, t=2.90) as statistically significant variables. Marital adjustment (β=-0.06, t=-0.69) and social support (β=-0.12, t=-1.79) were not statistically significant. The variables accounted for 84.1% of the variation.

Conclusion:

The results of the study show that infertility-related stress and depression have negative correlation, and spirituality has a positive correlation with infertile men’s quality of life. As such, there needs to be a development of practical and multi-faceted nursing intervention programs to control infertility-related stress and depression levels so as to sustain infertile men’s quality of life.

Why are multiple pregnancy rates and single embryo transfer rates so different globally, and what do we do about it?

In the early years of in vitro fertilization, overall pregnancy rates were low, and it was considered necessary to transfer more than one embryo to increase the chances of pregnancy. It was not until advances in assisted reproductive technologies resulting in increased pregnancy rates that the concept of transferring just one embryo was considered possible. A consequence of improvements in implantation rates was also an increase in multiple pregnancies when more than one embryo was transferred. Although some countries have reduced the number of embryos transferred, international data show that in many parts of the world high twin and higher order multiple pregnancy rates still exist. Even in developed countries these problems persist depending on clinical practice, funding of health services, and patient demands. Perinatal and other outcomes are significantly worse with twins compared with singleton pregnancies and there is an urgent need to reduce multiple pregnancy rates to at least 10%. This has been achieved in several countries and clinics by introducing single embryo transfer but there are many barriers to the introduction of this technique in most clinics worldwide. We discuss the background to the high multiple rate in assisted reproduction and the factors that contribute to its persistence even in excellent clinics and in high-quality health services. Practices that may promote single embryo transfer are discussed.

Single blastocyst transfer yields similar pregnancy rates compared with multiple cleavage embryo transfer, with reduced twin rate, in patients with low number of fertilized oocytes

Background

In patients with low numbers of embryos, there is not yet consensus on whether to extend culture to the blastocyst stage, especially due to the risk that some or all of the embryos will not make it to the blastocyst stage. The objective of our study was to evaluate pregnancy outcomes in patients with a low number of fertilized oocytes (< 4), comparing single blastocyst transfer to one or more cleavage embryo transfer.

Results

We analyzed 6795 cycles from the 2014–2105 Society for Assisted Reproductive Technology (SART) registry. All patients were ≤ 38 years old, had less than four fertilized oocytes, and were undergoing first fresh in vitro fertilization (IVF) transfer. Primary outcomes were clinical pregnancy (CP), live birth (LB), and miscarriage rate in both cleavage stage transfer and single blastocyst transfer. A secondary outcome was the rate of twin gestation. The comparison of interest in day of transfer included (1) single blastocyst vs single cleavage and (2) single blastocyst vs multiple cleavage stage. The association between day of transfer and primary outcome was investigated using logistic regression, controlling for the age, race/ethnicity, BMI, smoking, gravidity, parity, infertility diagnoses, and assisted hatching.

Single blastocyst transfer was associated with an increased odds of CP (adjusted OR 2.03) and LB (adjusted OR 1.86) when compared to single cleavage transfer, and no statistically significant association was observed when comparing single blastocyst transfer to multiple cleavage embryo transfer for CP (adjusted OR 0.94) and LB (adjusted OR = 0.88). The odds of having twins among single blastocyst transfer was significantly lower compared to those odds that among multiple cleavage stage transfer (unadjusted OR 0.09).

Conclusions

While pregnancy outcomes are similar between single blastocyst and multiple cleavage embryo transfer, the twin rate is reduced significantly among the single blastocyst transfers in patients with a low number of fertilized oocytes.