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Zhou Y, Ji H, Zhang M, Zhang J, Li X, Zhang J, Ling X, Chen L, Zhao C. Single versus double blastocyst transfer in first and second frozen-thawed embryo transfer cycle in advance-aged women: a two-center retrospective cohort study. BMC Womens Health 2024; 24:51. [PMID: 38238733 PMCID: PMC10795208 DOI: 10.1186/s12905-023-02753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 10/31/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The present evidence is deficient for the trade-offs between the pros and cons of single blastocyst transfer (SBT) versus double blastocyst transfer (DBT) in frozen-thawed embryo transfer cycles for women in advanced reproductive age, especially in the second cycle. The current study aimed to investigate the impact of transferred blastocyst numbers on pregnancy outcomes in the first and second embryo transfer for women ≥ 35 years. METHODS This was a retrospective cohort study including 1284 frozen-thawed blastocyst transfer (FBT) cycles from two reproductive centers. We analyzed the pregnancy outcomes after SBT and DBT in the first and second FBT cycles. Moreover, stratified analysis was conducted by maternal age. RESULTS In the first FBT cycle, the LBR was higher in the DBT group than that in the SBT group [52.3% vs. 33.9%; adjusted odds ratio (aOR), 1.65; 95% confidence interval (CI), 1.26-2.15, P < 0.001]. However, the LBR of the DBT group showed no remarkable difference compared with that of the SBT group in the second cycle of FBT (44.3% vs. 33.3%; aOR, 1.30; 95% CI, 0.81-2.08; P = 0.271). Furthermore, stratified analysis by age showed a higher LBR for the DBT group than the SBT group in patients aged 38-42 years (43.1% vs. 33.9%; aOR, 2.27; 95% CI, 1.05-4.90; P = 0.036). CONCLUSIONS The present study demonstrated that the SBT regimen is a better choice for both, the first and second frozen-thawed embryo transfer cycles, for women aged 35-37 years. Additionally, the DBT regimen is still recommended to achieve a high LBR in women aged 38-42 years in the second FBT cycle. These findings may be beneficial for deciding the embryo transfer regimens in women of advanced reproductive age.
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Affiliation(s)
- Yuxi Zhou
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Hui Ji
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Mianqiu Zhang
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Juanjuan Zhang
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Xin Li
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Junqiang Zhang
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Xiufeng Ling
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China
| | - Li Chen
- Department of Reproductive Medicine, Changzhou Maternal and Child Health Care Hospital, Changzhou, 213000, China
| | - Chun Zhao
- Department of Reproductive Medicine, Nanjing Women and Children's Healthcare Hospital, Women's Hospital of Nanjing Medical University, Nanjing, 210004, China.
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Demirel C, Goksever Celik H, Tulek F, Tuysuz G, Donmez E, Ergin T, Buyru F, Bastu E. The impact of a poor quality embryo on the implantation chance of a good quality one when transferred together: A study on double blastocyst transfers. J Gynecol Obstet Hum Reprod 2020; 50:101967. [PMID: 33161131 DOI: 10.1016/j.jogoh.2020.101967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Embryo quality assessment with morphological evaluation remains the first-line method of assessment to select the best embryo for transfer. We aimed to determine if an effect of poor quality embryos on good quality ones exists, whether by a paracrine effect or an adverse endometrial influence, when they are transferred together. MATERIALS AND METHODS We included 412 couples, who underwent intracytoplasmic sperm injection (ICSI) cycles in a tertiary IVF center. Single embryo transfer with a good quality embryo and double embryo transfers with a good + poor quality embryo were evaluated. Overall pregnancy (PR) and live birth rates (LBR) were our main outcome measures. RESULTS When PR and LBR are compared, there was no statistical significance between single embryo transfer (SET) and double embryo transfer (DET) groups (51.7 % vs 53.7 %, p = 0.620 and 47 % vs 43.1 %, p = 0.117). When the PR and LBRs were compared between SET from poor cohort and DET group, the outcomes were better in DET group (22.1 % vs 53.7 %, p < 0.001 and 22.1 % vs 43.1 %, p < 0.001). The PR and LBRs of SET from good cohort were significantly better than those of DET (64.4 % vs 53.7 %, p < 0.001 and 57.7 % vs 43.1, p < 0.001). When the PR and LBRs of SET from good cohort and SET from poor cohort were compared, better results were obtained in SET from good cohort. CONCLUSION The addition of poor quality embryo even is of benefit to the LBR, in the setting of when there is only one good quality blastocyst available for the transfer.
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Affiliation(s)
- Cem Demirel
- Ataşehir Memorial IVF Center, Department of Obstetrics and Gynecology, Istanbul, Turkey; Bilgi University, Faculty of Health Sciences, Istanbul, Turkey.
| | - Hale Goksever Celik
- Saglik Bilimleri University Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Firat Tulek
- Ataşehir Memorial IVF Center, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Gulsum Tuysuz
- Ataşehir Memorial IVF Center, Department of Embryology, Istanbul, Turkey.
| | - Ersan Donmez
- Ataşehir Memorial IVF Center, Department of Embryology, Istanbul, Turkey.
| | - Tolga Ergin
- Ataşehir Memorial IVF Center, Department of Obstetrics and Gynecology, Istanbul, Turkey; Bilgi University, Faculty of Health Sciences, Istanbul, Turkey.
| | - Faruk Buyru
- Acıbadem Mehmet Ali Aydinlar University, Department of Obstetrics and Gynecology, Istanbul, Turkey.
| | - Ercan Bastu
- Acıbadem Mehmet Ali Aydinlar University, Department of Obstetrics and Gynecology, Istanbul, Turkey.
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Chen S, Du H, Liu J, Liu H, Li L, He Y. Live birth rate and neonatal outcomes of different quantities and qualities of frozen transferred blastocyst in patients requiring whole embryo freezing stratified by age. BMC Pregnancy Childbirth 2020; 20:655. [PMID: 33121448 PMCID: PMC7596959 DOI: 10.1186/s12884-020-03353-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background Multiple pregnancies are associated with significant complications and health risks for both mothers and infants. Single blastocyst transfer (SBT) is a logical and effective measure to reduce the incidence of multiple pregnancy with assisted reproductive technology (ART). Whether it is suitable for everyone undergoing SBT was inconclusive, in view of the consideration of embryo quality and patients’ age. Therefore, this study aimed to explore live birth rate (LBR) and neonatal outcomes of different quantities and qualities of blastocysts in patients stratified by age, using a cutoff of 35 years, who required whole embryo freezing and underwent a subsequent frozen thawed transfer (FET) cycle. Methods Atotal of 3,362 patients were divided into five groups: group A (n=1569) received a single good-quality blastocyst, group B (n=1113) received two good-quality blastocysts, group C (n=313) received one good-and one average-quality blastocyst, group D (n=222) received two average-quality blastocysts, and group E (n=145) received one average-quality blastocyst. Results For patients who received good-quality blastocysts, irrespective of age, the LBR of double blastocyst transfer (DBT) was about 50–65% and the multiple pregnancy rate (MPR) was 40–60%; however, the LBR of SBT was 40–55%, and the MPR was 3.5–6.3%. For patients who only had average-quality blastocysts, the MPR of double average-quality blastocyst transfer was as high as 30–50%. Moreover, about 70–90% of preterm births resulted from multiple pregnancies, and about 85–95% of low birth weight babies come from multiple pregnancies. The neonatal outcomes (gestational age, birth weight, and birth height) of DBT were significantly lower than those of SBT regardless of age, and this statistical difference disappeared if the patients were subgrouped by singleton or twin. There is no significant difference in neonatal outcomes between single good-quality blastocyst and single average-quality blastocyst transfer. Conclusions SBT is a preferable option for patients regardless of age when good-quality blastocysts are available. For patients who only had average-quality blastocysts, they should be informed that DBT was associated with higher multiple pregnancy and adverse neonatal outcomes when compared with SBT regardless of age, suggesting that the practice of SBT is also feasible for these patients.
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Affiliation(s)
- Shiping Chen
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China.,Key Laboratory of Reproductive Medicine of Guangdong Province, Guangdong, Guangzhou, China.,Key Laboratory for Major Obstetric Diseases of Guangdong Province, Guangzhou, Guangdong, China.,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, Guangzhou, Guangdong, China
| | - Hongzi Du
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Jianqiao Liu
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Haiying Liu
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Lei Li
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China
| | - Yuxia He
- Department of Reproductive Medicine, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, China.
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Dahan MH, Tannus S. Believing that transferring more embryos will result in increased pregnancy rates: a flawed concept: a SWOT analysis. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2020. [DOI: 10.1186/s43043-020-00042-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractA belief exists that transferring multiple embryos can improve pregnancy rates. However, this concept is flawed. Multiple factors affect outcomes when transferring embryos, endometrial receptivity, and rates of aneuploidy among them. In this article, we will discuss how factors can affect outcomes at IVF that are independent of the number of embryos transferred. It is important to understand the role of accessory factors on pregnancy rates to be able to counsel patients as per the number of embryos that should be transferred. An understanding of this concept will also lead to a realistic understanding of how multiple embryo transfers may result in better cumulative pregnancy rates than a single transfer of multiple embryos. Finally, we will present a SWOT analysis diagram to help guide clinical decision-making.
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Wang W, Cai J, Liu L, Xu Y, Liu Z, Chen J, Jiang X, Sun X, Ren J. Does the transfer of a poor quality embryo with a good quality embryo benefit poor prognosis patients? Reprod Biol Endocrinol 2020; 18:97. [PMID: 32998748 PMCID: PMC7526391 DOI: 10.1186/s12958-020-00656-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/24/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While single embryo transfer (SET) is widely advocated, double embryo transfer (DET) remains preferable in clinical practice to improve IVF success rate, especially in poor prognosis patients with only poor quality embryos (PQEs) available in addition to one or no good quality embryos (GQEs). Furthermore, previous studies suggest PQE might adversely affect the implantation of a GQE when transferred together. This study aims to evaluate the effect of transferring an additional PQE with a GQE on the outcomes in poor prognosis patients. METHODS A total of 5037 frozen-thawed blastocyst transfer (FBT) cycles between January 2012 and May 2019 were included. Propensity score matching was applied to control for potential confounders, and we used generalized estimating equations (GEE) models to identify the association between the effect of an additional PQE and the outcomes. RESULTS Overall, transferring a PQE with GQE (Group GP) achieved significantly higher pregnancy rate (PR), live birth rate (LBR) and multiple pregnancy rate (MPR) than GQE only (group G). The addition of a PQE increased LBR in patients aged 35 and over and in patients who received over 3 cycles of embryo transfer (ET) (48.1% vs 27.2%, OR:2.56, 95% CI: 1.3-5.03 and 46.6% vs 35.4%, OR:1.6, 95% CI: 1.09-2.35), but not in women under 35 and in women who received less than 3 cycles of ET (48.7% vs 43.9%, OR:1.22, 95% CI: 0.93-1.59 and 48.3% vs 41.4%, OR:1.33, 95% CI: 0.96-1.85). Group GP resulted in significantly higher MPR than group G irrespective of age and the number of previous IVF cycles. CONCLUSIONS An additional PQE does not negatively affect the implantation potential of the co-transferred GQE. Nevertheless, the addition of a PQE contributes to both live birth and multiple birth in poor prognosis patients. Physicians should still balance the benefits and risks of DET.
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Affiliation(s)
- Wenjie Wang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Jiali Cai
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Lanlan Liu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Yingpei Xu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Zhenfang Liu
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Jinghua Chen
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Xiaoming Jiang
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Xiaohua Sun
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China
| | - Jianzhi Ren
- Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China.
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Yang M, Lin L, Sha C, Li T, Gao W, Chen L, Wu Y, Ma Y, Zhu X. Which is better for mothers and babies: fresh or frozen-thawed blastocyst transfer? BMC Pregnancy Childbirth 2020; 20:559. [PMID: 32967652 PMCID: PMC7513314 DOI: 10.1186/s12884-020-03248-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 09/14/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In recent years, there have been many reports on the pregnancy outcomes of fresh blastocyst transfer (BT) and frozen-thawed BT, but the conclusions are controversial and incomplete. To compare the pregnancy outcomes, maternal complications and neonatal outcomes of fresh and frozen-thawed BT in the context of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles, we conducted a meta-analysis. METHODS A meta-analysis was conducted by searching the PubMed, Embase, and Cochrane Library databases through May 2020. Data were extracted independently by two authors. RESULTS Fifty-four studies, including 12 randomized controlled trials (RCTs), met the inclusion criteria. Fresh BT was associated with a lower implantation rate, pregnancy rate, ongoing pregnancy rate, and clinical pregnancy rate and higher ectopic pregnancy rate than frozen-thawed BT according to the results of the RCTs. The risks of moderate or severe ovarian hyperstimulation syndrome, placental abruption, placenta previa and preterm delivery were higher for fresh BT than for frozen-thawed BT. The risk of pregnancy-induced hypertension and pre-eclampsia was lower for fresh BT; however, no significant differences in risks for gestational diabetes mellitus and preterm rupture of membrane were found between the two groups. Compared with frozen-thawed BT, fresh BT appears to be associated with small for gestational age and low birth weight. No differences in the incidences of neonatal mortality or neonatal malformation were observed between fresh and frozen-thawed BT. CONCLUSIONS At present there is an overall slight preponderance of risks in fresh cycles against frozen, however individualization is required and current knowledge does not permit to address a defintive response.
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Affiliation(s)
- Meiling Yang
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Obstetrics and Gynecology, Nantong City No 1 People's Hospital and Second Affiliated Hospital of Nantong University, Nantong, 226000, China
| | - Li Lin
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Chunli Sha
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Taoqiong Li
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Wujiang Gao
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Lu Chen
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Ying Wu
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Yanping Ma
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China
| | - Xiaolan Zhu
- Reproductive Medicine Center, The Fourth Affiliated Hospital of Jiangsu University (Zhenjiang Maternal and Child Health Hospital), 20 Zhengdong Road, Zhenjiang, Jiangsu, 212001, People's Republic of China.
- Reproductive Sciences Institute, Jiangsu University, Zhenjiang, 212001, Jiangsu, China.
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Racca A, Drakopoulos P, Van Landuyt L, Willem C, Santos-Ribeiro S, Tournaye H, Blockeel C, Polyzos NP. Single and double embryo transfer provide similar live birth rates in frozen cycles. Gynecol Endocrinol 2020; 36:824-828. [PMID: 32124642 DOI: 10.1080/09513590.2020.1712697] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Research question: Do live birth rates (LBRs) differ in frozen cycles of women who received single versus double embryo transfer?Design: Retrospective cohort study including women who underwent their first frozen embryo transfer (FET) in a tertiary referral University Hospital between 2009-2014.Results: 3601 patients were included in the analysis with 1936 (53.8%) having a single embryo transfer (SET) and 1665 (46.2%) having a double embryo transfer (DET). Overall, 657/3601 (18.24%) had a live birth. LBR were similar between SET and DET either for cleavage [100/757 (13.1%) versus 153/1032 (14.8%), p = .33] or blastocyst stage FET [256/1179 (21.7%) versus 148/633 (23.4%), p = .4). Ongoing pregnancy rates were comparable between DET and SET [316/1665 (18.9%) versus 359/1936 (18.5%)]. Multiple delivery rates were significantly higher in women with DET compared to SET [53/316 (16.7%) versus 7/359 (1.9%), p < .001]. Multivariate logistic regression analysis allowing adjustment for relevant confounders showed that the number of embryos transferred in the frozen cycle was not related to LBR.Conclusions: This is the largest study providing evidence that both SET and DET may result in similar LBR, albeit multiple pregnancy rates are significantly lower in case of SET. Therefore, SET should be the main strategy in women undergoing FET.
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Affiliation(s)
- A Racca
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Academic Unit of Obstetrics and Gynecology, IRCCS AOU San Martino-IST, University of Genoa, Genova, Italy
| | - P Drakopoulos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Surgical and Clinical Science, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - L Van Landuyt
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - C Willem
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | | | - H Tournaye
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - C Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Obstetrics and Gynecology, University of Zagreb-School of Medicine, Zagreb, Croatia
| | - N P Polyzos
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
- Department of Clinical Medicine, Faculty of Health University of Aarhus, Incuba/Skejby, Aarhus, Denmark
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Dobson SJA, Lao MT, Michael E, Varghese AC, Jayaprakasan K. Effect of transfer of a poor quality embryo along with a top quality embryo on the outcome during fresh and frozen in vitro fertilization cycles. Fertil Steril 2019; 110:655-660. [PMID: 30196962 DOI: 10.1016/j.fertnstert.2018.05.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/29/2018] [Accepted: 05/10/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To evaluate the impact of a poor quality embryo (PQE) during double ET (DET) with a top quality embryo (TQE) on IVF outcome. DESIGN A review of prospectively collected data. SETTING Tertiary level fertility clinic. PATIENT(S) All patients undergoing blastocyst transfers as part of fresh IVF (n = 939) and frozen ET (n = 1,009) cycles performed between 2010 and 2016. INTERVENTION(S) Single ET (SET) with TQE (group 1) was set as control and compared with outcomes for SET with PQE (group 2), DET with 2 TQEs (group 3), PQE plus TQE (group 4), and 2 PQE (group 5). MAIN OUTCOME MEASURE(S) Live births and multiple births. RESULT(S) The live birth rates for group 4 were statistically similar to group 1 during fresh IVF (26.5% vs. 33.7%; odds ratio [OR], 0.95; 95% confidence interval [CI] 0.53-1.7) and frozen ET (24.2% vs. 32.7%; OR, 0.75; 95% CI 0.48-1.2), although there was a trend for lower success. Conversely, multiple births were higher in group 4 for fresh IVF (19% vs. 4.7%; OR, 2.9; 95% CI 1.3-6.6) and frozen ET (10.3% vs. 2.6%; OR, 2.4; 95% CI 1.2-4.9). The live birth rates for group 2 (12.2% for fresh IVF and 14.6% for frozen ET) and group 5 (21.2% for fresh IVF and 14% for frozen ET) were lower and for group 3 were higher (40.8% for fresh IVF and 40.3% for frozen ET) when compared with group 1. Multiple births were significantly higher with DET. CONCLUSION(S) This study does not support DET with one PQE along with a TQE, when there is only one TQE and one or more PQEs available for fresh IVF or frozen ET.
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Affiliation(s)
| | | | - Essam Michael
- ASTRA Fertility Clinic, Mississauga, Ontario, Canada
| | | | - Kannamannadiar Jayaprakasan
- Department of Obstetrics and Gynaecology, Royal Derby Hospital, Derby, United Kingdom; Division of Obstetrics and Gynaecology, University of Nottingham, Nottingham, United Kingdom.
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Zeng M, Li L. Single fresh blastocyst transfer or single cryopreserved-thawed blastocyst transfer: which is preferable for infertile patients in IVF/ICSI cycles? A meta-analysis. Gynecol Endocrinol 2019; 35:17-22. [PMID: 30303701 DOI: 10.1080/09513590.2018.1490408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
PURPOSES Nowadays, an increasing number of studies have proposed single embryo transfer (SET), especially single blastocyst transfer (SBT). To compare the clinical outcomes of single fresh blastocyst transfer (BT) and single cryopreserved-thawed BT in patients undergoing in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) cycles. METHODS The PubMed, Embase, and Cochrane Library databases were searched from the start dates until February 2018. The primary outcomes were clinical pregnancy rate (CPR) and embryo implantation rate (IR). The secondary outcomes were multiple pregnancy rate (MPR), live birth rate (LBR), and miscarriage rate (MR). Using the Mantel-Haenszel random effects model to analyze summary risk ratio (RR) with 95% confidence intervals (CIs). Statistical heterogeneity scores were assessed with the standard Cochrane's Q test and I2 statistic. RESULTS In total, eight studies (two prospective studies, six retrospective studies) were included in our analysis. There was no statistically significant difference regarding clinical pregnancy (RR = 1.18, 95% CI = 0.91-1.55) and embryo implantation (RR = 1.04, 95% CI = 0.77-1.41). Regarding secondary outcomes, there was no significant difference regarding miscarriage (RR = 0.79, 95% CI = 0.60-1.03) and multiple pregnancy (RR = 1.23, 95% CI = 0.75-2.04). However, single fresh BT is associated with an increased live birth (RR = 1.28, 95% CI = 1.05-1.57) compared with single cryopreserved-thawed BT. CONCLUSIONS In summary, this meta-analysis supports the hypothesis that single cryopreserved BT might not be the best choice compared with single fresh BT in patients undergoing IVF/ICSI cycles.
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Affiliation(s)
- MeiFang Zeng
- a Reproductive Medicine Center, Guangxi Medical University First Affiliated Hospital , Nanning , Guangxi , China
| | - LiuMing Li
- a Reproductive Medicine Center, Guangxi Medical University First Affiliated Hospital , Nanning , Guangxi , China
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Mehta VP, Patel JA, Gupta RH, Shah SI, Banker MR. One Plus One Is Better Than Two: Cumulative Reproductive Outcomes Are Better after Two Elective Single Blastocyst Embryo Transfers Compared to One Double Blastocyst Embryo Transfer. J Hum Reprod Sci 2018; 11:161-168. [PMID: 30158813 PMCID: PMC6094541 DOI: 10.4103/jhrs.jhrs_117_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims The aim of this study is to compare cumulative in vitro fertilization-intracytoplasmic sperm injection outcomes following two elective single embryo transfer (eSET) versus one double embryo transfer (DET) using blastocyst(s). Settings and Design This was retrospective observational study. Study Period The study was conducted during January 2015-December 2015. Subjects and Methods Forty-one fresh + 25 frozen eSET versus 123 DET using self-oocytes and 68 fresh + 35 frozen eSET versus 184 DET using donor-oocytes were included in the study. All failing to achieve live birth after first eSET underwent frozen embryo transfer cycle with second blastocyst. Cumulative outcome after two eSET were compared with one DET. Statistical Analysis Used The analysis was performed by Chi-square and t-test. Results In self-oocytes group, higher but statistically nonsignificant cumulative clinical pregnancy rate (CPR) (58.5% vs. 57.7%, P = 0.92) and live birth rate (LBR) (48.7% vs. 44.7%, P = 0.65) with significantly lower multiple pregnancy rate (MPR) (4.2% vs. 45%, P = 0.0002) were obtained; whereas in donor-oocytes group, comparable cumulative CPR (73.5% vs. 65.7%, P = 0.24), significantly higher LBR (64.7% vs. 48.9%, P = 0.02) and significantly lower MPR (4% vs. 51.2%, P = 0.00005) were obtained after two eSET vs. one DET. In self-oocytes group, the incidence of prematurity (10% vs. 21.4%, P > 0.05) and low birth weight (25% vs. 45.6%, P > 0.05) were lower but statistically nonsignificant, whereas in donor-oocytes group, incidence of prematurity was lower but statistically nonsignificant (26.7% vs. 38.8%, P > 0.05) while of low birth weight was significantly lower (32.7% vs. 51.2%, P = 0.0038) after two eSET versus one DET. Conclusion Cumulative LBR was higher with lower incidence of multiple births, prematurity and low birth weight after two eSET versus one DET using self- or donor-oocytes. Higher use of eSET improves reproductive outcomes in patients with good prognosis.
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Affiliation(s)
- Vidhisha P Mehta
- Department of Reproductive Medicine, Nova IVI Fertility and Pulse Women's Hospital, Ahmedabad, Gujarat, India
| | - Jayesh A Patel
- Department of Reproductive Medicine, Nova IVI Fertility and Pulse Women's Hospital, Ahmedabad, Gujarat, India
| | - Reena H Gupta
- Department of Reproductive Medicine, Nova IVI Fertility and Pulse Women's Hospital, Ahmedabad, Gujarat, India
| | - Sandeep I Shah
- Department of Reproductive Medicine, Nova IVI Fertility and Pulse Women's Hospital, Ahmedabad, Gujarat, India
| | - Manish R Banker
- Department of Reproductive Medicine, Nova IVI Fertility and Pulse Women's Hospital, Ahmedabad, Gujarat, India
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Extended culture of poor-quality supernumerary embryos improves ART outcomes. J Assist Reprod Genet 2017; 35:311-319. [PMID: 29047006 DOI: 10.1007/s10815-017-1063-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE The aims of this study were to investigate the possible benefits of extending the culture of poor-quality day-2 embryos (PQE) versus good-quality embryos (GQE) and to identify factors associated with pregnancy and live birth when transferring frozen-thawed blastocysts originating from GQE and PQE. METHODS This is a retrospective cohort follow-up study performed between November 2012 and February 2015 at the IVF Laboratory Unit of Cochin University Hospital (Paris, France) including 3108 day-2 supernumerary embryos resulting from 1237 IVF/ICSI cycles. RESULTS Total blastulation rate was 67.2% from GQE and 48.7% from PQE. Percentage of good-quality blastocysts was 60.7 and 47.9% respectively including 14.7 and 7.3% top-quality blastocysts. A total of 150 blastocysts originating from GQE and 729 from PQE were frozen, and then, 37 and 164 were thawed and transferred respectively resulting in 19 (51.4%) and 61 (37.9%) clinical pregnancies with 13 (35.1%) deliveries from GQE and 32 (19.9%) from PQE (p = 0.046) without any difference in neonatal outcomes. Quality of blastocysts that resulted in live birth was similar in the two groups. Women < 35 years old and day-5 blastocyst expansion were predictive of pregnancy and live birth. CONCLUSIONS (i) PQE are able to reach the blastocyst stage, to implant, and to give healthy babies and (ii) women age and day of blastocyst expansion are predictive of pregnancy and live birth.
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Sun L, Chen ZH, Yin MN, Deng Y, Liu J. [Pregnancy and obstetric outcomes of elective single versus double cleavage-stage embryo transfer]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2016; 37:512-516. [PMID: 28446405 PMCID: PMC6744098 DOI: 10.3969/j.issn.1673-4254.2017.04.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To compare the pregnancy and obstetric outcomes in elective single versus two cleavage-stage embryo transfer. METHODS Fresh cleavage-stage embryo transfer cycles between January, 2014 and October, 2015 were reviewed, including 39 single embryo transfer (eSET) cycles and 200 double embryo transfer (DET) cycles. The clinical pregnancy rates, implantation rates, multiple pregnancy rates, live birth rate, and obstetric outcomes (gestational age, preterm delivery rate and mean birth weight) were compared between the two groups. RESULTS The baseline characteristics were comparable between the two groups. The estradiol level on the day of trigger and the oocyte number were significantly higher in eSET group than in DET group (10654.4 pmol/L vs 8284.2 pmol/L and 8.4 vs 7.0, respectively). No significant difference was found in the pregnancy rate (56.4% vs 66.0%) or live birth rate (48.7% vs 51.5%) between the two groups, and their implantation rates differed significantly (56.4% vs 37.8%). No multiple pregnancies occurred in eSET group while the rate of multiple pregnancies was 22.7% in DET group. The gestational age and mean birth weight were significantly higher in eSET group (P<0.05), and the preterm delivery rate after DET was nearly three times of that after eSET, although this difference was not statistically significant. CONCLUSIONS Elective single embryo transfer can be performed without compromising the live birth rates. Multiple pregnancy rates can be significantly reduced with eSET, which also results in a higher chance of delivering a term singleton live birth compared with DET.
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Affiliation(s)
- Ling Sun
- Assisted Reproductive Medical Center, Guangzhou Women and Children's Hospital, Guangzhou 510623, China. E-mail:
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