Comparing sequential vs day 3 vs day 5 embryo transfers in cases with recurrent implantation failure: randomized controlled trial

Sequential embryo transfer combined with intrauterine perfusion improved pregnancy outcomes in patients with recurrent implantation failure

OBJECTIVE

To compare the application of sequential embryo transfer, cleavage embryo transfer, and blastocyst transfer combined with intrauterine perfusion in frozen-thawed embryo transfer cycles in patients with recurrent implantation failure to provide a reference for reproductive clinicians.

METHODS

The 166 patients who underwent frozen-thawed embryo transfer due to recurrent implantation failure in the reproductive center from January 2021 to March 2022 were retrospectively analyzed. According to the different embryos transferred, they were divided into cleavage embryo transfer groups (72 cases in Group A), blastocyst transfer group (29 cases in Group B), and sequential transfer group (65 cases in Group C). All three groups were treated with intrauterine perfusion 5 days before embryo transfer. The general data and clinical pregnancy outcome indicators, such as embryo implantation rate, clinical pregnancy rate, ongoing pregnancy rate, live birth rate, twin rate, were compared among the three groups.

RESULTS

The embryo implantation rate (53.1%), clinical pregnancy rate (76.9%), ongoing pregnancy rate (67.7%) and live birth rate(66.15%) in the sequential transfer group were significantly higher than those in the other two groups (P < 0.05), and the ectopic pregnancy rate was lower in the sequential transfer group.

CONCLUSION

Sequential transfer combined with intrauterine perfusion partially improves clinical pregnancy outcomes and reduces the risk of ectopic pregnancy in frozen embryo cycle transfers in patients with recurrent implantation failure, which may be a favourable transfer reference strategy for patients with recurrent implantation failure.

Sequential embryo transfer versus double cleavage-stage embryo or double blastocyst transfer in patients with recurrent implantation failure with frozen-thawed embryo transfer cycles: a cohort study

Background

Recurrent implantation failure (RIF) is more common among patients receiving assisted reproductive treatment. Many efforts have been made to increase the incidence of clinical pregnancy among patients with RIF. The effect of the sequential transfer procedure, a two-step interval transfer of a cleavage-stage embryo followed by a blastocyst in one transfer cycle, on the clinical outcomes of RIF patients remains controversial.

Methods

In total, 1774 frozen-thawed embryo transfer (FET) cycles in RIF patients were included. Of these cycles, 302 were sequential embryo transfer (ET) cycles, 979 were double day 3 cleavage-stage ET cycles, and 493 were double blastocyst ET cycles. The primary outcomes were the rates of implantation, clinical pregnancy and multiple pregnancy, and the secondary outcomes were the rates of hCG positive, early miscarriage and ectopic pregnancy.

Results

The implantation, hCG positive, and clinical pregnancy rates in the sequential ET group (32.1%, 58.9%, 50.7%) were significantly higher than those in the day 3 cleavage-stage ET group (24.9%, 46.5%, 40.4%) and were similar to those in the blastocyst transfer group (30.1%, 56.4%, 47.1%). The early miscarriage rate in the blastocyst transfer group was significantly higher than that in the cleavage-stage ET group (17.2% vs. 8.1%, P <0.05), while the ectopic pregnancy rate in the blastocyst transfer group was significantly lower than that in the cleavage-stage ET group (0.4% vs. 3.0%, P <0.05). The multiple pregnancy rate in the sequential ET group was significantly lower than that in the cleavage-stage ET group (17.0% vs. 25.5%, P <0.05) and the blastocyst transfer group (17.0% vs. 27.6%, P <0.05). When cycles of blastocyst culture failure were excluded, the clinical pregnancy rate was significantly higher (55.7% vs. 47.1%, P <0.05), and the early miscarriage rate and multiple pregnancy rate were significantly lower (8.5% vs. 17.2%, 17.7% vs. 27.6%; P <0.05, respectively) in the sequential ET group than in the double blastocyst ET group.

Conclusions

Sequential embryo transfer in FET cycles could improve the clinical outcomes of patients with RIF.

The efficacy of sequential day 3 embryo and blastocyst transfer in patients with repeated implantation failure

OBJECTIVE

To evaluate the efficacy of sequential transfer that one cleavage-stage embryo on day 3 and one blastocyst on day 5 are sequentially transferred in the same treatment cycle over conventional day 3 embryo transfer and blastocyst transfer in patients with repeated implantation failure (RIF).

STUDY DESIGN

2836 frozen embryo transfer (FET) cycles in patients with RIF were divided into three groups according to female age: <35, 35-39 and >39 years old groups, and four groups depending on the number and period of embryo transferred: two day 3 embryo, two blastocyst, single blastocyst and sequential transfer groups; Pregnancy outcomes including implantation rate (IR), clinical pregnancy rate (CPR), abortion rate (AR), ectopic pregnancy rate (EPR), multiple pregnancy rate (MPR), live birth rate (LBR) and neonatal characteristics from all the groups were assessed.

RESULTS

Sequential transfer caused a significant increase in the IR, CPR and LBR over two day 3 embryo transfer and did not improve the IR, CPR and LBR over two blastocyst transfer in patients with RIF. Sequential transfer had higher CPR, MPR and LBR and lower IR than single blastocyst transfer. No significant differences were present in neonatal characteristics among the transfer protocol groups. Singleton group had a higher average gestational age and birthweight as well as a lower cesarean section rate, preterm labor rate and low birthweight rate than twin group. Additionally, the AR had no significant difference and the EPR of blastocyst transfer was low.

CONCLUSIONS

Sequential transfer was not an effective method to improve IR in patients with RIF, and blastocyst transfer with higher IR was suggested. Single blastocyst transfer could serve as an effective transfer protocol to reduce MPR.

Comparing the effect of sequential embryo transfer versus double blastocyst embryo transfer on pregnancy outcomes in intracytoplasmic sperm injection (ICSI) cycles in patients with repeated implantation failure: A randomized controlled trial

OBJECTIVE

Recurrent implantation failure (RIF) is the main challenge in assisted reproductive technology (ART) practice. Sequential embryo transfer, in which both, cleavage-stage embryo on day 3 and blastocyst on day 5, are sequentially transferred in the same cycle, has been suggested for increasing embryo implantation in RIF patients. The aim of the present study was to compare the effect of sequential embryo transfer versus double blastocyst embryo transfer on pregnancy outcomes in intracytoplasmic sperm injection (ICSI)/frozen embryo transfer (FET) cycles in RIF patients.

MATERIALS AND METHODS

This prospective study was enrolled 224 RIF patients undergoing ICSI/FET cycles and randomly divided to sequential and control groups. In sequential group, embryo transfer was conducted on day 3 (cleavage stage) and day 5 (blastocyst stage). In control group, two top-quality blastocysts were transferred on day 5.

RESULTS

Two hundred and two couples accomplished the trial, and their data were analyzed. Results demonstrated that sequential embryo transfer on day 3 and day 5 compared to double blastocyst transfer on day 5 significantly increased implantation rate, clinical pregnancy rate and ongoing pregnancy rate in RIF patients (p-value = 0.0142, p-value = 0.0154, p-value = 0.0201, respectively). However, there were no significant differences in terms of chemical pregnancy rate, multiple pregnancy rate, miscarriage rate and ectopic pregnancy rate in the studied groups.

CONCLUSION

Sequential embryo transfer is associated with improved pregnancy outcomes in RIF patients. Further prospective studies with larger sample sizes are required to validate these results.