scholarly journals Double embryo transfer of a euploid blastocyst after a failed single embryo transfer does not improve live birth rate but significantly increases the risk of twins

2018 ◽  
Vol 109 (3) ◽  
pp. e39 ◽  
Author(s):  
S.J. Morin ◽  
S.A. Neal ◽  
A.W. Tiegs ◽  
R.T. Scott
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Single Embryo Transfer ◽  
Double Embryo Transfer

P–545 Impact of screening for aneuploidies in blastocysts on single embryo transfer live birth rates. A systematic review and meta-analysis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
L H Sordia-Hernandez ◽  
F A Morale. Martinez ◽  
A Flore. Rodriguez ◽  
F Diaz-Gonzale. Colmenero ◽  
P Leyv Camacho ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Meta Analysis ◽  
Genetic Diagnosis ◽  
Live Birth Rate ◽  
Single Embryo Transfer ◽  
Reproductive Outcomes ◽  
Vitro Fertilization

Abstract Study question Does the selection of blastocysts for single embryo transfer, through the diagnosis of aneuploidy, improves the live birth rate in patients undergoing in vitro fertilization? Summary answer There seems to be no statistical difference in live birth rates between embryos with preimplantational genetic diagnosis (PGD) and those without. What is known already: Initial reports indicate that reproductive results improve after the selection of embryos to be transfer after performing a biopsy of the blastomeres, or trophectoderm cells, with the subsequent comprehensive analysis of the chromosomes. However, these results are now questioned. Reports in the literature are contrasting, so the real utility of selecting all embryos through comprehensive chromosome analysis calls for a more careful analysis that compares the risks, costs, and benefits of these techniques and their actual utility in reproductive results of patients treated with in vitro fertilization. Specifically results related to live birth rate. Study design, size, duration A systematic review of prospective studies evaluating live birth rate after embryo transfer of embryos selected by blastocyst biopsy for aneuploidy analysis compared with reproductive outcomes in embryo transfers of embryos selected morphologically, without biopsy nor screening for aneuploidies. Participants/materials, setting, methods A literature search was performed in PubMed, EmBase, and the Cochrane library (from January 2000 to december 2019). A cumulative meta-analysis and evaluation of heterogeneity was performed for the clinical pregnancy rate. The quality of the included studies was assessed using Cochrane’s Risk of Bias tool and ROBINS I for observational studies Main results and the role of chance Seven studies were included, three were randomized controlled trials and four were non-randomized studies of intervention (NRSI). The included studies were published between 2013 and 2019. For the preimplantational genetic diagnosis, three studies used array comparative genomic hybridization, three studies used next generation sequencing and only one study used qPCR. A total of 1638 patients were included, only two studies excluded patients with advanced maternal age (>35 years), two studies studied patients with recurrent implantation failure and three studies patients with recurrent pregnancy loss. Regarding the assisted reproduction techniques (ART), only studies where embryos where biopsied after day five for the genetic diagnosis where considered, most used ICSI and performed frozen-thawed transfer of up to two embryos, only one study allowed patients to be transferred with more than two embryos per cycle. Reproductive outcomes (live birth rate, miscarriage rate, clinical pregnancy) were extracted considering the events per embryo transfer and calculating the pooled odds ratios (OR) with 95% confidence intervals (95%CI) as our main outcome, sensitivity analyses will be performed using the events per cycles to assess the robustness of the effect estimate. Preliminary meta-analyses resulted in a pooled OR of 1.45 (95%CI 0.24–8.78) for NRSI and 1.34 (95%CI 0.85–2.11) for RCT. Limitations, reasons for caution The main limitation was the quantity of studies with acceptable methodology. This generated heterogeneity, hindering the evaluation of the true impact of PGD in ART outcomes. The use of events per embryo transfer as a main outcome could bias the results favoring PGD as less embryos are usually transferred. Wider implications of the findings: Our results show that there are too few studies with adequate methodology to generate a conclusion about the true benefit of PGD. However, a slight tendency favoring the reproductive outcomes of PGD was found. Trial registration number PROSPERO CRD42020198866

P–780 The increase of single embryo transfers does not impair pregnancy and live birth rates, although it lowers twin rate

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
M Stimpfel ◽  
L Bacer-Kermavner ◽  
T Fevzer ◽  
P Petric ◽  
N Jancar ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Culture Media ◽  
Statistical Significance ◽  
Live Birth Rate ◽  
Single Embryo Transfer ◽  
Favorable Effect ◽  
Birth Rates ◽  
Live Birth Rates

Abstract Study question How does significant increase of the proportion of single embryo transfer over 10 years period affect pregnancy, live birth and twin rate. Summary answer Increase in single embryo transfer doesn’t change pregnancy and live birth rate, although it significantly lowers twin rate. What is known already Due to widely used approach in IVF of transferring multiple embryos to improve the pregnancy and birth rate, multiple pregnancies, mostly twin, are quite common. But because they are more often associated with adverse neonatal and perinatal outcomes as singleton pregnancies, they are not desirable. Therefore, more and more often the transfer of single embryo is encouraged. Furthermore, in the last years with improvements in cryopreservation techniques leading to effective cryopreservation of supernumerary embryos, there is more options for performing repeated single embryo transfers. Study design, size, duration We retrospectively collected the data of all fresh embryo transfers in couples treated in our centre from January 2010 to December 2019. We excluded embryo transfer where embryos were derived from cryopreserved oocytes and analysed the outcome of fresh embryo transfer regarding to the number of transferred embryos. Participants/materials, setting, methods In our analysis we included 10583 fresh embryo transfers. We tried to evaluate how the proportion of single embryo transfer has changed through analysed period of time and if this led to any differences in pregnancy, live birth, and twin rate. To determine the differences between the groups, the data were analysed with one-way ANOVA and Pearson’s chi-square, as appropriate. Statistical significance was set at P < 0.05. Main results and the role of chance The analysis revealed that the proportion of single embryo transfers significantly increased from year 2010 to year 2019 (from 28% to 73%; P < 0.001). The proportion increased every year, minimum increase was 1% whereas maximum increase was 16%. This increase over the years did not negatively affect the pregnancy (32% in 2010 vs. 34% in 2019: p = 0.317) and live birth rates (24% vs. 25%; p = 0.584), although it had favorable effect on twin rate (16% vs. 7%; p = 0.002). If we separately analyzed only single and double embryo transfer, we observed that pregnancy (24% in 2010 and 34% in 2019; p = 0.001) and live birth rates (17% vs. 26%, p = 0.001) significantly increased after single embryo transfers, but no difference was observed in double embryo transfers (pregnancy rate: 35% vs. 35%, p = 1; live birth rate: 27% vs. 22%, p = 0.097; twins rate: 20% vs. 27%, p = 0.244). Additionally, we observed that female mean age value significantly increased over analyzed period (34.2±4.5 years in 2010 vs. 35.7±4.7 years in 2019, p < 0.001), although there was no difference in mean number of retrieved oocytes (8.2±5.4 vs. 8.1±4.9, p = 1) and obtained embryos (4.5±3.3 vs. 4.2±2.9; p = 0.684). Limitations, reasons for caution The limitation of the study is retrospective design, and not evaluating the influence of elective single embryo transfer. Also, the IVF laboratory methods and IVF culture media improved over the years meaning they could be partly responsible for observed differences. Wider implications of the findings: Single embryo transfer could probably be performed in even higher proportion without lowering the chances for pregnancy. Trial registration number not applicable’

scholarly journals Endometriosis and Cumulative Live Birth Rate After Fresh and Frozen IVF Cycles With Single Embryo Transfer in Young Women

2020 ◽  
Vol 75 (1) ◽  
pp. 35-36
Author(s):  
Michael Feichtinger ◽  
Emelie Nordenhök ◽  
Jan I. Olofsson ◽  
Nermin Hadziosmanovic ◽  
Kenny A. Rodriguez-Wallberg
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Young Women ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Single Embryo Transfer ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth

scholarly journals The Morphology of Inner Cell Mass Is the Strongest Predictor of Live Birth After a Frozen-Thawed Single Embryo Transfer

2021 ◽  
Vol 12 ◽  
Author(s):  
Jihui Ai ◽  
Lei Jin ◽  
Yu Zheng ◽  
Peiwen Yang ◽  
Bo Huang ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Inner Cell Mass ◽  
Cell Mass ◽  
Live Birth Rate ◽  
Single Embryo Transfer ◽  
Clinical Pregnancy ◽  
Stage 4

BackgroundThe scoring system for human blastocysts is traditionally based on morphology; however, there are controversies on the effect of morphology parameters on pregnancy outcomes. The aim of this study is to evaluate the predicting value of each morphology parameter on pregnancy outcomes in a setting of single embryo transfer.MethodsThis is a retrospective cohort study on patients undergoing frozen-thawed single blastocyst transfer at our center, between Jan. 2009 and Dec. 2018. A total of 10,482 cycles were analyzed. The blastocysts were scored according to the expansion and hatching status, morphology of inner cell mass (ICM), and cells of trophectoderm (TE). The primary outcome measure was live birth rate. One-way analysis of variance, chi-square test, and multiple logistic regression were used for statistical analysis.ResultsThe clinical pregnancy rate was lower in the blastocysts of stage 3 (48.15%), compared with those of stage 4 (56.15%), stage 5 (54.91%), and stage 6 (53.37%). The live birth rate was lower in the blastocysts of stage 3 (37.07%), compared with those of stage 4 (44.21%) and stage 5 (41.67%). The rates of clinical pregnancy (A: 66.60%, B: 53.25%, C: 39.33%) and live birth (A: 54.62%, B: 41.29%, C: 28.45%) were both decreased with decreasing grade of ICM morphology, and these differences were pairwise significant. The miscarriage rate of blastocysts with ICM grade A was lower, compared with ICM grade C (17.53 vs. 27.66%). Blastocysts with TE morphology of C had lower rates of clinical pregnancy (43.53%) and live birth (32.57%), compared with those with TE morphology of A and B (clinical pregnancy rate: 64.26% for A, 58.11% for B; live birth rate: 52.74% for A, 45.64% for B). There were no significant differences in rates of clinical pregnancy, live birth, and miscarriage between the blastocysts with TE grade A and B.ConclusionsThe blastocyst expansion stage, ICM grade, and TE grade are all associated with pregnancy outcomes. ICM grade is the strongest predictor of live birth. A blastocyst with stage 4–5, ICM grade A, and TE grade A/B should be given priority for single embryo transfer.

O-110 A randomised, controlled, assessor-blind trial assessing clinical outcomes of individualised dosing with follitropin delta in Asian IVF/ICSI patients

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J Qiao ◽  
Y Zhang ◽  
X Liang ◽  
T Ho ◽  
H Y Huang ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Ovarian Response ◽  
Preventive Interventions ◽  
Follitropin Alfa ◽  
Randomised Controlled ◽  
Individualised Dosing ◽  
Double Embryo Transfer

Abstract Study question To evaluate the efficacy and safety of individualised dosing with follitropin delta versus conventional dosing with follitropin alfa in an Asian population undergoing ovarian stimulation. Summary answer Individualised dosing with follitropin delta results in significantly higher live birth rate and fewer early OHSS and/or preventive interventions compared to conventional follitropin alfa dosing. What is known already Previous randomised controlled trials conducted in Europe, North- and South America mainly including Caucasian IVF/ICSI patients as well as in Japan have demonstrated that ovarian stimulation with the individualised follitropin delta dosing regimen based on serum AMH level and body weight modulated the ovarian response and reduced the risk of OHSS without compromising pregnancy and live birth rates. Study design, size, duration Randomised, controlled, assessor-blind trial conducted in 1,009 Asian patients from mainland China, South Korea, Vietnam and Taiwan, undergoing their first IVF/ICSI cycle. Randomisation was stratified by age (<35, 35-37, 38-40 years). The primary endpoint was ongoing pregnancy assessed 10-11 weeks after transfer (non-inferiority limit -10.0%; analysis adjusted for age strata). Patients <35 years underwent single embryo transfer if a good-quality embryo was available, otherwise double embryo transfer. Patients ≥35 years underwent double embryo transfer. Participants/materials, setting, methods Follitropin delta (Rekovelle, Ferring Pharmaceuticals) daily treatment consisted of a fixed dose individualised according to each patient’s initial AMH level (<15 pmol/L: 12 μg; ≥15 pmol/L: 0.19 to 0.10 μg/kg; min-max 6-12 μg) and body weight. Follitropin alfa (Gonal-f, Merck Serono) dose was 150 IU/day for the first five days with subsequent potential dose adjustments according to individual response. A GnRH antagonist protocol was applied. OHSS was classified based on Golan’s system. Main results and the role of chance The ongoing pregnancy rate was 31.3% with follitropin delta and 25.7% with follitropin alfa (adjusted difference 5.4% [95% CI: -0.2%; 11.0%]). The live birth rate was significantly higher at 31.3% with follitropin delta compared to 24.7% with follitropin alfa (adjusted difference 6.4% [95% CI: 0.9%; 11.9%]; p < 0.05). Live birth rates per age stratum were as follows for follitropin delta and follitropin alfa; <35 years: 31.0% versus 25.0%, 3537 years: 35.3% versus 26.7%, 38-40 years: 20.0% versus 14.3%. Early OHSS risk, evaluated as the incidence of early OHSS and/or preventive interventions, was significantly (p < 0.01) reduced from 9.6% with follitropin alfa to 5.0% with follitropin delta. The number of oocytes was 10.0±6.1 with follitropin delta and 12.4±7.3 with follitropin alfa. Individualised follitropin delta dosing compared to conventional follitropin alfa dosing resulted in 2 more oocytes (9.6±5.3 versus 7.6±3.5) in potential low responders (AMH <15 pmol/L) and 3 fewer oocytes (10.1±6.3 versus 13.8±7.5) in potential high responders (AMH ≥15 pmol/L). Among patients with AMH ≥15 pmol/L, excessive response occurred less frequently with individualised than conventional dosing (≥15 oocytes: 20.2% versus 39.1%; ≥20 oocytes: 6.7% versus 18.5%). Total gonadotropin dose was reduced from 109.9±32.9 μg with follitropin alfa to 77.5±24.4 μg with follitropin delta. Limitations, reasons for caution The trial only covered the clinical outcome of one treatment cycle with fresh cleavage-stage embryo transfers. Wider implications of the findings The present trial implies that in addition to reducing the early OHSS risk, individualised dosing has the potential to improve the take-home baby rate in fresh cycles across all ages and with a lower gonadotropin consumption. The benefits in outcomes appear to be explained by the modulation of ovarian response. Trial registration number NCT03296527

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