Pregnancy outcomes after day 5 versus day 6 blastocyst‐stage embryo transfer: A systematic review and meta‐analysis

2020 ◽  
Vol 46 (4) ◽  
pp. 595-605 ◽  
Author(s):  
Yi‐xin Li ◽  
Jin Wang ◽  
Tian‐ze Sun ◽  
Mo‐qi Lv ◽  
Pan Ge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Embryo Transfer ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Blastocyst Stage ◽  
Stage Embryo

P–775 Obstetric and perinatal outcomes of singleton pregnancies after blastocyst-stage embryo transfer: a systematic review and cumulative meta-analysis

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
N Marconi ◽  
C Allen ◽  
S Bhattacharya ◽  
A Maheshwari
Keyword(s):  
Systematic Review ◽  
Preterm Birth ◽  
Embryo Transfer ◽  
Gestational Age ◽  
Lower Risk ◽  
Meta Analysis ◽  
Blastocyst Stage ◽  
Cleavage Stage ◽  
Stage Embryo ◽  
Singleton Pregnancies

Abstract Study question Are obstetric/perinatal outcomes different in singleton pregnancies following blastocyst-stage embryo transfer when compared to cleavage-stage embryo transfer and have results changed over time? Summary answer Pregnancies following blastocyst are consistently associated with higher risk of large for gestational age and lower risk of small for gestational age babies What is known already Extended embryo culture to blastocyst-stage is widely used to select best embryos in in vitro fertilisation (IVF) cycles to improve pregnancy rates. Transfer of blastocyst-stage embryos is increasing with this being the default strategy in most clinics. As blastocysts are kept in culture until day 5, 6 or 7 after oocyte fertilisation, there are suggestions that longer exposure to culture media may have a negative impact on pregnancy outcomes. More recent primary studies have challenged some of the initial findings. We therefore conducted an updated systematic review and cumulative meta-analysis (CMA) to examine if these results have changed over time. Study design, size, duration Systematic review of studies published between 1980 and 2020, followed by aggregated meta-analysis and CMA to track the accumulation of evidence over the period of time. Exposed group: singleton pregnancies following blastocyst transfer. Non-exposed group: singleton pregnancies following cleavage-stage transfer. Sub-group analyses were conducted on fresh and frozen-thawed embryo transfers. Perinatal (categories of preterm birth and birth weight) and obstetric outcomes (hypertensive disorders of pregnancy, gestational diabetes, c-section, placental anomalies) were compared between the groups. Participants/materials, setting, methods Medline, EMBASE, CINHAL, Web of Science, Cochrane Central Register of Clinical Trials and International Clinical Trials Registry Platform databases were searched. Relevant journals were searched for advance access publications. Critical Appraisal Skills Programme (CASP) checklists were used to assess study quality. Two independent reviewers extracted data in 2 × 2 tables. Aggregated and CMA were performed using Comprehensive Meta-Analysis software. Risk ratio (RR) with 95% confidence interval (CI) were calculated. Main results and the role of chance A total of 33 observational studies were included (n = 574,756 singleton pregnancies). Pregnancies following blastocyst-stage embryo transfer are associated with a higher risk of preterm birth (PTB) (RR 1.09; 95% CI 1.01–1.17), very preterm birth (VPTB) (RR 1.15; 95% CI 1.07–1.24), large for gestational age (LGA) babies (RR 1.13; 95% CI 1.08–1.19), c-section (RR 1.05; 95% CI 1.02–1.09), and with a lower risk of small for gestational age (SGA) babies (RR 0.86; 95% CI 0.81–0.93) as compared to singleton pregnancies following cleavage-stage embryo transfer. These findings were maintained in both fresh and frozen-thawed sub-groups for LGA and SGA. PTB was not significantly different in both sub-group analyses. The risk of VPTB was higher after blastocyst-stage embryo transfer only in the sub-group analysis of fresh embryo transfers (RR 1.17; 95% CI 1.09–1.27) and that of c-section only in the frozen-thawed sub-group (RR 1.08; 95% CI 1.04–1.12). No other statistically significant differences for the other outcomes were noted. The CMA suggests that for SGA and LGA subsequent studies have increased the precision of the point estimate with no change in the direction or magnitude of the treatment effect since 2014. Limitations, reasons for caution This analysis was constrained by the intrinsic limitations of observational studies with some of them receiving a CASP score < 10. Adjustment for confounders was not possible and a high degree of clinical and statistical heterogeneity was noted among studies. Wider implications of the findings: Blastocyst is associated with a higher risk of LGA and a lower risk of SGA with a stable body of evidence since 2014. We may need to revisit the default position of extending embryo culture and individualise care, until further high-quality data from individual-patient-data of large registries are available. Trial registration number Not applicable

scholarly journals Influence of cryopreservation on perinatal outcome after blastocyst- vs cleavage-stage embryo transfer: systematic review and meta-analysis

2018 ◽  
Vol 51 (1) ◽  
pp. 54-63 ◽  
Author(s):  
C. Alviggi ◽  
A. Conforti ◽  
I. F. Carbone ◽  
R. Borrelli ◽  
G. de Placido ◽  
...  
Keyword(s):  
Systematic Review ◽  
Embryo Transfer ◽  
Perinatal Outcome ◽  
Meta Analysis ◽  
Cleavage Stage ◽  
Cleavage Stage Embryo ◽  
Stage Embryo

scholarly journals Blastocyst vs cleavage-stage embryo transfer: systematic review and meta-analysis of reproductive outcomes

2017 ◽  
Vol 49 (5) ◽  
pp. 583-591 ◽  
Author(s):  
W. P. Martins ◽  
C. O. Nastri ◽  
L. Rienzi ◽  
S. Z. van der Poel ◽  
C. Gracia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Embryo Transfer ◽  
Meta Analysis ◽  
Reproductive Outcomes ◽  
Cleavage Stage ◽  
Cleavage Stage Embryo ◽  
Stage Embryo

scholarly journals Elevated Serum Estradiol Levels Have Different Effects on Pregnancy Outcomes Depending on Whether Cleavage-stage or Blastocyst-stage Embryo Transfer Is Performed During Artificial Frozen Embryo Transfer Cycles

2020 ◽  
Author(s):  
Qing Li ◽  
Liming Ruan ◽  
Lingling Zhu ◽  
Zengyu Yang ◽  
Maoling Zhu ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Pregnancy Outcomes ◽  
Blastocyst Stage ◽  
Frozen Embryo Transfer ◽  
Serum Estradiol ◽  
Cleavage Stage ◽  
Significant Difference ◽  
Cleavage Stage Embryo ◽  
Stage Embryo ◽  
The Impact

Abstract Objective: The aim of this study was to evaluate the association between serum estradiol (E2) and pregnancy outcomes of cleavage- or blastocyst-stage frozen embryo transfer (FET) cycles using hormone replacement therapy.Methods: A total of 776 FET cycles (669 couples) performed from January 2016 to December 2019 were included in the present retrospective cohort study. The impact of progesterone-initiation-day serum E2 levels on the ongoing pregnancy/live birth (OP/LB) rates was determined, and cleavage-stage embryo transfers and blastocyst-stage embryo transfers were analyzed separately. Results: Regarding cleavage-stage embryo transfer cycles, serum E2 levels on progesterone initiation day were significantly lower in the OP/LB group than in the non-OP/LB group (214.75 ± 173.47 vs. 253.20 ± 203.30 pg/ml; P = 0.023). In addition, there were downward trends in implantation, clinical pregnancy and OP/LB rates with increasing E2 levels. However, in blastocyst-stage embryo transfer cycles, such trends were not observed, and there was no significant difference between the OP/LB group and the non-OP/LB group. Logistic regression analysis revealed that E2 levels on progesterone initiation day in cleavage-stage embryo transfer cycles were independently associated with OP/LB (odds ratio = 1.000, 95% confidence interval: 1.000-1.001, P = 0.008). The areas under the receiver operating characteristic curve were 0.55 in cleavage-stage embryo transfer cycles and 0.53 in blastocyst-stage embryo transfer cycles.Conclusions: The association of low OP/LB rates with elevated E2 levels on the progesterone initiation day in cleavage-stage embryo transfer cycles suggests that E2 levels should be monitored during artificial cleavage-stage embryo transfer cycles. However, it is not necessary to monitor serum E2 levels when transferring blastocysts in artificial FET cycles.

scholarly journals The Developmental Stage at Cryopreservation in Assisted Reproduction: A Systematic Review and Meta-Analysis of Pregnancy Outcomes

2021 ◽  
Vol 6 (1) ◽  
Keyword(s):  
Systematic Review ◽  
Pregnancy Rate ◽  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Birth Rate ◽  
Developmental Stages ◽  
Meta Analysis ◽  
Live Birth Rate ◽  
Frozen Embryo Transfer

To date, there is no consensus in embryo developmental stages for cryopreservation. The present study aimed to investigate the impact of embryo developmental stages at cryopreservation on pregnancy outcomes of frozen embryo transfer. Systematic review and meta-analysis of relevant studies identified through MEDLINE literature search was performed. The primary outcome was live birth/delivery rate, and the secondary outcomes included implantation rate, ongoing pregnancy rate, clinical pregnancy rate, miscarriage rate, and multiple pregnancy rate. The protocol of this systematic review has been registered on PROSPERO 2017 (registration number: CRD42017072828). Five studies met the eligibility criteria were included in the present review. The outcomes of embryos frozen at different stages but transferred at the same stage were analyzed and compared. Embryos frozen at non-blastocyst showed a significant higher delivery/live birth rate than those cryopreserved at blastocyst (odds ratio=1.37; 95% confidence interval, 1.13-1.66) in the setting of frozen embryo transfer with blastocysts. There was only a limited number of studies with analyzable data for comparisons. The literature varied substantially in study design and methodology applied. Although a significant difference was observed toward an improved delivery/live birth rate for blastocyst transfer with embryos frozen at non-blastocyst stage, future studies are required to further corroborate this finding.

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