Abstract
Background. Although the optimal outcome of assisted reproductive technology (ART) is a healthy singleton pregnancy, the rate of twin gestation from ART in women over the age of 35 is persistently high. Methods/Findings. We compared clinical pregnancy rates (PRs), ongoing pregnancy/live birth rates, and multiple gestation rates (MGRs) in 108 women who chose elective single blastocyst transfer (eSBT) to 415 women who chose elective double blastocyst transfer (eDBT) at a hospital-based IVF center. There was no significant difference in PR between eSBT and eDBT (57.4% versus 50.2%, P = 0.47) nor between eSBT and eDBT within each age group: <35, 35–37, 38–40, and >40. The risk of multiple gestations, however, was greatly increased between eSBT and eDBT (1.6 versus 32.4%, P < 0.00005), and this difference did not vary across age groups. Conclusion(s). Women undergoing eDBT are at uniformly high risk of multiple gestation regardless of age. eSBT appears to significantly lower the risk of multiple gestation without compromising PR.
Highlights
The optimal outcome of assisted reproductive technology (ART) is a healthy singleton pregnancy [1]
There were no differences between the elective single blastocyst transfer (eSBT) and elective double blastocyst transfer (eDBT) groups in terms of prior live births or cycle characteristics, such as number of oocytes, number of embryos, number of blastocysts, and percent of cycles using intracytoplasmic sperm injection (ICSI) or preimplantation genetic diagnosis (PGD)
There was no significant difference in live birth/ongoing pregnancy rates (PRs) between the eSBT (48.1%) and eDBT (41.7%) groups (P = 0.22) overall
Summary
The optimal outcome of assisted reproductive technology (ART) is a healthy singleton pregnancy [1]. Aimed at reducing rates of highorder multiple (HOM) pregnancies, these guidelines were revised most recently in 2006 and recommend transferring two to three cleavage stage embryos for women aged 35–37, and no more than two blastocysts, depending on prognostic factors and patient preference. For women aged 38–40 years, the recommendation is for three to four cleavage stage embryos, and between two to three blastocysts [4] The implementation of these guidelines has been associated with a decrease in HOM [5], but the rate of twins remains persistently high. The optimal outcome of assisted reproductive technology (ART) is a healthy singleton pregnancy, the rate of twin gestation from ART in women over the age of 35 is persistently high. Women undergoing eDBT are at uniformly high risk of multiple gestation regardless of age. eSBT appears to significantly lower the risk of multiple gestation without compromising PR
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