ELECTIVE DOUBLE EUPLOID EMBRYO TRANSFER IN ADVANCED MATERNAL AGE COUPLES – IS THERE A BENEFICIAL ROLE?

Abstract

Is there a beneficial role for elective euploid double embryo transfer(e-DET) in Advanced Maternal Age (AMA) couples to optimize reproductive outcomes? This retrospective case series study was done from May 2014 to May 2019 at a Private Teaching Fertility Clinic. A total of 51 AMA (Age ≥ 37 years) in our study group and 181 young (Age < 37 years) patients in control group underwent Intracytoplasmic Sperm Injection(ICSI), Trophectoderm(TE) biopsy and Next Generation Sequencing(NGS). Patients who at least had two euploid embryo were considered in this study. Based on the number of embryos transferred in Frozen Embryo Transfer cycle (FET) patients were divided into eSET group and eDET group. All In-Vitro Fertilization (IVF) patients who underwent Pre-Implantation Genetic Testing for Aneuploidy (PGT-A) were divided into 2 groups depending on number of embryo/s transferred. Decision on the number of embryos for FET was taken by the couples after discussion with the clinicians about the risks and benefits. A written consent was obtained for the same. Reproductive outcomes of the study group were compared with control group. Group 1 (eSET) – AMA (n = 32) Vs Young (n = 147) Group 2 (eDET) – AMA (n = 19) Vs Young (n = 34) Following reproductive outcomes were compared - Implantation Rate (IR), Clinical Pregnancy Rate (CPR), Miscarriage Rate (MR), Multiple Pregnancy Rate (MPR), Live Birth Rate (LBR) Mean of the Reproductive outcomes with eSET in Study Vs Control group were as follows: CPR – 65.63% Vs 65.99% (P=0.96) IR – 68.75% Vs 67% (P=0.84) MR – 15.63% Vs 10.88% (P=0.45) MPR – 0% Vs 0.68% (P=0.64) LBR – 50% Vs 55.10% (P=0.60) Mean of the Reproductive outcomes with eDET were as follows: CPR – 78.95% Vs 82.35% (P=0.76) IR – 47.36% Vs 53% (P=0.57) MR – 21.05% Vs 14.71% (P=0.57) MPR – 15.78% Vs 2.94% (P=0.09) LBR – 57.89% Vs 67.65% (P=0.48) When considering Euploid embryos for transfer, AMA women or younger women had comparable reproductive outcomes with eSET or eDET. In spite of transferring two euploid embryos the IR was still lower in eDET group (when compared with eSET) and there was no statistical significance with LBR. Higher multiple pregnancies in AMA group poses higher risk for maternal morbidity and mortality. AMA women with euploid embryos should be counselled for eSET as there is no added benefit with eDET. Transferring two euploid embryos in advanced maternal age women doesn’t optimize reproductive outcomes. Even in AMA women eSET policy is recommended.