Abstract
Study Question: The question: is there any difference in pregnancy rate between embryo transfer day 5 and day 6 in IVF? What Is Known Already? Blastocyst transfer is increasingly popular in assisted reproductive technology (ART) centers today. Very few articles concentrate on comparing Day 5 and Day 6 embryo transfer with conflict results. Objective, Study Design: Systematic review and meta-analysis of published controlled studies. Searches conducted from 2001-2020 on PubMed. Medline, EMBASE, and ISI Web of Science Electronic database is used to collect data, using the following search terms: blastocyst, Day 5, Day 6, embryo transfer (E.T.) and pregnancy rate. Materials, Setting, Methods: A total of 6 full-text articles preselected from 211 references, based on title and abstract. Two independent reviewers performed data selection and extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). This systematic review was conducted according to (PICO) standard. Random-effect meta-analysis performed on all data (overall analysis). Results and the Role of Chance: Data from 6 relevant articles were extracted and integrated into the meta-analysis that reported clinical pregnancy rate (CPR) as an outcome in 5640 cycles, 2274 cycle had embryo transfer at day 6 and the control was 3366 cycle had embryo transfer day 5 showed a significantly higher clinical pregnancy rate following Day 5 embryo transfer compared with Day 6 embryo transfer with odd ratio and 95% confidence limit 0.73 (0.66 - 0.82) p value < 0.000. Sensitivity analysis led to similar results and conclusions. Limitations, Reasons for Caution: The validity of meta-analysis results depends mainly on the quality and the number of published studies available. Indeed, this meta-analysis included no randomized controlled trial (RCT). Wider Implications of the Findings: In regards to the results of this original meta-analysis, ART practitioners should preferably transfer D5 rather than D6 blastocysts. Further RCTs are needed to address the question of whether D6 embryos should be transported.
Highlights
Assisted reproductive technology (ART) The most commonly used assisted reproductive technology (ART) procedures are in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) which start with patient’s selection such as women with damaged or blocked fallopian tubes, or infertility due to male factor including decreased sperm count or sperm motility, women with ovulation disorders, and unexplained infertility [1]
Role of Chance: Data from 6 relevant articles were extracted and integrated into the meta-analysis that reported clinical pregnancy rate (CPR) as an outcome in 5640 cycles, 2274 cycle had embryo transfer at day 6 and the control was 3366 cycle had embryo transfer day 5 showed a significantly higher clinical pregnancy rate following Day 5 embryo transfer compared with Day 6 embryo transfer with odd ratio and 95% confidence limit 0.73 (0.66 0.82) p value < 0.000
A meta-analysis of the six studies that reported clinical pregnancy rate (CPR) as an outcome, in 5640 cycles, 2274 cycle had embryo transfer at day 6 and the control was 3366 cycle had embryo transfer at day 5 showed a significantly higher clinical pregnancy rate following Day 5 embryo transfer compared with Day 6 embryo transfer with odd ratio and 95% confidence limit 0.73 (0.66 0.82) p value < 0.000 [10]-[15]
Summary
Assisted reproductive technology (ART) The most commonly used ART procedures are in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) which start with patient’s selection such as women with damaged or blocked fallopian tubes, or infertility due to male factor including decreased sperm count or sperm motility, women with ovulation disorders, and unexplained infertility [1]. The IVF & ICSI and embryo transfer process start by controlled hyperstimulation to stimulate multiple oocytes productions [1]. This can be monitored by hormonal level and transvaginal ultrasound [2]. Embryos that develop to the expanded blastocyst stage at embryo transferred on day 5 are likely to have an implantation rate more than embryo transfer on Day 6 [8]. The rate of development to the expanded blastocyst stage (Day five and Day 6) is associated with higher implantation rates than of younger cleavage stage embryos being related to viability [10]. The aim is to identify if there is any difference in pregnancy rate between embryo transfer day 5 and day 6 (Review and Meta-analysis)
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