Abstract
This study aimed to evaluate if single medium is better than sequential medium at improving ongoing pregnancy rates in patients undergoing assisted reproductive technology (ART) procedures. The data featured in this meta-analysis were extracted from four randomized controlled trials yielded from a systematic search carried out on electronic databases. The primary endpoint was ongoing pregnancy rate. Secondary endpoints included clinical pregnancy and miscarriage rates. The endpoints for ongoing pregnancy rate were also analyzed based on the time at which the embryo transfers were performed: cleavage stage (day 2/3) and/or blastocyst stage (day 5/6). There were no significant differences between single and sequential medium for clinical pregnancy (RR=1.09; 95%CI=0.83-1.44; p=0.53), ongoing pregnancy (RR=1.11; 95%CI=0.87-1.40; p=0.39), or miscarriage rates (RR=0.89; 95%CI=0.44-1.81; p=0.74). No significant difference was found for ongoing pregnancy rate (RR=1.29; 95%CI=0.93-1.78; p=0.12) between single and sequential medium when only trials in which embryos were transferred at the blastocyst stage were included. In conclusion, the choice of embryo culture approach - single or sequential medium - did not affect the ongoing pregnancy rates of patients undergoing ART cycles.
Highlights
Several factors affect the success of in vitro fertilization (IVF) treatment
Miscarriage was defined as any pregnancy, including clinical pregnancies, which failed to reach the status of ongoing pregnancy
Study data were combined using a Random-effects model. p-values
Summary
Several factors affect the success of in vitro fertilization (IVF) treatment. Proper embryo culture conditions and medium formulation in particular are two indispensable requirements (Mauri et al, 2001; Summers & Biggers, 2003; Hentemann & Bertheussen, 2009; Paternot et al, 2010). The fallopian tubes are the natural environment for human oocyte fertilization and the stage where early embryonic development unfolds; they provide the optimal environment for the developing preimplantation embryo before it reaches the endometrial cavity (Lyons et al, 2006; Hambiliki et al, 2011). Two possible formulations have been considered for culture media: one is the “back to nature” approach, based on sequential embryo culture medium (Sequential-ECM) designed to mimic in vivo conditions; and the other is the “let the embryo choose” approach, based on single culture medium (Single-ECM) in which the embryo is cultured in a constant medium containing all the ingredients needed for its development (Lane & Gardner, 2007; Biggers & Summers, 2008; Paternot et al, 2010)
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