Abstract
ObjectiveThe single-embryo transfer (SET) is the recommended approach to improve the live birth rate and reduce the complications related with multiple pregnancies. However, the physicians generally chose to transfer two embryos when the embryo quality decreased. The effect on the in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) outcomes following the transfer of a poor-quality embryo (PQE) along with a good-quality embryo (GQE) has been explored. However, previous studies were limited by the fresh embryo transfer cycles or the small sample size.MethodsA retrospective cohort study was performed among 26,676 women (the mean age was 31.72 years) undergoing first frozen embryo transfer (FET) from January 2011 to December 2017. Patients were grouped into five subgroups, including SET with one GQE (SET-GQE, 2235 patients for cleavage-stage embryo transfer and 756 patients for blastocyst transfer), SET with one PQE (SET-PQE, 148 patients for cleavage-stage embryo transfer and 362 patients for blastocyst transfer), double-embryo transfer with two GQE (DET-2GQE, 20,461 patients for cleavage-stage embryo transfer and 519 patients for blastocyst transfer), double-embryo transfer (DET) with one GQE plus one PQE (DET-GQE+PQE, 1541 patients for cleavage-stage embryo transfer and 266 patients for blastocyst transfer), and DET with two PQE (DET-2PQE, 228 patients for cleavage-stage embryo transfer and 160 patients for blastocyst transfer). Multivariable logistic regression models were performed after controlling for other potential confounders to estimate the effect of number and quality of transferred embryos on pregnancy outcomes.ResultAlthough the live birth rate was significantly higher after DET-GQE+PQE compared with SET-GQE for cleavage-stage embryo transfer [574 of 1541 (37.25%) vs. 571 of 2235 (25.55%)], no significant difference was found between DET-GQE+PQE and SET-GQE for blastocyst transfer [143 of 266 (53.76%) vs. 325 of 756 (42.99%)]. However, DET-GQE+PQE also had the highest multiple live births in both cleavage-stage embryo transfer [134 of 1541 (8.70%)] and blastocyst transfer [46 of 266 (17.29%)]. The live birth rate after SET-PQE significantly decreased in comparison with SET-GQE [cleavage-stage embryo transfer: 18 of 148 (12.16%) vs. 571 of 2235 (25.55%); blastocyst transfer: 107 of 362 (29.56%) vs. 325 of 756 (42.99%)] and significantly increased after DET-2GQE compared with SET-GQE [cleavage-stage embryo transfer: 9357 of 20,461 (45.73%) vs. 571 of 2235 (25.55%); blastocyst transfer: 313 of 519 (60.31%) vs. 325 of 756 (42.99%)]. The live birth rate was also not different between DET-2PQE and SET-GQE for cleavage-stage embryo transfer and blastocyst transfer [cleavage-stage embryo transfer: 75 of 228 (32.89%) vs. 571 of 2235 (25.55%); blastocyst transfer: 74 of 160 (46.25%) vs. 325 of 756 (42.99)].ConclusionIn order to minimize the risk of multiple births, the data from this study did not support transferring DET with a GQE plus a PQE compared with SET with a GQE, especially for blastocyst transfer. However, the proportion of patients older than 35 years was small (12.07% for patients aged 36–39 years and 7.31% for patients 40 years or older), which limited the generalization of these results to other population.
Highlights
The development of clinical and laboratory techniques over decades has improved the live birth rate after assisted reproduction technology (ART) and increased the multiple pregnancy rate, which increased the obstetric complication and adverse neonatal outcomes (Neubourg et al, 2002; McLernon et al, 2010)
Two studies have explored the effect on the in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) outcomes following the transfer of a poor-quality embryo (PQE) along with a good-quality embryo transfer (GQE) and found that the clinical pregnancy rate and live birth rate were similar when compared with transfer of two GQEs, but the above studies were all conducted in the fresh cycles (Wintner et al, 2017; Li et al, 2018)
This large retrospective cohort study showed that double-embryo transfer (DET) with a GQE plus a PQE increased the live birth rate for cleavage-stage embryo transfer but did not increase the live birth rate for blastocyst transfer when compared with single-embryo transfer (SET) with a GQE during the first frozen embryo transfer (FET) treatments
Summary
The development of clinical and laboratory techniques over decades has improved the live birth rate after assisted reproduction technology (ART) and increased the multiple pregnancy rate, which increased the obstetric complication and adverse neonatal outcomes (Neubourg et al, 2002; McLernon et al, 2010). Two studies have explored the effect on the in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) outcomes following the transfer of a PQE along with a GQE and found that the clinical pregnancy rate and live birth rate were similar when compared with transfer of two GQEs, but the above studies were all conducted in the fresh cycles (Wintner et al, 2017; Li et al, 2018). Dobson et al (2018) evaluated the influence of double-embryo transfer (DET) with a PQE plus a GQE on the IVF outcome in the fresh and frozen cycles and reported that the live birth rate did not increase but the multiple birth increased compared with SET. The impact of DET and SET on IVF outcome at different grades of embryo quality in the vitrified cleavage and blastocyst stages needed to be further explored in a large sample study
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