Double Blastocyst Transfer Research Articles

Early miscarriage after single and double blastocyst transfer - an analysis of 1020 blastocyst transfers.

Background: Occurrence of early miscarriage in pregnancies accomplished by in vitro fertilisation procedures was studied, almost exclusively, in women in whom cleavage stage embryos were transferred. The primary objective of our retrospective study was to identify the factors predicting early miscarriage following the transfer of one or two blastocysts. Materials and Methods: Using the multivariate logistic regression model, we analyzed the parameters of 1020 sequential IVF/ICSI cycles with the transfer of one or two blastocysts, in which positive levels of βhCG were observed. Age of the patient, fertilization method, number of retrieved oocytes, number of developed, frozen and transferred blastocysts and their quality were analyzed as possible predictors for early spontaneous miscarriage. Results: The overall frequency of biochemical pregnancies in the observed group of patients was 6.6 % (67/1020). Biochemical pregnancies occurred somewhat more frequently following the transfer of one, rather than two blastocysts (9.05 % (23/254) vs. 5.8 % (44/763)). The rate of early clinical miscarriage was 13.3 % (136/1020), with the rate of miscarriage higher following the transfer of one as opposed to two blastocysts (15.3 % (39/254) vs. 12.7(97/763)). If biochemical pregnancies and early clinical miscarriages were observed together, the rate of early pregnancy losses in the overall sample studied was 19.9 % (203/1020), following the transfer of one blastocyst 24.4 % (62/254) and following the transfer of two 18.4 % (141/763). Using the multivariate logistic regression, we demonstrated that statistically significant predictors for early spontaneous miscarriages were the patient’s age (OR = 1.098; 95 % CI 1.057–1.140, P < 0.001), the number of blastocysts transferred (OR = 0.592; 95 % CI 0.412–0.851, P = 0.005), the quality of blastocysts transferred (OR=0.666; 95 % CI 0.468–0.949; P = 0.024), as well as the number of blastocysts frozen (OR = 0.912; 95 % CI 0.832–0.999; P = 0.048). Conclusion: The transfer of optimal quality blastocyst(s) and transfer of two blastocysts were associated with a reduced rate of spontaneous miscarriages in pregnancies achieved by ART.

Comparison of Pregnancy Outcomes in Elective Single-Blastocyst Transfer Versus Double-Blastocyst Transfer Stratified by Age

Objective To determine whether there is a difference in pregnancy outcomes, stratified by age, between women undergoing elective single blastocyst transfer (eSBT) versus those undergoing double blastocyst transfer (2BT). Design Retrospective analysis. Setting University IVF center. Patient(s) A total of 1,141 nondonor IVF cycles in women aged Intervention(s) None. Main Outcome Measure(s) Eggs retrieved, embryos cryopreserved, implantation rates, clinical pregnancy rates (PR), live birth rates (LBR), spontaneous abortion rates (SAB). Result(s) Pregnancy outcomes in 52 cycles of women Conclusion(s) Women who are

Frozen-thawed embryo transfer cycles: clinical outcomes of single and double blastocyst transfers

To evaluate clinical outcomes of frozen-thawed embryo transfer cycles when one or two blastocysts are transferred. Retrospective chart review Two hundred forty-three frozen blastocyst transfer (FBT) cycles were analyzed. Clinical pregnancy rate (50.4% vs. 34.7%), live birth rate (45.8% vs. 30.6%), and twin live birth rate (19.3% vs. 0) were significantly higher in the double versus single FBT group, respectively (p < 0.05). Prior fresh cycle success with same-cohort embryos did not predict outcome of FBT cycle. When the fresh cycle was unsuccessful, there still was a significant increase in twinning when two frozen-thawed blastocysts were transferred. Transferring two blastocysts during an FBT cycle resulted in higher live birth and twin live birth rates. Single FBT provided acceptable pregnancy rates for couples seeking to avoid a multiple pregnancy or for those having a single blastocyst stored. Interestingly, the outcome of fresh cycle with same-cohort embryos did not influence the outcome of frozen-thawed cycle.

Letters to Editor A of bilateral tubal ectopic pregnancy following day 5 embryo transfer

Letters to Editor A of bilateral tubal ectopic pregnancy following day 5 embryo transfer

Comparison of pregnancy outcomes in elective single blastocyst transfer versus double blastocyst transfer stratified by age

Comparison of pregnancy outcomes in elective single blastocyst transfer versus double blastocyst transfer stratified by age

Comparison of pregnancy outcomes in elective single blastocyst transfer versus double blastocyst transfer stratified by age

Comparison of pregnancy outcomes in elective single blastocyst transfer versus double blastocyst transfer stratified by age

Comparison of single blastocyst transfer versus double blastocyst transfer in women less than 37 years old

OBJECTIVE: Single embryo transfer can decrease multiple pregnancies but it has also resulted in lower pregnancy rate than double embryo transfer in fresh cycle. It has been suggested that extended embryo culture to the blastocyst stage would increase the likelihood of pregnancy. The aim of this study is to compare the efficacy of single blastocyst transfer (SBT) versus double blastocyst transfer (DBT) on day 5 in fresh cycles.

Comparison of pregnancy outcomes in elective single blastocyst transfer versus double blastocyst transfer stratified by age

To determine whether there is a difference in pregnancy outcomes, stratified by age, between women undergoing elective single blastocyst transfer (eSBT) versus those undergoing double blastocyst transfer (2BT). Retrospective analysis. University IVF center. A total of 1,141 nondonor IVF cycles in women aged <40 years from January 2004-March 2007. None. Eggs retrieved, embryos cryopreserved, implantation rates, clinical pregnancy rates (PR), live birth rates (LBR), spontaneous abortion rates (SAB). Pregnancy outcomes in 52 cycles of women <40 years of age who underwent eSBT were compared with 1,086 cycles of women who underwent 2BT in fresh IVF cycles from January 2004-March 2007. Overall, the eSBT was associated with a statistically significant 92% reduction in the twinning rate (from 25%-2%) while maintaining a high clinical PR (63% in the eSBT group vs. 61% in the 2BT group). Women who are <40 years of age undergoing nondonor fresh IVF cycles can electively choose to transfer a single blastocyst for the purpose of significantly reducing their risk of multiples without compromising their PR.

Single blastocyst transfer minimizes multiple pregnancy rate without hindering pregnancy rate compared to double blastocysts transfer in certain age group

OBJECTIVE: Although ART has been used widely, lately multiple pregnancy is a serious issue. Multiple embryos are transferred to maintain high pregnancy rate and it causes high incidence of multiple pregnancy. Single cleaved stage embryo transfer has been attempted to minimize multiple pregnancy rate, but it decreased pregnancy rate. Recently, blastocyst transfer is performed, and high pregnancy and implantation rates are reported. Therefore, the present study was conducted to determine whether single blastocyst transfer could prevent multiple pregnancy without hindering pregnancy rate compared to double blastocysts transfer. DESIGN: Retrospective clinical study at private clinic. MATERIALS AND METHODS: Totally 188 cycles of blastocyst transfer were analyzed. Single blastocyst transfers were 55 cycles and double blastocysts transfers were 133 cycles. The rates of clinical pregnancy, implantation, multiple pregnancy, and miscarriage were compared. These comparisons were also performed in the following age groups; less than 29 years old, 30∼34 years old, 35∼39 years old. Furthermore, pregnancy and implantation rates according to the quality of blastocyst were analyzed. RESULTS: The rates of pregnancy and implantation in single blastocyst transfer were not different from those in double blastocysts transfer. However, multiple pregnancy rate in single blastocyst transfer was significantly lower than that in double blastocysts transfer. The miscarriage rate in single blastocyst transfer was significantly lower than that in double blastocysts transfer. In the age group of 35∼39 years old, pregnancy rate in double blastocysts transfer was significantly higher than that in single transfer. Transfer of high quality blastocyst achieved higher pregnancy rates in double blastocysts transfer compared to single blastocyst transfer in the same age group. CONCLUSIONS: Pregnancy rate in single blastocyst transfer was identical to that in double blastocysts transfer. However, multiple pregnancy rate in single blastocyst transfer was minimized compared to double blastocysts transfer. In age group of 35∼39 years old, pregnancy rate in double blastocysts transfer was significantly higher than that in single blastocyst transfer. The present study suggested two conclusions. Single blastocyst transfer is able to minimize multiple pregnancy rate without hindering pregnancy rate in the age group of 34 years or younger. Double blastocysts transfer could not be abandoned to achieve high pregnancy rate in the age group of 35 years or older.

Age-related success with elective single versus double blastocyst transfer

OBJECTIVE: Multiple gestations are a continued challenge in IVF. The incidence is thought to diminish with advancing age, and the risk may be greatly reduced by the elective transfer of a single blastocyst. We sought to compare pregnancy outcomes between elective single blastocyst transfer (eSBT) and elective double blastocyst transfer (eDBT), stratified by age.

Vitrified-thawed single blastocyst transfer (vSBT) reduces the multiple pregnancy rate compared with vitrified-thawed double blastocyst transfer (vDBT) without compromising IVF outcomes

OBJECTIVE: We determined criteria for elective single blastocyst transfer (eSBT) using fresh balstocysts as; (1) more than two 3AA or higher blastocysts, (2) age less than 36 years, and (3) less than three failed embryo transfer cycles. To reduce multi-pregnancies, it was crucial to apply the SBT policy to fresh cycles as well as to cryopreserved-thawed ones. We also investigated whether vSBT compromised outcomes of our IVF protocol compared with fresh SBT (fSBT) and vDBT.DESIGN: Retrospective study.MATERIALS AND METHODS: We analyzed 209 fresh IVF/ICSI and vitrified-thawed blastocyst transfer cycles. We offered eSBT to patients before oocyte retrieval. Fertilized oocytes were cultured in sequential medium for 5 days and each embryo evaluated by the Gardner's criteria. For patients not under the eSBT policy, one or two embryos, if they were morula or a higher blastocyst, were transferred. Surplus 3BB or higher blastocysts were cryopreserved by vitrification. When no embryo developed to 3BB or higher blastocysts at day 5, lesser grade blastocysts were vitrified if the patient chose. We proffered our SBT policy even for vitrified-thawed transfer cycles when two or more 3BB or higher blastocysts were available. Compulsory SBT was performed if just one blastocyst was available. Overall, 111 cycles underwent SBT (40 thawed, 71 fresh) and 41 underwent vDBT. Clinical outcomes of vSBT were compared with those of vDBT and fSBT. Clinical pregnancy was defined as a positive serum hCG test and a sac seen on an ultrasound scan. Statistical analysis was performed using χ-square methods. p<0.05 was considered significant.RESULTS: vSBT, vDBT and fSBT groups had similar patient ages and other demographic characteristics. Overall clinical pregnancy, miscarriage, and multiple pregnancy rates for vSBT were similar to those of fSBT; 43% vs. 32%, 18% vs. 22%, 0% vs. 0%, respectively. Clinical pregnancy and miscarriage rates for vSBT were similar to vDBT; 59%, 42%, 29%, respectively. The multiple pregnancy rate for vSBT compared with vDBT was significantly reduced (0% vs. 29%: p<0.05). A significantly high clinical pregnancy rate was achieved following the transfer of vitrified-thawed single 3BB or higher blastocysts compared with lesser grade ones (53.3% vs. 10%; p<0.05).CONCLUSIONS: vSBT offers good outcomes for an IVF protocol. When good quality blastocysts are available, the number of embryos transferred does not need to increase and multiple pregnancies can be reduced even in vitrified-thawed transfer cycles. OBJECTIVE: We determined criteria for elective single blastocyst transfer (eSBT) using fresh balstocysts as; (1) more than two 3AA or higher blastocysts, (2) age less than 36 years, and (3) less than three failed embryo transfer cycles. To reduce multi-pregnancies, it was crucial to apply the SBT policy to fresh cycles as well as to cryopreserved-thawed ones. We also investigated whether vSBT compromised outcomes of our IVF protocol compared with fresh SBT (fSBT) and vDBT. DESIGN: Retrospective study. MATERIALS AND METHODS: We analyzed 209 fresh IVF/ICSI and vitrified-thawed blastocyst transfer cycles. We offered eSBT to patients before oocyte retrieval. Fertilized oocytes were cultured in sequential medium for 5 days and each embryo evaluated by the Gardner's criteria. For patients not under the eSBT policy, one or two embryos, if they were morula or a higher blastocyst, were transferred. Surplus 3BB or higher blastocysts were cryopreserved by vitrification. When no embryo developed to 3BB or higher blastocysts at day 5, lesser grade blastocysts were vitrified if the patient chose. We proffered our SBT policy even for vitrified-thawed transfer cycles when two or more 3BB or higher blastocysts were available. Compulsory SBT was performed if just one blastocyst was available. Overall, 111 cycles underwent SBT (40 thawed, 71 fresh) and 41 underwent vDBT. Clinical outcomes of vSBT were compared with those of vDBT and fSBT. Clinical pregnancy was defined as a positive serum hCG test and a sac seen on an ultrasound scan. Statistical analysis was performed using χ-square methods. p<0.05 was considered significant. RESULTS: vSBT, vDBT and fSBT groups had similar patient ages and other demographic characteristics. Overall clinical pregnancy, miscarriage, and multiple pregnancy rates for vSBT were similar to those of fSBT; 43% vs. 32%, 18% vs. 22%, 0% vs. 0%, respectively. Clinical pregnancy and miscarriage rates for vSBT were similar to vDBT; 59%, 42%, 29%, respectively. The multiple pregnancy rate for vSBT compared with vDBT was significantly reduced (0% vs. 29%: p<0.05). A significantly high clinical pregnancy rate was achieved following the transfer of vitrified-thawed single 3BB or higher blastocysts compared with lesser grade ones (53.3% vs. 10%; p<0.05). CONCLUSIONS: vSBT offers good outcomes for an IVF protocol. When good quality blastocysts are available, the number of embryos transferred does not need to increase and multiple pregnancies can be reduced even in vitrified-thawed transfer cycles.

Reducing multiple pregnancy in assisted reproduction technology: towards a policy of single blastocyst transfer in younger women

To investigate the effects of single blastocyst transfer (SBT) on live birth and multiple pregnancy in women undergoing in vitro fertilisation (IVF). Descriptive cohort study. A London private IVF/postgraduate training unit. A total of 700 fresh and 102 frozen blastocyst cycles performed between January 2005 and December 2006. Young women aged 25-37 years and those aged 38-43 years were further divided into those who had SBT and those who received two blastocysts (double blastocyst transfer [DBT]). Live birth and multiple pregnancy rates were compared between groups. Cumulative live birth was compared between women who had DBT and those who received a SBT followed by a frozen blastocyst if the fresh cycle was unsuccessful. Live birth rate, cumulative live birth rate, multiple pregnancy rate, uptake of SBT. Among women aged 25-37 years, live birth rate following SBT was 59.0 versus 60.7% following DBT. The twin pregnancy rate in this group was 2.3 and 47.6% respectively. For women aged 38-43 years, live birth following SBT was 29.4% and multiple pregnancy rate was 33.3%. DBT in older women gave a higher live birth rate (44.3%) and a multiple pregnancy rate of 36.4%. Cumulative live birth following SBT in women aged 25-37 years was 72.8% versus 60.5% following DBT. Among the women aged 38-43 years, cumulative live birth was higher (63.3%) following DBT versus 28.6% following SBT. Single blastocyst transfer followed by transfer of a frozen blastocyst if the preceding fresh cycle was unsuccessful resulted in a better cumulative live birth and lower twin pregnancy in young women. In older women, two fresh blastocysts gave better results than one fresh followed by a frozen cycle. Older women should have the option of replacing two fresh blastocysts as this optimises their chances of taking home a baby.

Should the practice of double blastocyst transfer be abandoned? A retrospective analysis

As multiple pregnancy is now considered to be an adverse event of an IVF procedure, reducing the multiple pregnancy rates has become the goal of many IVF centres. A large number of double blastocyst transfers in non-selected patients were performed in the author's institution over recent years, and a retrospective analysis was conducted to investigate if multiple pregnancy rates in such a population are still unacceptably high. In addition, the factors determining the birth of singletons or multiple births following the transfer of two blastocysts was analysed. The live-birth rate per cycle was 35.7%, and the multiple-birth rate was 44.2% of all births. When clinically important variables that performed significantly in univariate analysis were analysed in the multiple regression model, age was negatively correlated with singleton and multiple births, and the transfer of two optimal blastocysts was positively correlated. Based on these results, abandoning the transfer of two blastocysts at least in patients younger than 37 years is recommended, regardless of embryo quality, as even the transfer of two non-optimal blastocysts results in almost 20% multiple births.

Characteristics of Twin-Prone Women Undergoing In Vitro Fertilization and Double Blastocyst Transfer - The Slovenian Experience

PURPOSE: To identify a subgroup of twin-prone women undergoing in vitro fertilization (IVF) with blastocyst transfer. MATERIALS AND METHODS OF INVESTIGATION: In a retrospective cohort study, 2539 IVF cycles (1334 classical IVF and 1205 intracytoplasmic sperm injection [ICSI] cycles) in 1641 couples in the 3-year period were included. The cycles resulting in blastocysts were analysed in terms of female age, number of IVF attempts, infertility indication, number of developed blastocysts, and pregnancy, twin pregnancy and abortion rates. RESULTS: Blastocysts developed in 52 % of cycles. The pregnancy rate per blastocyst transfer was 43 % and the twin rate per pregnancy 20 %. We found a negative correlation between twin pregnancy rates, female age and number of IVF attempts, and a positive correlation between twin pregnancy rates and number of developed blastocysts. ICSI compromised blastocyst development without directly affecting pregnancy and twin pregnancy rates. Significantly higher twin pregnancy rates (39 % per pregnancy) were observed in women younger than 34 years who had 3 or more developed blastocysts. DISCUSSION, CONCLUSIONS: The subgroup of twin-prone women undergoing blastocyst transfer is characterized by age < 34 years, and number of developed blastocysts ≥ 3. Elective single blastocyst transfer in these selected women would hypothetically reduce twin pregnancy rates from 20 to 8 % per pregnancy.

Single-blastocyst transfer decreases twin gestation without affecting pregnancy outcome

To compare the respective pregnancy outcomes of cycles undergoing fresh elective single-blastocyst transfer (eSBT) and double-blastocyst transfer (DBT) after IVF. Retrospective medical record review. Academic medical center. Couples undergoing fresh blastocyst transfer after IVF. One thousand, four hundred, ninety-nine consecutive IVF cycles from January 1, 2002 through March 31, 2006 at the Massachusetts General Hospital Fertility Center were reviewed. Patients undergoing fresh blastocyst transfer (eSBT, n = 52; DBT, n = 187) were identified. Respective pregnancy outcomes and the trend in twin gestations in all cycles undergoing blastocyst transfer, before and after the introduction of the eSBT program. Statistically similar rates of biochemical pregnancy (76.9% vs. 77.6%), clinical pregnancy (61% vs. 63.4%), live birth (53.8% vs. 54.4%), and pregnancy loss (20% vs. 18.6%) per embryo transfer were observed for fresh eSBT and DBT cycles, respectively. Twin rates for eSBT were statistically significantly lower than for DBT cycles (3.1% vs. 51%). Fresh eSBT and DBT cryopreserved 2.8 vs. 1.7 blastocysts per cycle, respectively. Twenty-four months after the start of eSBT, the twin rate per transfer for all cycles undergoing blastocyst transfer (1, 2, or 3 blastocysts) was statistically significantly reduced from 47.2% to 22.9%, whereas the twin rate per transfer for all embryo transfers in women younger than 35 years of age was statistically significantly reduced from 28.8% to 15.6%. Given the promising potential of eSBT to markedly reduce the risk of twin gestation without a significant compromise to pregnancy outcomes, an active attempt should be made to consider and use eSBT in the young, favorable-prognosis patient who has good-quality embryos available for transfer and cryopreservation.

O-261: Implementation of elective single blastocyst transfer significantly decreases the incidence of multiple gestation without affecting overall and clinical pregnancy rates compared to double blastocyst transfer

To evaluate the effect of implementing an elective single blastocyst transfer (eSBT) program on pregnancy outcome, multiple pregnancy rates (twins), and the frequency of double embryo transfers (DBT) during the first 18 months of practice in an IVF program. Although the benefits of reduced multiple pregnancy rates of eSBT are apparent, hesitancy to adopt this practice is predicated on the concern for reducing pregnancy success. During the incipience of this center’s blastocyst transfer (BT) program in 2002, all patients qualifying for BT exclusively underwent DBT (1/02 to 9/04) due to concerns for the potential reduction of success with transfer of one blastocyst (SBT).

Pregnancy rate, multiple pregnancy rate, and embryo quality: Clues for single blastocyst transfer from double blastocyst transfer in an unselected population

Objective: Minimizing multiple pregnancy is a priority in assisted reproduction. As implantation rates are critical to success and reduce multiple pregnancy, we investigated whether blastocyst grade determined implantation rate following double blastocyst transfer in unselected cases. Materials and Methods: We studied 69 three-cleavage stage embryo transfers and 64 two-blastocyst transfers. Two blastocysts, or one when two blastocysts were not available, were transfered after evaluating the grade of blastocysts. The difference in pregnancy and implantation rates to patient age, the number of retrieved oocytes and grade of blastocysts were analyzed. Results: Blastocyst and grade 3AA rates per fertilized egg were 50.3% and 26.0%, respectively. Following two-blastocyst transfer, pregnancy rate per transfer, implantation rate per embryo, and multiple pregnancy rate per pregnancy were 39.1%, 26.5%, and 24.0%, respectively. Two-blastocyst transfer achieved implantation more often than three-cleavage-stage embryo transfer, but did not reduce multiple pregnancy. Pregnancy, implantation, and multiple pregnancy rates did not reflect maternal age. Higher pregnancy and implantation rates per transfer were attained for with six or more oocytes retrieved or transfer of two-blastocyst graded 3AA or higher especially when two or more blastocysts graded 3AA or higher are available, but the latter showed a high multiple pregnancy rate (38.5%). Conclusions: Single embryo transfer could be carried out when two or more blastocysts of grade 3AA or higher have been developed. (Reprod Med Biol 2005; 4: 153-160).

Selected single blastocyst transfers maintained pregnancy outcome and eliminated multiple pregnancies.

Background: Transfer of more than one embryo following in vitro fertilization/intracytoplasmic sperm injection cycles have increased pregnancy rate at the cost of increasing the incidence of triplets and twins. It has been proposed that prolonged culture to the blastocyst stage would automatically result in the selection of good quality embryos for transfer and minimize the incidence of triplets and twins. Methods and Results: The objectives of the present retrospective analysis were to examine the pregnancy outcome, multiple pregnancy and related data following: (i) single blastocyst transfer (BT) and double BT; (ii) single BT in patients belonging to different age groups; and (iii) good, fair or poor quality of BT. A total of 260 BT were carried out between August 1998 and July 2002 and they are included in the current study. Sixty of the 260 BT patients received a single BT, and 41 of them received selected single good quality BT (SSBT). The implantation rate has no significant difference between following single BT (53.3%) and double BT (42.8%). No multiple pregnancy occurred following single BT, while significantly higher (P<0.05) multiple pregnancy rate was observed following a double BT (45.8%). The clinical pregnancy and implantation rates following a single BT were similar (P>0.05) in patients belonging to <30years (62.5%), 30-34years (57.9%) and 35-39years old (35.8%). Conclusion: Selected single good quality BT maintained pregnancy and avoided multiple pregnancies. It is recommended for patients with a risk for high-order multiple pregnancy. (Reprod Med Biol 2004; 3: 13-18).