Adding a low‐quality blastocyst to a high‐quality blastocyst for a double embryo transfer does not decrease pregnancy and live birth rate

Theodorou, Efstathios; Jones, Benjamin P; Cawood, Suzanne; Heath, Carleen; Serhal, Paul; Ben-Nagi, Jara

doi:10.1111/aogs.14088

Cited by 5 publications

(4 citation statements)

References 31 publications

(64 reference statements)

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“…Theodorou et al. also reached the same conclusion ( 26 ). It seems that the predictive value of the morphology score for LBR and MBR was diminished when double blastocysts were transferred.…”

Section: Discussionmentioning

confidence: 54%

“…Based on a report enrolling 2,582 blastocyst transfer cycles from China, the transfer of double PQB and GQB+PQB had similar LBR and MBR, regardless of the age of ≤37 years or older (25). Theodorou et al also reached the same conclusion (26). It seems that the predictive value of the morphology score for LBR and MBR was diminished when double blastocysts were transferred.…”

Section: Results In the Context Of What Is Knownmentioning

confidence: 68%

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Association between transferred embryos and multiple pregnancy/live birth rate in frozen embryo transfer cycles: A retrospective study

Zhou²,

Xu³

et al. 2023

Front. Endocrinol.

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BackgroundPhysicians need an appropriate embryo transfer strategy to address the challenge of reducing multiple birth rates, while maintaining the couples’ live birth rate during assisted reproductive technology.MethodsWe included 10,060 frozen embryo transfer cycles from January 2015 to March 2020 in reproductive medical center of Ruijin hospital, Shanghai, China. Patients were grouped according to the number and grade of cleavage-stage embryo or blastocysts transferred. Live birth rate and multiple live birth rate were compared among groups of women of different ages. Multivariable logistic regression models were used to estimate the risk of multiple live birth using different combinations of transferred embryos.ResultsThe transfer of double good-quality embryos was an independent predictor for multiple birth in women aged <30 years and those aged 36−39 years [<30 years: aOR =1.54 (95% CI: 1.14−2.06, P < 0.01); 36−39 years: aOR =1.84 (95% CI: 1.0−3.4, P < 0.01)]. Further, for women aged <36 years, the transfer of good-quality + poor-quality blastocysts was an independent predictor for multiple birth rate [<30 years: aOR=2.46 (95% CI: 1.45−4.18, P < 0.01); 31−35 years: aOR =4.45 (95% CI: 1.97−10.06, P < 0.01)].ConclusionsSingle-good-quality blastocyst transfer is recommended for women of all ages. When good-quality cleavage embryos are available, the choice of single or double embryo transfer with good- or average-quality embryo should depend on the age of women. Double embryo transfer with the highest possible grade of embryos is recommended for women aged ≥40 years.

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Section: Discussionmentioning

confidence: 54%

Section: Results In the Context Of What Is Knownmentioning

confidence: 68%

Association between transferred embryos and multiple pregnancy/live birth rate in frozen embryo transfer cycles: A retrospective study

Zhou²,

Xu³

et al. 2023

Front. Endocrinol.

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“…Blastocysts should also be transferred in a SET because of the higher monozygotic twin potential of blastocysts ( Hviid et al , 2018 ) and because of the high risk of multiple pregnancy and complications after the transfer of two blastocysts, regardless of the developmental stage of the embryo at the time of cryopreservation or its quality ( Van Landuyt et al , 2011 ; Liu et al , 2014 ; Abuzeid et al , 2017 ; Dobson et al , 2018 ; Park et al , 2019 ; Aldemir et al , 2020 ; Arab et al , 2020 ; Chen et al , 2020 ; Hill et al , 2020 ; Wang et al , 2020 ; Zhu et al , 2020 ; Theodorou et al , 2021 ).…”

Section: Discussionmentioning

confidence: 99%

ESHRE guideline: number of embryos to transfer during IVF/ICSI

Alteri,

Arroyo,

Baccino

et al. 2024

Human Reproduction

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STUDY QUESTION Which clinical and embryological factors should be considered to apply double embryo transfer (DET) instead of elective single embryo transfer (eSET)? SUMMARY ANSWER No clinical or embryological factor per se justifies a recommendation of DET instead of eSET in IVF/ICSI. WHAT IS KNOWN ALREADY DET is correlated with a higher rate of multiple pregnancy, leading to a subsequent increase in complications for both mother and babies. These complications include preterm birth, low birthweight, and other perinatal adverse outcomes. To mitigate the risks associated with multiple pregnancy, eSET is recommended by international and national professional organizations as the preferred approach in ART. STUDY DESIGN, SIZE, DURATION The guideline was developed according to the structured methodology for development and update of ESHRE guidelines. Literature searches were performed in PUBMED/MEDLINE and Cochrane databases, and relevant papers published up to May 2023, written in English, were included. Live birth rate, cumulative live birth rate, and multiple pregnancy rate were considered as critical outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on the collected evidence, recommendations were discussed until a consensus was reached within the Guideline Development Group (GDG). A stakeholder review was organized after the guideline draft was finalized. The final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE The guideline provides 35 recommendations on the medical and non-medical risks associated with multiple pregnancies and on the clinical and embryological factors to be considered when deciding on the number of embryos to transfer. These recommendations include 25 evidence-based recommendations, of which 24 were formulated as strong recommendations and one as conditional, and 10 good practice points. Of the evidence-based recommendations, seven (28%) were supported by moderate-quality evidence. The remaining recommendations were supported by low (three recommendations; 12%), or very low-quality evidence (15 recommendations; 60%). Owing to the lack of evidence-based research, the guideline also clearly mentions recommendations for future studies. LIMITATIONS, REASONS FOR CAUTION The guideline assessed different factors one by one based on existing evidence. However, in real life, clinicians’ decisions are based on several prognostic factors related to each patient’s case. Furthermore, the evidence from randomized controlled trials is too scarce to formulate high-quality evidence-based recommendations. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides health professionals with clear advice on best practice in the decision-making process during IVF/ICSI, based on the best evidence currently available, and recommendations on relevant information that should be communicated to patients. In addition, a list of research recommendations is provided to stimulate further studies in the field. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed and funded by ESHRE, covering expenses associated with the guideline meetings, the literature searches, and the dissemination of the guideline. The guideline group members did not receive payment. DPB declared receiving honoraria for lectures from Merck, Ferring, and Gedeon Richter. She is a member of ESHRE EXCO, and the Mediterranean Society for reproductive medicine and the president of the Croatian Society for Gynaecological Endocrinology and Reproductive Medicine. CDG is the past Chair of the ESHRE EIM Consortium and a paid deputy member of the Editorial board of Human Reproduction. IR declared receiving reimbursement from ESHRE and EDCD for attending meetings. She holds an unpaid leadership role in OBBCSSR, ECDC Sohonet, and AER. KAR-W declared receiving grants for clinical researchers and funding provision to the institution from the Swedish Cancer Society (200170F), the Senior Clinical Investigator Award, Radiumhemmets Forskningsfonder (Dnr: 201313), Stockholm County Council FoU (FoUI-953912) and Karolinska Institutet (Dnr 2020-01963), NovoNordisk, Merck and Ferring Pharmaceuticals. She received consulting fees from the Swedish Ministry of Health and Welfare. She received honoraria from Roche, Pfizer, and Organon for chairmanship and lectures. She received support from Organon for attending meetings. She participated in advisory boards for Merck, Nordic countries, and Ferring. She declared receiving time-lapse equipment and grants with payment to institution for pre-clinical research from Merck pharmaceuticals and from Ferring. SS-R received research funding from Roche Diagnostics, Organon/MSD, Theramex, and Gedeo-Richter. He received consulting fees from Organon/MSD, Ferring Pharmaceuticals, and Merck Serono. He declared receiving honoraria for lectures from Ferring Pharmaceuticals, Besins, Organon/MSD, Theramex, and Gedeon Richter. He received support for attending Gedeon Richter meetings and participated in the Data Safety Monitoring Board of the T-TRANSPORT trial. He is the Deputy of ESHRE SQART special interest group. He holds stock options in IVI Lisboa and received equipment and other services from Roche Diagnostics and Ferring Pharmaceuticals. KT declared receiving payment for honoraria for giving lectures from Merck Serono and Organon. She is member of the safety advisory board of EDQM. She holds a leadership role in the ICCBBA board of directors. ZV received reimbursement from ESHRE for attending meetings. She also received research grants from ESHRE and Juhani Aaltonen Foundation. She is the coordinator of EHSRE SQART special interest group. The other authors have no conflicts of interest to declare. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose (full disclaimer available at https://www.eshre.eu/Guidelines-and-Legal).

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“…High-quality embryo = Grade 1 + Grade 2. Grade 1 embryos had 6–10 cells, a fragmentation of 0–10%, and perfect symmetry; Grade 2 embryos had either 6–10 cells with fragmentation of 0–25% and perfect or moderate symmetry or they had 4–6 or > 10 cells with fragmentation of 0–10% and perfect symmetry [ 22 ].…”

Section: Methodsmentioning

confidence: 99%

Effect of PFOA exposure on diminished ovarian reserve and its metabolism

Shen

Gao

et al. 2023

Reprod Biol Endocrinol

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Owing to its difficulty in degrading and ease of accumulation in the body, perfluorooctanoic acid (PFOA) has a detrimental effect on reproduction. This study aimed to examine the effect of PFOA concentration in follicular fluid during ovulation stimulation on embryo quality and the impact of PFOA exposure on the metabolic components of follicular fluid. This was a single-center prospective study that included 25 patients with diminished ovarian reserve (DOR), 25 with normal ovarian reserve (NOR), and 25 with polycystic ovary syndrome (PCOS). Follicular fluid samples were analyzed using ultra-high performance liquid chromatography-tandem mass spectrometry. We demonstrated that the PFOA levels of follicular fluid in the DOR group were higher than those in the NOR group and PCOS group (P < 0.05). PFOA concentration in the PCOS group was negatively correlated with high-quality embryos (P < 0.05). To gain more insight into the impact of PFOA on the metabolic composition of follicular fluid, we classified the DOR group based on the PFOA concentration, for which metabolomic analysis was performed. In the high-concentration PFOA group, there was an increase and a decrease in three and nine metabolites, respectively, compared to that in the low-concentration group. These results suggest that PFOA may alter the metabolic composition of follicular fluid, thus, affecting ovarian reserve function.

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Adding a low‐quality blastocyst to a high‐quality blastocyst for a double embryo transfer does not decrease pregnancy and live birth rate

Cited by 5 publications

References 31 publications

Association between transferred embryos and multiple pregnancy/live birth rate in frozen embryo transfer cycles: A retrospective study

Association between transferred embryos and multiple pregnancy/live birth rate in frozen embryo transfer cycles: A retrospective study

ESHRE guideline: number of embryos to transfer during IVF/ICSI

Effect of PFOA exposure on diminished ovarian reserve and its metabolism

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