Age-related success with elective single versus double blastocyst transfer

Friedman, Bruce J.; Davis, L.B.; Lathi, Ruth B.; Westphal, Lynn M.; Milki, Amin A.

doi:10.1016/j.fertnstert.2008.07.1606

Cited by 2 publications

(4 citation statements)

References 24 publications

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“…Despite this, clinical pregnancy and live birth rates remained comparable in both groups throughout the study period. These data comply with other studies demonstrating that the transfer of a single blastocyst does not decrease pregnancy rates compared with the transfer of two blastocysts (Gardner et al, 2004;Friedman et al, 2011).…”

Section: Discussionsupporting

confidence: 92%

Comparison of embryo transfer strategies and assisted reproduction outcome in Slovenian and cross-border patients

Knez

Kovačič

Vlaisavljević

2013

Reproductive BioMedicine Online

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A reduction in the number of embryos transferred is the most important step in decreasing multiple gestation rates after medically assisted reproduction. Slovenia has implemented insurance company regulations that regulate single-embryo transfer in selected good-prognosis couples. The aim of the present study was to evaluate its effects on the Slovenian population compared with cross-border patients, who are not affected by the insurance company policy. Ultimately, 2403 couples undergoing IVF or intracytoplasmic sperm injection were included in the retrospective analysis. Patients were classified according to their origin. The decision about the number of embryos transferred and the treatment success were evaluated. The implementation of the policy favouring single-embryo transfer resulted in a significant decrease in the twin birth rate in Slovenian patients (24.4% before policy versus 6.7% after policy implementation, P<0.001). Although in cross-border patients twin birth rates have declined through the study period, they remained significantly higher compared with Slovenian patients (23.1% versus 6.7%, P<0.001). The data demonstrate that insurance company policies favouring single-embryo transfer are an effective tool in decreasing multiple gestation rates. Similar mechanisms should be implemented in the cross-border patient population.

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Section: Discussionsupporting

confidence: 92%

Comparison of embryo transfer strategies and assisted reproduction outcome in Slovenian and cross-border patients

Knez

Kovačič

Vlaisavljević

2013

Reproductive BioMedicine Online

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“…Thus, it is thought the present study demonstrates the utility of an eSET policy on pregnancy and live-birth rates in current clinical practice, providing an evaluation of current performance rather than procedural efficacy. While the high pregnancy and live-birth rates in the current study reflect the strength of the clinical program at this fertility center,[ 4 5 6 7 8 9 10 11 ] they also suggest that eSET policies could be strengthened to further reduce the extremely high rate of multiples seen (54% among eDBT patients and an unexpectedly high rate of monozygotic twinning [8%] overall).…”

Section: Discussionmentioning

confidence: 79%

“…[ 15 ] Had we not performed equivalence analyses, we also would have concluded pregnancy and live-birth rates did not differ between groups, consistent with existing literature. [ 4 5 6 8 9 11 ] This is important as the true intention of these studies should be to establish whether two procedures result in similar outcomes to facilitate use in a clinical setting. Results from the present study are in accord with results from the one cleavage stage study that utilized equivalency analysis.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 2 3 ] Despite this recommendation, studies of eSET at the blastocyst stage are limited. [ 4 5 6 7 8 9 10 11 ] The only existing randomized trial found no differences in implantation or pregnancy rates between eSET and double-embryo transfer. [ 6 ] Cohort study results are heterogeneous, with one study showing a significant reduction in pregnancy rates in eSET,[ 7 ] four reporting no significant differences,[ 4 5 9 11 ] and two reporting differences among select patients.…”

Section: Introductionmentioning

confidence: 99%

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Equivalency of in vitro fertilization success rates in elective single blastocyst transfer and elective double blastocyst transfer: An example of equivalence methodology in clinical reproductive health

2018

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Context:When comparing success rates between treatments, it is more appropriate to structure analyses in terms of equivalence rather than traditional analyses that assess differences. Unfortunately, no studies of elective single blastocyst transfer (eSBT) have been conducted in this manner.Aims:The objective of this study was to assess clinical equivalence of in vitro fertilization success rates among patients undergoing eSBT.Settings and Design:A historical prospective study was conducted at a private fertility center.Methods:Medical records were reviewed to identify patients eligible for eSBT. Equivalency of success rates, defined as no more than a 10% difference based on 95% confidence intervals (CIs), was compared between eSBT (n = 125) and eDBT (n = 213) groups.Results:Using traditional analysis techniques, no differences in pregnancy or live-birth rates were seen (eSBT: 84.6% vs. eDBT: 84.5%, P = 0.99; eSBT: 65.3% vs. eDBT: 72.3%, P = 0.23). The 95% CI around the difference in pregnancy rates ranged from –7.9 to 8.1, suggesting clinically equivalent pregnancy rates. Clinical equivalence was not established for live-births (95% CI = −18.5–4.5).Conclusions:Findings suggest comparable pregnancy rates can be achieved in a clinical setting when utilizing eSBT in good-prognosis patients. Although live-birth rate equivalence was not demonstrated, it is thought the additional complications associated with multiple gestations outweigh the potentially higher live-birth rate. The present study highlights the importance of utilizing equivalence analyses when making statements regarding the similarity of two treatments in reproductive health, rather than relying on superiority analyses alone.

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Age-related success with elective single versus double blastocyst transfer

Cited by 2 publications

References 24 publications

Comparison of embryo transfer strategies and assisted reproduction outcome in Slovenian and cross-border patients

Comparison of embryo transfer strategies and assisted reproduction outcome in Slovenian and cross-border patients

Equivalency of in vitro fertilization success rates in elective single blastocyst transfer and elective double blastocyst transfer: An example of equivalence methodology in clinical reproductive health

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