Application of a validated prediction model for in vitro fertilization: comparison of live birth rates and multiple birth rates with 1 embryo transferred over 2 cycles vs 2 embryos in 1 cycle

Abstract

Objective To use a validated prediction model to examine whether single embryo transfer (SET) over two cycles results in live birth rates (LBR) comparable to two embryos transferred (DET) in one cycle, while reducing the probability of a multiple birth (i.e., multiple birth rate, MBR). Study Design Prediction models of LBR and MBR for a woman considering ART developed from linked cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) for 2006-2012 was used to compare SET over two cycles with DET in one cycle. The prediction model is based on a woman’s age, body mass index (BMI), gravidity, prior full-term births, infertility diagnoses, embryo state, number of embryos transferred, and number of cycles. Results To demonstrate the effect of number of embryos transferred (1 or 2), the LBRs and MBRs were estimated for women with a single infertility diagnosis (male factor, ovulation disorders, diminished ovarian reserve, and unexplained); nulligravid; BMI of 20, 25, 30, and 35; and ages 25, 35, and 40 by cycle (1st or 2nd). The cumulative LBR over two cycles with SET was similar to or better than the LBR with DET in a single cycle. For example, for women with the diagnosis of ovulation disorders, age 35, BMI 30: 54.4% versus 46.5%; for women age 40, BMI 30: 31.3% versus 28.9%. The MBR with DET in one cycle was 32.8% for women age 35 and 20.9% for women age 40; with SET the cumulative MBR was 2.7% and 1.6%, respectively. Conclusions Applying this validated predictive model demonstrated that the cumulative LBR is as good as or better with SET over two cycles than with DET in one cycle, while greatly reducing the probability of a multiple birth.

Costs of achieving live birth from assisted reproductive technology: a comparison of sequential single and double embryo transfer approaches

“…These results align with other studies that have found cumulative live birth rates for two SETs to be at least as high as live birth rates for one DET (16–18) and two SETs to be more cost effective than one DET (19–21). These studies were small in size compared with our study or did not explore both birth rates and costs.…”

Strategies in the transfer of varying grades of vitrified‐warmed blastocysts in women aged over 35 years: A propensity‐matched analysis

“…Recently, some studies have reported that two sequential SET have a similar cumulative LBR with DET. Additionally, two sequential SET had lower MPR and cost than DET . Although our study did not include data from two sequential SET, the IR were similar between GG and GS.…”

“…To evaluate the optimal number of embryos to transfer, several studies compared single blastocyst transfer (SBT) to double blastocyst transfer (DBT). [7][8][9][10][11] According to these studies, DBT are associated with a higher live birth rate (LBR) than SBT. However, the multiple pregnancy rate (MPR) is significantly lower with SBT.…”

Assessment of the Field of Assisted Reproductive Technology: Improvements and the Future of Human In Vitro Fertilization

“…Even more astonishing than the aforementioned data is the finding that only around 20% of multiple gestations occur with natural conception [27]. The results of a very recent study showed even more reason to choose SET: an ART treatment of two cycles of SET results in comparable pregnancy rates to that of one cycle of DET, while concurrently causing a drop in multiple pregnancy rates by more than 90% [28]. As indicated, a decline in twinning rate following SET or DET is feasible without a drop in overall pregnancy and live-birth rates by, when given the choice, opting for SET instead of DET.…”