Cumulative live birth rate following elective single blastocyst transfer compared with double blastocyst transfer in women aged 40 years and over

Abstract

This retrospective cohort study aimed to identify predictive factors for live birth following blastocyst transfer in women aged 40-43, and to compare the cumulative live birth rate (LBR) following elective single blastocyst (eSBT) and double blastocyst (DBT) transfer. The study included 411 women who had fresh blastocyst transfers on day 5. In stepwise logistic regression, independent predictive factors for live birth were: transferring fully expanded blastocysts (Gardner stage ≥3) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.59-9.71) and transferring two blastocysts compared with a single blastocyst (OR 1.7, 95% CI 1.08-2.9). Maternal age was not found to be significant (OR 0.78, 95% CI 0.62-1.1). When comparing eSBT (n = 150) with DBT (n = 151), the DBT group achieved higher LBRs (26.5 versus 19.3%, P = 0.017) and higher multiple births (0 versus 17.5%, P = 0.02). However, the cumulative LBR was similar (28.0 versus 31.1%), with significantly lower multiple births in the eSBT group (0 versus 14.9%, P = 0.03). These results indicate that in women aged 40-43, when fully expanded blastocysts are achieved, maternal age is not a predictor for live birth, and eSBT can be performed without compromising cumulative LBRs.

Live birth rate and neonatal outcomes of different quantities and qualities of frozen transferred blastocyst in patients requiring whole embryo freezing stratified by age

“…Our results suggested that SBT also appeared to be a promising option that did not compromise the LBR for women over the age of 35 years with available good-quality blastocysts. Moreover, recent studies also indicated that the practice of selective SBT was feasible and resulted in reduced MPRs in women aged 40–43 years without compromising cumulative LBR compared with DBT [ 9 , 10 ], suggesting that maternal age was not a significant predictor of live birth, and the competence of the oocytes developing into good-quality blastocysts is more important than maternal age (10). Additionally, another study reported that maternal age has no effect on pregnancy rates when fully expanded blastocysts are achieved [ 20 ].…”

“…It is well known that multiple pregnancies are associated with a higher risk of neonatal and perinatal complications [ 10 ]. Our results consisted of the aforementioned conclusion, showing that 70–90% of preterm births resulted from multiple pregnancies, and about 85–95% of low birth weight babies come from multiple pregnancies.…”

“…A clear definition of selective SBT was given in a study [ 9 ], namely, a single blastocyst was transferred, and at least one blastocyst was available for cryopreservation. However, the detailed grading of transferred embryos for eSBT and DBT in these studies was not clearly described [ 7 , 10 , 11 ]. The quality of the blastocysts transferred in the DBT group met the conditions of one of the three scenarios: the two blastocysts may have been both of good-quality, average-quality, or a combination of one good- and one average-quality blastocyst.…”

Live Birth Rate and Neonatal Outcomes of Different Quantities and Qualities of Frozen Transferred Blastocyst in Patients Requiring Whole Embryo Freezing Stratified by Age

“…A clear de nition of selective SBT was given in a study [9], namely, a single blastocyst was transferred and at least one blastocyst was available for cryopreservation. However, the detailed grading of transferred embryos for eSBT and DBT in these studies was not clearly described [7,10,11]. The quality of the blastocysts transferred in the DBT group met the conditions of one of three scenarios; the two blastocysts may have been both of good-quality, of averagequality or a combination of one good-and one average-quality blastocyst.…”

The Ethics of IVF

“…16 Transferring more embryos will increase the chances of a pregnancy, but is likely to result in twins or higher-order births. 17 Multiple birth is significantly more dangerous for the mother, with a high risk of complications and potential need for cesarean section delivery. 18 Other physical risks of IVF include side effects of hormonal treatment, ovarian hyperstimulation syndrome during pre-treatment for egg retrieval, 19 infection from retrieval or transfer procedures, 20 and risks associated with pregnancy and delivery especially for older mothers.…”