Implantation: Two instead of three embryo transfer in in-vitro fertilization

Abstract

The rational of transferring two instead of three embryos was studied through 468 in-vitro fertilization (IVF) treatment cycles in 287 couples. The quality of 1224 embryos was determined according to the fragmentation rate and the morphology as good (A) and poor (B). The influence of the number of embryos transferred (two or three) on the pregnancy rate when the same quality or combinations of good and poor quality embryos transferred was examined. When only good quality embryos were transferred the pregnancy rates in double (AA) and triple (AAA) embryo transfer were 40.5 (17/42) and 42.9% (30/70) respectively (not significant). When only poor quality embryos were transferred, the pregnancy rates in double (BB) and triple (BBB) embryo transfers were 11.0% (11/100) and 22.9% (16/70) respectively (P < 0.001). On the other hand, when good and poor quality embryos were transferred together as AB in double and as AAB and ABB in triple embryo transfer, the pregnancy rates were 36.8 (14/38) and 39.9% (59/148) respectively (not significant). There was no difference in the miscarriage rate between double and triple embryo transfers; 16.7 and 18.1% respectively. The multiple pregnancy rate was 14.3% for double embryo transfers and 32.4% for triple embryo transfers (P < 0.001). This study demonstrates that if there is at least one good quality embryo available for transfer, then double instead of triple embryo transfer will not yield a significantly lower pregnancy rate. The influence of the number of embryos transferred on the pregnancy rate became significant when only poor quality embryos were transferred.(ABSTRACT TRUNCATED AT 250 WORDS)

Guidelines for the number of embryos to transfer following in vitro fertilization

“…Several observational studies have reported comparable pregnancy rates, with an accompanying maintenance or reduction in multiples, for DET compared with TET in young women with good prognoses. Although a significant incidence of HOM was reported after TET in all studies (3.9-18.0%), none resulted from DET in these series [85][86][87][88][89].…”

Predictors of embryo fragmentation and outcome after fragment removal in in vitro fertilization

“…In 1996, Jurisicova et al (2) found that cellular fragmentation might induce apoptosis of blastomeres. Embryos with extensive fragmentation are known to have lower implantation rates, presumably due to a reduction of cytoplasm available for normal cell division or reduced intercellular communication resulting from obstructed gap junctions (3)(4)(5). In retrospective studies, severe fragmentation has been associated with diminished implantation rates (3)(4)(5).…”

“One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients

“…The average number of embryos transferred per IVF cycle ranged from 3.6 to 4.2 [57]; a figure all the more striking given that improved IVF techniques had led researchers to observe that pregnancy rates could be maintained with fewer embryos being transferred [58][59][60][61].…”