Is there still a role for a cleavage-stage embryo transfer?

Abstract

Objective To determine whether pregnancy outcomes are poor or futile when an intended day 5 transfer is converted to a cleavage-stage transfer because of poor embryo development or a lower number of embryos. Design Retrospective cohort study. Setting Academic medical center. Patient(s) Women with a limited number of embryos, defined as ≤6 two pronuclear embryos, after in vitro fertilization. Intervention(s) Patients who had a cleavage-stage transfer were age matched with patients who had a day 5 transfer. Main Outcome Measure(s) Live birth rate. Result(s) A total of 146 women were included in the study with 73 women in each group. Cleavage-stage transfer was associated with significantly lower implantation and clinical pregnancy rates compared with those of day 5 transfer. Although the live birth rate of the cleavage-stage transfer group was lower than that of the day 5 transfer group (25% vs. 40%, respectively), the cleavage-stage transfer still resulted in a live birth rate of 25%. A subanalysis comparing women who did and did not achieve live birth after cleavage-stage transfer demonstrated a live birth rate of 27% when at least one grade A embryo was transferred vs. 17% when a lesser quality embryo (grade B or C) was transferred. Conclusion(s) As expected, the live birth rate after cleavage-stage transfer was lower than that after day 5 transfer. However, the live birth rate of cleavage-stage transfer still fell into acceptable practice, >5%, for patients who were otherwise at very high risk of having no day 5 embryo transfer. Extended culture may not be necessary for all patients.

Nucleation status of Day 2 pre-implantation embryos, acquired by time-lapse imaging during IVF, is associated with live birth

“…Fertility clinics in the United States have preferentially transitioned to transferring blastocysts over cleavage stage embryos, cleavage stage embryo transfers are still performed in various parts of the world [ 47 ]. This could indicate a higher prevalence of Day 2 and Day 3 transfers for Europe, relative to the United States.…”

“…In spite of the benefits given to extended culture, the primary clinical disadvantage of the rationale behind offering only blastocyst transfers is the potential cancellation of an embryo transfer that would have resulted in a live birth [ 50 ]. The choice of cleavage stage or blastocyst embryo transfer for poor prognosis patients becomes even more arduous with increased likelihood of cycle cancellations, financial burden as well as emotional and psychological toll on patients [ 47 ].…”

Optimal Embryo Selection: The Irreplaceable Role of the Embryologist in an Age of Advancing Technology

“…Furthermore, although blastocyst transfer is considered the standard of care, cleavage stage transfers are still performed with success. [ 18 ] Cleavage transfer may be recommended if the embryo's morphokinetic pattern is behind the anticipated division rate or the morphologic characteristics are less than ideal. Therefore, our practice still relies heavily on embryo grading earlier in culture, when there is less data for the morphokinetic model to take into account.…”

Продленное Культивирование Эмбрионов В Естественных И Модифицированных Циклах Программ Вспомогательных Репродуктивных Технологий

“…Показано, что эффективность программ при переносе бластоцист выше, чем при переносе дробящихся эмбрионов третьих суток [7,8]. Продленное культивирование позволяет улучшить селекцию эмбрионов, повысить эффективность программ ВРТ и уменьшить количество эмбрионов на перенос [9]. Однако с внедрением продленного культивирования увеличились риски отмены переноса или криоконсервации из-за полной остановки в развитии эмбрионов в связи с тем, что только 40% эмбрионов хорошего качества на третий день развиваются до стадии бластоцисты [10,11].…”