Prospective evaluation of simple morphological criteria for embryo selection in double embryo transfer cycles

Abstract

Preventing the occurrence of high-rank multiple pregnancies without reducing the pregnancy rate remains a high priority of in-vitro fertilization and embryo transfer programmes. Our previous study demonstrated that, if there is at least one embryo with a good morphological grade, then the transfer of two (a double embryo transfer) instead of three embryos does not result in a lower pregnancy rate, and that the influence of the number of embryos transferred becomes significant only when poor-quality embryos are transferred. This result allowed us to employ the simple policy of systematically selecting double embryo transfer cycles without affecting the pregnancy rate. Since January 1994, when patients < 37 years of age had more than two embryos available for transfer, only two instead of three embryos were transferred if at least one of the embryos demonstrated a good morphological grade. After a 1 year application of this policy, of the 147 cycles (group A) that fulfilled the above criteria, two embryos were transferred in 92 cycles, while three embryos were transferred in the other 55 cycles. The results of these cycles were compared to those of the control 144 cycles (group B) in which three embryos were transferred, prior to the application of this policy. The on-going pregnancy rates and the incidence of multiple and triplet pregnancies were 24% and 28%, 22% and 23%, and 2% and 9% in groups A and B respectively. The rates were not significantly different. In conclusion, although our prospective trial demonstrated a tendency of decreasing pregnancy rate and an invariable incidence of multiple pregnancies, the very low occurrence of triplets during this period indicated that this policy provided a practical compromise between achieving a high pregnancy rate and an acceptable incidence of triplet pregnancies.

Single or multiple embryo transfer following in vitro fertilisation for improved neonatal outcome: A systematic review of the literature

“…Of the 17 included cohort studies, four were prospective, 28–31 eight retrospectively reviewed clinic or database records, 32–39 and five used historical controls 40–44 …”

“…Women were selectively allocated to ‘control’ or intervention groups according to the quality of their embryos, 28,40,41,43 the number of previous IVF attempts, 40,41 the number of embryos available, 37,38 maternal medical conditions 38 and age 33 …”

“…Data comparing DET with transfer of three or more embryos was extracted from 12 cohort studies describing a total of 53 551 women (Table 5). 28,32–37,40–44 Six studies which included 49 379 participants showed that fewer women had a live birth of a healthy baby following DET compared with three or more embryos (RR 0.84; 95% CI 0.74–0.96) 35,37,40–42,44 . However, there was evidence of significant statistical heterogeneity ( P = 0.011).…”

Der Blastozystentransfer

“…Aus diesem Grund werden bei einem Transfer von Blastozysten nur 1 oder maximal 2 Embryonen übertragen. Dies verhindert das Entstehen höhergradiger Mehrlinge und führt gleichzeitig dazu, dass die Schwangerschaftsrate signifikant besser ist verglichen mit dem Transfer von 3 Embryonen am Tag 2 oder 3 (Puissant et al 1987;Kodama et al 1995, Beier 1997.…”

Die Beurteilung der Eizellreifung und frühen Embryonalentwicklung bei der assistierten Reproduktion

“…besserer Embryonen, kam es häufi-ger zu Mehrlingsgraviditäten. Eine Reduktion der Zahl der transferierten Embryonen von drei auf zwei Embryonen oder gar einem Embryo ist bei exzellenter Embryonenqualität anzuraten (Puissant et al 1987;Kodama et al 1995;Beier 1997).…”