Reduced Ectopic Pregnancy Rate on Day 5 Embryo Transfer Compared with Day 3: A Meta-Analysis

Abstract

ObjectiveTo compare the risk of ectopic pregnancy (EP) after embryo transfer on day 3(D3-ET) and day 5(D5-ET).DesignMeta-analysisPatientsWomen with pregnancy resulting from in vitro undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI)Result(s)Twenty-two studies were identified through research conducted using the PubMed, Embase, and Cochrane databases and ClinicalTrials.gov. All studies were conducted prior to October 2016. Adding the reproductive data from our center, a total of 143 643 pregnancies were reviewed(D3-ET: n = 62027,D5-ET:n = 81616). A lower EP rate was found in women undergoing D5-ET than in those undergoing D3-ET [relative risk (RR), 0.67;95% confidence interval (CI), 0.54–0.85;143643 pregnancies in 23 studies; I2 = 67%]. These results were validated in subgroups of fresh embryo-transfer (Fre-ET) cycles [RR, 0.78; 95%CI, 0.69–0.88; 91 871 pregnancies in 21 studies; I2 = 29%] and frozen-thawed embryo-transfer (Fro-ET) cycles [RR, 0.43; 95%CI, 0.36–0.51; 51 772 pregnancies in 10 studies; I2 = 33%]. After separating out the randomized controlled trials (RCTs), a significant difference was found in the retrospective studies in both subgroups [both Fre-ET (RR,0.78;95% CI 0.69–0.88);91182 pregnancies in 14 studies; I2 = 45%] and Fro-ET(RR,0.43;95% CI 0.36–0.51; 51751pregnancies in 9 studies;I2 = 33%)], while the RCTs showed no statistical significance for Fre-ET cycles[RR,0.86;95% CI 0.32–2.26); 689 pregnancies in 7 studies; I2 = 0%].Conclusion(s)The present study indicates that D5-ET reduces the risk for EP in cycles that use IVF or ICSI, compared with D3-ET. It suggests that D5-ET may be a better choice for decreasing the EP rate in assisted reproductive technology. Further high-quality randomized controlled trials are anticipated.

Frozen Blastocyst Transfer during <i>in Vitro</i> Fertilization/Intracytoplasmic Sperm Injection Cycle Lowers the Rate of Ectopic Pregnancy

“…In addition, abnormal increases in E 2 levels cause abnormal uterine activities and contractions, which are also important contributing factors for the occurrence of ectopic shorter period of motility than D3 embryos do. This decreases the effects of oviduct abnormalities on freely swimming blastocysts, and therefore the risk of ectopic pregnancy [13]. This is consistent with our findings, which reflect a lower incidence rate of ectopic pregnancy in frozen blastocyst transfer cycles with D5 blastocysts.…”

Double-Lumen Needle Follicular Flushing System versus Single-Lumen Aspiration Needle in IVF/ICSI Patients with Poor Ovarian Response: A Meta-Analysis

“…The two evaluators evaluated the studies according to the Cochrane Handbook for Systematic Reviews of Interventions [10]. Six related domains were assessed in each included trial: 1) random sequence generation; 2) allocation concealment; 3) blinding of participants and personnel; 4) incomplete outcome data; 5) selective reporting; 6) other bias.…”

A rare case of triplet heterotopic pregnancy with a live intrauterine and bilateral tubal ectopic

“…The incidence of ectopic pregnancy has been reported to be significantly lower if embryo transfer is done on day 5 instead of day 3. 8 Additionally, it is lower for frozen blastocyst transfer, as compared to fresh blastocyst transfer. 9 According to recent green guidelines, the ART process should be separated into 2 parts, create the embryos in the first month and transfer them after freezing in the second month.…”