Should the flexibility enabled by performing a day-4 embryo transfer remain as a valid option in the IVF laboratory? A systematic review and network meta-analysis

Abstract

Purpose The present systematic review and network meta-analysis aims to uniquely bring to literature data supporting the true place of the alternative practice of day-4 embryo transfer (D4 ET) in an IVF laboratory, beyond the one-dimensional option of facilitating a highly demanding program. Methods A systematic search was conducted in the databases of PubMed/Medline, Embase, and Cochrane Central Library, resulting to six prospective along with nine retrospective cohort studies meeting eligibility criteria for inclusion. A comparison of D4 ET with day-2 (D2), day-3 (D3), and day-5 (D5) ET, respectively, was performed employing R statistics. Results The sourced results indicate no statistically significant difference regarding clinical pregnancy rates, and ongoing pregnancy/live birth rates stemming from the comparison of D4 with D2, D4 with D3, and D4 with D5 ET, respectively. Additionally, no statistically significant difference could be established in respect to cancelation, and miscarriage rates, following the comparison of D4 with D3 and D4 with D5 ET. Interestingly, we report statistically significant lower preterm birth rates associated with D4 ET, in contrast with D5 ET (RR, 0.19; 95% CI, 0.05-0.67; p value = 0.01). Conclusions The aforementioned results may serve as advocates buttressing the option of D4 ET as a valid candidate in the ET decision-making process. Possible limitations of the current study are the publication bias stemming from the retrospective nature of certain included studies, along with various deviations among studies' design, referring to number and quality of transferred embryos, or different culture conditions referring to studies of previous decades.

Multivariate analysis of the factors associated with live births during in vitro fertilisation in Southeast Asia: a cross-sectional study of 104,015 in vitro fertilisation records in Taiwan

“…The ORs for DET, triple-embryo transfer (TET), and quadruple-embryo transfer were 3.31 (95% CI = 2.93-3.81), 3.39 (95% CI = 2.55-4.15), and 4.87 (95% CI = 4.34-10.77), respectively (Table 3). No significant difference in the ORs for live births was found between IVF cycles performed in patients aged 40 3). The use of a donated ovum also increased the OR of a live birth compared to the use of the couple's embryo (OR: 1.90 for SET and 2.42 for TET) (Table 3).…”

“…ICSI intracytoplasmic sperm injection, AH assisted hatching, PGS preimplantation genetic screening, PGD preimplantation genetic diagnosis performed on days 2-3 [37][38][39]40]. A recent systematic review indicated that there were no significant differences regarding clinical pregnancy rates and ongoing pregnancy/live birth rates between embryo transfers occurring on day 4 and those occurring on days 2, 3, or 5 [39].…”

Stress Management during the Intracytoplasmic Sperm Injection Cycle May Slow Down First Embryo Cleavage and Accelerate Embryo Compaction: A Pilot Randomized Controlled Trial

“…methods). Day 4 embryos were transferred in 10 µL of total global medium (Life Global, Ibra Haddad, Lebanon) using a TDT (tight difficult transfer) embryo transfer catheter (Omni Medical, Lebanon) under ultrasound guidance [34]. Daily vaginal progesterone (Crinone 8%, Merck-Serono) and a single injection of 500 IU hCG (Pregnyl, Organon) were used for the luteal support [35].…”

Commercially Available Molecular Approaches to Evaluate Endometrial Receptivity: A Systematic Review and Critical Analysis of the Literature

“…In an effort to enhance clinical outcomes of in vitro fertilization (IVF), numerous studies in the literature have investigated optimal embryo culture conditions [ 1 , 2 ], morphological criteria for embryo assessment [ 3 , 4 ], and the preferred day for embryo transfer [ 5 , 6 , 7 ]. These studies portray the astonishing progress in the field of assisted reproduction technology (ART) within the last 40 years, although live birth rates remain poor [ 8 ].…”