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No advantage of fresh blastocyst versus cleavage stage embryo transfer in women under the age of 39: a randomized controlled study

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

Is there a difference in implantation and pregnancy rates between embryos transferred electively at cleavage or blastocyst stage in infertile women ≤ 38 years with at least four zygotes on day 1 post retrieval?

Methods

A randomized clinical trial was conducted in a single tertiary care hospital with a sample size of 194 patients in each arm for a total population of 388 women. Patients less than 39 years of age with more than three fertilized oocytes and less than four previous assisted reproductive technology (ART) attempts were inclusion criteria.

Results

The two groups were similar for age, years of infertility, indication to treatment, basal antimüllerian hormone and FSH, number of previous ART cycles, primary or secondary infertility, type of induction protocol, days of stimulation, total gonadotrophin dose, and estradiol (E2) and progesterone (P) levels at trigger. No statistically significant differences were found in terms of number of retrieved oocytes, inseminated oocytes, fertilization rate, canceled transfers (7.73% in blastocyst and 3.61% in cleavage stage group), and cycles with frozen embryos and/or oocytes. Although a higher number of fertilized oocytes were in the blastocyst stage group (6.18 ± 1.46 vs 5.89 ± 1.54, p = 0.052), a statistically greater number of embryos/randomized cycle were transferred at cleavage stage (1.93 ± 0.371) compared with the number of transferred blastocysts (1.80 ± 0.56), probably due to the number of embryos not reaching blastocyst stage (3.09%). The implantation rate (28.37 vs 25.67%), pregnancy rate per cycle (36.06 vs38.66%), transfer (39.66 vs 40.11%), spontaneous abortions (19.72% vs 12.00%), delivery rate per cycle (27.84 vs 32.99%), and transfer (30.17 vs 34.22%) were not significantly different between the blastocyst and cleavage stage groups. The twin delivery rate was higher in the blastocyst stage group, although not significant (42.59 vs 28.12%). The mean numbers of frozen blastocyst (2.30 ± 1.40 vs 2.02 ± 1.00) and frozen oocytes (7.09 ± 3.55vs 6.79 ± 3.26) were not significantly different between the two groups.

Conclusions

Fresh blastocyst-stage transfer versus cleavage-stage transfer did not show any significant difference in terms of implantation and pregnancy rate in this selected group of patients. A high twin delivery rate in both groups (35.59%) was registered, and although not significant, they were higher in the blastocyst transfer group (42.59 vs 28.12%). Our conclusion supports considering single embryo transfer (SET) policy, even in cleavage stage in patients younger than 39 years with at least four zygotes.

Trial registration

ClinicalTrials.gov registration number NCT02639000

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Acknowledgements

The authors wish to acknowledge and sincerely thank all the Humanitas Fertility Center staff for their unique support in conducting this study. We thank Pasquale Patrizio, Yale Fertility Center, for his support in revising the manuscript.

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Authors and Affiliations

  1. Humanitas Fertility Center, Department of Gynaecology, Division of Gynaecology and Reproductive Medicine, Humanitas Research Hospital, 20084, Rozzano, Milan, Italy

    Paolo Emanuele Levi-Setti, Federico Cirillo, Antonella Smeraldi & Elena Albani

  2. Department of Obstetrics, Gynaecology and Reproductive Sciences, School of Medicine, Yale University, New Haven, CT, USA

    Paolo Emanuele Levi-Setti

  3. Biostatistics Unit, Humanitas Research Hospital, Rozzano, Milan, Italy

    Emanuela Morenghi

  4. Humanitas University, Rozzano, Milan, Italy

    Giulia E. G. Mulazzani

Authors
  1. Paolo Emanuele Levi-Setti
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  2. Federico Cirillo
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  3. Antonella Smeraldi
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  4. Emanuela Morenghi
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  5. Giulia E. G. Mulazzani
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  6. Elena Albani
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Contributions

PELS, EA, and EM were involved in the study concept and design. FC, EA, and AS contributed to the acquisition of data. EM analyzed data. PELS, FC, and GEGM wrote the manuscript and had a primary responsibility for the final content. PELS supervised the analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Paolo Emanuele Levi-Setti.

Ethics declarations

The study protocol and specific consent form have been approved by our Ethical Committee on June 24, 2010.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Levi-Setti, P.E., Cirillo, F., Smeraldi, A. et al. No advantage of fresh blastocyst versus cleavage stage embryo transfer in women under the age of 39: a randomized controlled study. J Assist Reprod Genet 35, 457–465 (2018). https://doi.org/10.1007/s10815-017-1092-2

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  • DOI: https://doi.org/10.1007/s10815-017-1092-2

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