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What Are the Live Birth and Multiple Pregnancy Rates When 1 Versus 2 Low-Quality Blastocysts Are Transferred in a Cryopreserved Cycle? a Retrospective Cohort Study, Stratified for Age, Embryo Quality, and Oocyte Donor Cycles

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Abstract

Outcomes among women who transferred only Gardner’s grade BB or lower quality frozen embryos transferred (FET) are not well known. Our objective is to study whether transferring 2 versus 1 frozen low-quality blastocysts will increase the live birth rate (LBR) and the multiple pregnancy rate (MPR). This is a retrospective cohort study including 1104 FET cycles. Only day 5–6 blastocysts of grade BB or lower quality were included. Clinical pregnancy rate (CPR), MPR, and LBR per cycle were compared between single embryo transfer (SET) (n = 969) and double embryo transfer (DET) (n = 135). CPR and MPR were compared between SET and DET in grade BB, BC, CB, and CC individually. Among SET, BB blastocysts had higher CPR 34% (P = 0.0001) and a sub-significant increase in LBR 19% (P = 0.059) in comparison to other grade SET. Among all BB, MPR was significantly higher when transferring two versus one (5.9 vs. 1.9, P = 0.009). If age at egg collection ≥ 40 years (n = 97), no difference was found in CPR (11.1 vs. 11.7, P = 0.9), MPR (0 vs. 0), and LBR (6.3 vs. 0,P = 0.13) when SET or DET was performed. If age was < 40 years (n = 818), the MPR was significantly higher in DET than SET (6.7 vs. 1.63, P = 0.004). In egg donor cycles (n = 189), there was no difference in CPR, MPR, and LBR between SET and DET. Single embryo transfer should be offered even in women ≥ 40 years of age or transferring lower quality embryos since transferring more did not increase outcomes in this group, and SET is likely the safest path.

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Abbreviations

AFC:

antral follicle count

CP:

clinical pregnancy

DET:

double embryo transfer

DOR:

diminish ovarian reserve

ET:

endometrial thickness

FET:

frozen embryo transfer

FSH:

follicle-stimulating hormone

GnRH:

gonadotropin-releasing hormone

HRT:

hormonal replacement treatment

HCG:

human chorionic gonadotropin

IVF:

in vitro fertilization

ICM:

inner cell mass

ICSI:

intracytoplasmic sperm injection

LBR:

live born rate

MP:

multiple pregnancy

PGT-A:

preimplantation genetic testing for aneuploidy

PCOS:

polycystic ovarian syndrome

SET:

single embryo transfer

TE:

trophectoderm

ZP:

zona pellucid

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Acknowledgments

We wish to thank David Gardner PhD for having read a version of this manuscript and making suggestions for edit.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility Center, McGill University, 888 Boulevard de Maisonneuve East, suit # 200, Montreal, Quebec, H2l 4S8, Canada

    Suha Arab, Weon-Young Son & Michael H. Dahan

  2. Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada

    Ahmad Badegiesh & Sarah Aldhaheri

Authors
  1. Suha Arab
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  2. Ahmad Badegiesh
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  3. Sarah Aldhaheri
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  4. Weon-Young Son
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  5. Michael H. Dahan
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Contributions

S. Arab’s role included in study design, data collection, data analysis, and writing the manuscript. A. B’s role included in the statistical data analysis. S. Aldahaheri’s was involved in data collection. Y. S was included in writing the manuscript and review. MHD was included in study design, data analysis, writing the manuscript, and review. MHD acted as the senior author.

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Correspondence to Suha Arab.

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Arab, S., Badegiesh, A., Aldhaheri, S. et al. What Are the Live Birth and Multiple Pregnancy Rates When 1 Versus 2 Low-Quality Blastocysts Are Transferred in a Cryopreserved Cycle? a Retrospective Cohort Study, Stratified for Age, Embryo Quality, and Oocyte Donor Cycles. Reprod. Sci. 28, 1403–1411 (2021). https://doi.org/10.1007/s43032-020-00404-2

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  • DOI: https://doi.org/10.1007/s43032-020-00404-2

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