Does cleavage- versus blastocyst-stage embryo transfer improve fertility rates in women over 38 years of age undergoing assisted reproductive technology?
advanced maternal age
blastocyst transfer
embryo transfer day 5
extended embryo culture
in vitro fertilization
pregnancy rate
Journal
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
ISSN: 1879-3479
Titre abrégé: Int J Gynaecol Obstet
Pays: United States
ID NLM: 0210174
Informations de publication
Date de publication:
30 Jun 2024
30 Jun 2024
Historique:
revised:
05
06
2024
received:
14
02
2024
accepted:
14
06
2024
medline:
30
6
2024
pubmed:
30
6
2024
entrez:
30
6
2024
Statut:
aheadofprint
Résumé
To evaluate whether extending embryo culture to day 5 (D5) affects pregnancy rates in women older than 38 years undergoing in vitro fertilization (IVF). This retrospective, observational cohort study included data from fresh IVF cycles of women over 38 years, during 2011-2021. The cohort was divided according to day 3 (D3) versus D5 embryo transfer (ET). A total of 346 patients (ages 38-45 years) who underwent 496 IVF cycles were included, each yielding one to six embryos. A total of 374 (75%) fresh D3 ETs were compared with 122 (25%) D5 ETs. Demographically, there were more nulliparas in the D3 group (189 [50.9%] vs 47 [38.8%], P = 0.021). Higher gonadotropin dosage was used (3512 ± 1346 vs 3233 ± 1212 IU, P = 0.045) and lower maximum estradiol levels were reached in the D3 group (1129 ± 685 vs 1432 ± 708 pg/mL, P = 0.002). Thirty-three (27%) of the D5 cycles resulted in transfer cancelation due to failure of blastocyst formation (P = 0.001). However, clinical pregnancy rates (P = 0.958), live birth rates (P = 0.988), and miscarriage rates (P = 0.710) did not differ between D3 and D5 ETs. Multivariable logistic regression for clinical pregnancy rate showed that day of transfer did not have a significant effect on the odds (P = 0.376), but maternal age (P = 0.001) and number of retrieved oocytes (P = 0.009) were significant variables. In older women, culturing embryos to blastocyst stage can decrease invalid ETs without reducing pregnancy rates. Cancelation rates are higher but it may avoid interventions and conserve valuable time.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024 International Federation of Gynecology and Obstetrics.
Références
Glujovsky D, Farquhar C, Quinteiro Retamar AM, Sesdo CRA, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2016;(6):CD00218. doi:10.1002/14651858.CD002118.pub5
Sfontouris IA, Martins WP, Nastri CO, et al. Blastocyst culture using single versus sequential media in clinical IVF: a systematic review and meta‐analysis of randomized controlled trials. J Assist Reprod Genet. 2016;33:1261‐1272. doi:10.1007/s10815-016-0774-5
Biggers JD, Summers MC. Choosing a culture medium: making informed choices. Fertil Steril. 2008;90:473‐483.
European IVF‐monitoring Consortium (EIM) for the European Society of Human Reproduction and Embryology (ESHRE), Wyns C, Bergh C, Calhaz‐Jorge C, et al. ART in Europe, 2016: results generated from European registries by ESHRE. Hum Reprod Open. 2020;2020(3):hoaa032. doi:10.1093/hropen/hoaa032
Coskun S, Hollanders J, Al‐Hassan S, Al‐Sufyan H, Al‐Mayman H, Jaroudi K. Day 5 versus day 3 embryo transfer: a controlled randomized trial. Hum Reprod. 2000;15:1947‐1952. doi:10.1093/humrep/15.9.1947
Gardner DK, Schoolcraft WB, Wagley L, Schlenker T, Stevens J, Hesla J. A prospective randomized trial of blastocyst culture and transfer in in‐vitro fertilization. Hum Reprod. 1998;13:3434‐3440. doi:10.1093/humrep/13.12.3434
Janny L, Menezo YJR. Maternal age effect on early human embryonic development and blastocyst formation. Mol Reprod Dev. 1996;45:31‐37.
Pantos K, Athanasiou V, Stefanidis K, Stavrou D, Vaxevanoglou T, Chronopolou M. Influence of advanced age on the blastocyst development rate and pregnancy rate assisted reproductive technology. Fertil Steril. 1999;71:1144‐1146. doi:10.1016/s0015-0282(99)00121-1
Levi‐Setti PE, Cirillo F, Smeraldi A, Morenghi E, Mulazzani GEG, Albani E. 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. 2018;35:457‐465.
Magli MC, Jones GM, Gras L, Gianaroli L, Korman I, Trounson AO. Chromosome mosaicism in day 3 aneuploid embryos that develop to morphologically normal blastocysts in vitro. Hum Reprod. 2000;15:1781‐1786. doi:10.1093/humrep/15.8.1781
Chen P, Li T, Jia L, Fang C, Xiaoyan L. Should all embryos be cultured to blastocyst for advanced maternal age women with low ovarian reserve: a single center retrospective study. Gynecol Endocrinol. 2018;34:761‐765. doi:10.1080/09513590.2018.1450379
Gardner DK, Schoolcraft WB. In vitro culture of human blastocysts. In: Jansen R, Mortimer D, eds. Towards Reproductive Certainty Fertility and Genetics Beyond. Parthenon Publishing Group Ltd; 1999:377‐388.
Neblett MF, Kim T, Jones TL, et al. Is there still a role for a cleavage‐stage embryo transfer? F S Rep. 2021;2:269‐274. doi:10.1016/j.xfre.2021.06.004
Awadalla MS. Cleavage‐stage embryo transfer: we'll never let it go. F S Rep. 2021;2:261‐262.
Reed BG, Babayev SN, Bukulmez O. Shifting paradigms in diminished ovarian reserve and advanced reproductive age in assisted reproduction: customization instead of conformity. Semin Reprod Med. 2015;33:169‐178.
Glujovsky D, Quinteiro Retamar AM, Alvarez Sedo CR, et al. Cleavage‐stage versus blastocyst‐stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2022;(5):CD002118. doi:10.1002/14651858.CD002118.pub6
Staessen C, Platteau P, Van Assche E, et al. Comparison of blastocyst transfer with or without preimplantation genetic diagnosis for aneuploidy screening in couples with advanced maternal age: a prospective randomized controlled trial. Hum Reprod. 2004;19:2849‐2858. doi:10.1093/humrep/deh536