Elective single blastocyst transfer reduces twin rates without compromising pregnancy rates.

OBJECTIVE To compare IVF outcome in single versus two blastocyst transfer in good-prognosis patients. DESIGN Retrospective data analysis. SETTING University-based IVF practice. PATIENT(S) Assisted reproductive technology outcome was compared in 41 patients who underwent elective single blastocyst transfer and 66 patients who underwent two blastocyst transfer. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Implantation rates, clinical pregnancy rates, cumulative pregnancy rates, twin pregnancy rates. RESULT(S) Blastocyst cycles between January 2003 and August 2004 (n = 238) were reviewed. Criteria for elective single embryo transfer established by our clinic were applied retrospectively to blastocyst cycles. Patients who met the criteria were divided into two groups, those who underwent elective single embryo transfer (eSET) and those who underwent two embryo transfer (2ET). Patient and cycle characteristics were similar for both groups. There were no differences in implantation rate (76% vs. 66%) or pregnancy rate (76% vs. 79%) between the eSET and 2ET groups. There was a significant difference in the number of twin pregnancies (3.2% vs. 62%) in the eSET versus 2ET group. Cumulative pregnancy rates were found to be 83% for both groups. CONCLUSION(S) Single blastocyst transfer can be performed in good-prognosis patients without compromising pregnancy rates. Twin pregnancy rates can be significantly reduced with eSET.

[1]  D. Gardner,et al.  Culture and transfer of human blastocysts increases implantation rates and reduces the need for multiple embryo transfers. , 1998, Fertility and sterility.

[2]  S. Cox,et al.  Parenting stress in first-time mothers of twins and triplets conceived after in vitro fertilization. , 2004, Fertility and sterility.

[3]  L. Rienzi,et al.  Day 3 embryo transfer with combined evaluation at the pronuclear and cleavage stages compares favourably with day 5 blastocyst transfer. , 2002, Human reproduction.

[4]  R. Karaki,et al.  Blastocyst culture and transfer: a step toward improved in vitro fertilization outcome. , 2002, Fertility and sterility.

[5]  A. Tiitinen,et al.  Impact of elective single embryo transfer on the twin pregnancy rate. , 2003, Human reproduction.

[6]  T. Pool,et al.  Preliminary clinical experience with human blastocyst development in vitro without co-culture. , 1999, Human reproduction.

[7]  M. D'Alton,et al.  The desire of infertile patients for multiple births. Authors' replies , 2004 .

[8]  L. Giudice,et al.  Incidence of monozygotic twinning with blastocyst transfer compared to cleavage-stage transfer. , 2002, Fertility and sterility.

[9]  David K Gardner,et al.  Single blastocyst transfer: a prospective randomized trial. , 2004, Fertility and sterility.

[10]  B. Behr.  Blastocyst culture and transfer. , 1999, Human reproduction.

[11]  M Orava,et al.  One versus two embryo transfer after IVF and ICSI: a randomized study. , 2001, Human reproduction.

[12]  Jan Gerris,et al.  Elective single day 3 embryo transfer halves the twinning rate without decrease in the ongoing pregnancy rate of an IVF/ICSI programme. , 2002, Human reproduction.

[13]  Eshre Campus Course Report.  Prevention of twin pregnancies after IVF/ICSI by single embryo transfer. ESHRE Campus Course Report. , 2001, Human reproduction.

[14]  D. Gardner,et al.  A prospective randomized trial of blastocyst culture and transfer in in-vitro fertilization. , 1998, Human reproduction.

[15]  D. De Neubourg,et al.  Prevention of twin pregnancy after in-vitro fertilization or intracytoplasmic sperm injection based on strict embryo criteria: a prospective randomized clinical trial. , 1999, Human reproduction.

[16]  T. D’Hooghe,et al.  A prospective randomized study: day 2 versus day 5 embryo transfer. , 2002, Human reproduction.

[17]  Anja Pinborg,et al.  What is the most relevant standard of success in assisted reproduction? Is there a single 'parameter of excellence'? , 2004, Human reproduction.

[18]  J. Ellenberg,et al.  The Risk of Mortality or Cerebral Palsy in Twins: A Collaborative Population-Based Study , 2002, Pediatric Research.

[19]  K. Dafopoulos,et al.  What is the most relevant standard of success in assisted reproduction? Is BESST (birth emphasizing a successful singleton at term) truly the best? , 2004, Human reproduction.

[20]  Kate Northstone,et al.  Twins as a natural experiment to study the causes of mild language delay: I: Design; twin-singleton differences in language, and obstetric risks. , 2003, Journal of child psychology and psychiatry, and allied disciplines.

[21]  O. Hovatta,et al.  Elective transfer of one embryo results in an acceptable pregnancy rate and eliminates the risk of multiple birth , 1999 .

[22]  J. A. Martin,et al.  Trends in twin birth outcomes and prenatal care utilization in the United States, 1981-1997. , 2000, JAMA.

[23]  C. Racowsky,et al.  Blastocyst-ET and Monozygotic Twinning , 2000, Journal of Assisted Reproduction and Genetics.

[24]  S. Coskun,et al.  Day 5 versus day 3 embryo transfer: a controlled randomized trial. , 2000, Human reproduction.

[25]  S. Bhattacharya,et al.  A randomized comparison of alternative methods of information provision on the acceptability of elective single embryo transfer. , 2004, Human reproduction.

[26]  W. Feichtinger,et al.  A Prospective Randomized Multicenter Study to Evaluate the Best Day for Embryo Transfer: Does the Outcome Justify Prolonged Embryo Culture? , 2003, Journal of Assisted Reproduction and Genetics.

[27]  D. Seidman,et al.  A prospective randomized study comparing day 3 with blastocyst-stage embryo transfer. , 2002, Fertility and sterility.

[28]  J. Segars,et al.  Blastocyst transfer decreases multiple pregnancy rates in in vitro fertilization cycles: a randomized controlled trial. , 2003, Fertility and sterility.

[29]  A. Pinborg,et al.  Morbidity in a Danish national cohort of 472 IVF/ICSI twins, 1132 non-IVF/ICSI twins and 634 IVF/ICSI singletons: health-related and social implications for the children and their families. , 2003, Human reproduction.

[30]  Dk Gardner,et al.  In-vitro culture of human blastocysts , 1999 .

[31]  T. Utsunomiya,et al.  A prospective trial of blastocyst culture and transfer. , 2002, Human reproduction.