Author:
Hsieh Han-Chih,Lee Chun-I,Lai En-Yu,Su Jia-Ying,Huang Yi-Ting,Zheng Wei-Lin,Chen Chien-Hong,Huang Chun-Chia,Lin Pin-Yao,Lee Maw-Sheng,Liu Mark,Huang Yen-Tsung
Abstract
Abstract
Background
For women undergoing in vitro fertilization (IVF), the clinical benefit of embryo transfer at the blastocyst stage (Day 5) versus cleavage stage (Day 3) remains controversial. The purpose of this study is to compare the implantation rate, clinical pregnancy rate and odds of live birth of Day 3 and Day 5 embryo transfer, and more importantly, to address the issue that patients were chosen to receive either transfer protocol due to their underlying clinical characteristics, i.e., confounding by indication.
Methods
We conducted a retrospective cohort study of 9,090 IVF cycles collected by Lee Women’s Hospital in Taichung, Taiwan from 1998 to 2014. We utilized the method of propensity score matching to mimic a randomized controlled trial (RCT) where each patient with Day 5 transfer was matched by another patient with Day 3 transfer with respect to other clinical characteristics. Implantation rate, clinical pregnancy rate, and odds of live birth were compared for women underwent Day 5 transfer and Day 3 transfer to estimate the causal effects. We further investigated the causal effects in subgroups by stratifying age and anti-Mullerian hormone (AMH).
Results
Our analyses uncovered an evidence of a significant difference in implantation rate (p=0.04) favoring Day 5 transfer, and showed that Day 3 and Day 5 transfers made no difference in both odds of live birth (p=0.27) and clinical pregnancy rate (p=0.11). With the increase of gestational age, the trend toward non-significance of embryo transfer day in our result appeared to be consistent for subgroups stratified by age and AMH, while all analyses stratified by age and AMH were not statistically significant.
Conclusions
We conclude that for women without strong indications for Day 3 or Day 5 transfer, there is a small significant difference in implantation rate in favor of Day 5 transfer. However, the two protocols have indistinguishable outcomes on odds of live birth and clinical pregnancy rate.
Funder
Academia Sinisa; Binflux Inc
Publisher
Springer Science and Business Media LLC
Subject
Obstetrics and Gynaecology
Reference39 articles.
1. Jones G, Trounson A. Blastocyst stage transfer: pitfalls and benefits: The benefits of extended. Hum Reprod (Oxford. Print). 1999; 14(6):1405–8.
2. Guerif F, Lemseffer M, Bidault R, Gasnier O, Saussereau M, Cadoret V, Jamet C, Royère D. Single day 2 embryo versus blastocyst-stage transfer: a prospective study integrating fresh and frozen embryo transfers. Hum Reprod. 2009; 24(5):1051–8.
3. Schoolcraft W, Gardner D. Blastocyst versus day 2 or 3 transfer. In: Seminars in Reproductive Medicine: 2001. p. 259–68. CopyrightⒸ 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New ….
4. Gardner D, Vella P, Lane M, Wagley L, Schlenker T, Schoolcraft W. Culture and transfer of human blastocysts increases implantation rates and reduces the need for multiple embryo transfers. Fertil Steril. 1998; 69(1):84–8.
5. Papanikolaou E, Kolibianakis E, Tournaye H, Venetis C, Fatemi H, Tarlatzis B, Devroey P. Live birth rates after transfer of equal number of blastocysts or cleavage-stage embryos in ivf. a systematic review and meta-analysis. Hum Reprod. 2008; 23(1):91–9.