Impact of Transferring a Poor Quality Embryo Along with a Good Quality Embryo on Pregnancy Outcomes in IVF/ICSI Cycles: a Retrospective Study

Abstract

Background The number and the quality of embryos transferred are important predictors of success in in vitro fertilization (IVF) cycles. In the presence of more than one good quality embryo on the transfer day, double-embryo transfer (DET) can be performed with these embryos, but generally, different quality embryos are present in the available transfer cohort. We aimed to investigate the effect of transferring a poor quality embryo along with a good quality embryo on IVF outcomes.

Methods In this study, 2298 fresh IVF/intracytoplasmic sperm injection (ICSI) cycles with two good quality embryos (group A), one good and one poor quality embryo (group B), and single good quality embryo (group C) transfers were examined. All groups were divided into two subgroups according to the transfer day as cleavage or blastocyst stage. Clinical pregnancy and live birth rates were the primary outcomes.

Results In the cleavage stage transfer subgroups, the clinical pregnancy rates were lower in the single-embryo transfer (SET) subgroup compared with DET subgroups, but the difference was not statistically significant compared with DET with mixed quality embryos. The live birth rates were comparable between the three groups. In the blastocyst transfer subgroups, the clinical pregnancy and live birth rates were significantly higher in DET with two good quality embryos than DET with mixed quality embryos and SET groups. Multiple pregnancy rates were higher in both DET groups in terms of transfer day (p = 0.001).

Conclusion DET with mixed quality embryos results with lower clinical pregnancy and live birth rates compared with DET with two good quality embryos at the blastocyst stage. At cleavage stage transfer, there is no difference in live birth rates between the two groups.

Zusammenfassung

Hintergrund Anzahl und Qualität von transferierten Embryos sind wichtige Prädiktoren für den Erfolg bei In-vitro-Fertilisations-(IVF-)Zyklen. Wenn mehr als ein Embryo von guter Qualität am Transfertag vorhanden ist, kann ein Doppelembryonentransfer (DET) mit diesen Embyros vorgenommen werden. Generell sind aber die verfügbaren Embryos von sehr unterschiedlicher Qualität. Ziel dieser Studie war es, die Auswirkung eines Transfers von einem Embryo schlechter Qualität zusammen mit einem Embryo guter Qualität auf das IVF-Outcome zu untersuchen.

Methoden In dieser Studie wurden 2298 frische IVF/intrazytoplasmatische Spermieninjektions-(ICSI-)Zyklen, bei denen entweder 2 Embryos von guter Qualität (Gruppe A), ein Embryo von guter Qualität und ein Embryo von schlechter Qualität (Gruppe B), oder ein einziges Embryo von guter Qualität (Gruppe C) transferiert wurden, verglichen. Alle diese Gruppen wurden je nach Transfertag (im Teilungsstadium bzw. Blastozystenstadium) nochmals in 2 Untergruppen unterteilt. Die primären Endpunkte waren klinische Schwangerschaftsrate und Lebendgeburtenrate.

Ergebnisse In den Teilungsstadiumtransfer-Untergruppen waren die klinischen Schwangerschaftsraten niedriger in der Untergruppe mit einem einzigen transferierten Embryo (SET) verglichen mit den DET-Untergruppen, aber der Unterschied zu den DET-Untergruppen mit Embyros gemischter Qualität war nicht statistisch signifikant. Die Lebendgeburtenraten waren bei allen 3 Gruppen vergleichbar. Bei den Blastozystentransfer-Untergruppen waren die klinischen Schwangerschaftsraten und Lebendgeburtenraten signifikant höher in der DET-Untergruppe mit 2 Embyros guter Qualität verglichen mit der DET-Untergruppe mit Embryos gemischer Qualität und den SET-Untergruppen. Die Mehrlingsschwangerschaftsraten waren in beiden DET-Gruppen höher (p = 0,001).

Schlussfolgerung DET mit Embryos von gemischter Qualität geht einher mit niedrigeren klinischen Schwangerschaftsraten und Lebendgeburtenraten als DET mit 2 Embryos von guter Qualität im Blastozystenstadium. Werden die Embryos im Teilungsstadium transferiert, gibt es hinsichtlich der Lebendgeburtenraten keinen Unterschied zwischen den 2 Gruppen.

Key words

double embryo transfer - embryo quality - cleavage stage - blastocyst stage - live birth rate - multiple pregnancy

Schlüsselwörter

Doppelembryonentransfer - Embryoqualität - Teilungsstadium - Blastozystenstadium - Lebendgeburtenrate - Mehrlingsschwangerschaft

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