Keywords
pregnancy
oocyte donation
embryo development
How to Cite
Abstract
Study question: Are pregnancy rates comparable between oocyte recipients who perform fresh embryo transfers at 120 hours and those who perform them at 144 hours?
Summary answer: Sixth day embryo transfers were associated with higher clinical and ongoing pregnancy rates than fifth day embryo transfers in oocyte recipients.
What is known already: Embryo quality and endometrial receptivity are both conditions that play an important role in implantation. Blastocyst stage transfers have shown better pregnancy rates, with controversial findings between fifth and sixth day embryo transfers.
Study design: Retrospective cohort study conducted between January 2018 and November 2019 to analyze fresh embryo transfers performed in 120 and 144 hours.
Materials and methods: A total of 436 fifth-day embryo transfers (control group) and 41 sixth-day embryo transfers (study group) were analyzed. All cycles were artificially prepared with estradiol and progesterone. The differences in the quantitative variables between the groups were compared with t-test, and the differences between the proportions with Chi-square test. Statistically significant differences were considered at probabilities less than 0.05. Statistical analysis was performed with STATA version 13.0 software.
Main results: Clinical pregnancy rate was higher in the sixth-day group compared to the fifth-day group (43.9% vs 28.4%, p=0.03), with an ongoing pregnancy rate of 41.4% and 27.1% (p=0.05), and a miscarriage rate of 9.75% and 14.4% (p=0.4), respectively.
Limitations: One of the limitations is the retrospective nature of the study, as well as the disparity in the number of patients included in each arm.
Wider implications of the findings: Extended culture to 144 hours seems to be a strategy with good reproductive outcomes, which allows flexibility in the scheduling of transfers and allows greater embryo selection.
References
Ferreux L, Bourdon M, Sallem A, Santulli P, Barraud-Lange V, Le Foll N, et al. Live birth rate following frozen–thawed blastocyst transfer is higher with blastocysts expanded on Day 5 than on Day 6. Human Reproduction. 2018. pp. 390–398. doi:10.1093/humrep/dey004
Hammond ER, Cree LM, Morbeck DE. Should extended blastocyst culture include Day 7? Hum Reprod. 2018;33: 991–997.
Haas J, Meriano J, Laskin C, Bentov Y, Barzilay E, Casper RF, et al. Clinical pregnancy
rate following frozen embryo transfer is higher with blastocysts vitrified on day 5 than on day 6. J Assist Reprod Genet. 2016;33: 1553–1557.
Poulsen V, Ingerslev HJ, Kirkegaard K. Elective embryo transfers on Day 6 reduce implantation compared with transfers on Day 5. Hum Reprod. 2017;32: 1238–1243.
Sciorio R, Thong KJ, Pickering SJ. Single blastocyst transfer (SET) and pregnancy outcome of day 5 and day 6 human blastocysts vitrified using a closed device. Cryobiology. 2018;84: 40–45.
Sciorio R, Thong KJ, Pickering SJ. Increased pregnancy outcome after day 5 versus day 6 transfers of human vitrified-warmed blastocysts. Zygote. 2019;27: 279–284.
Kaye L, Will EA, Bartolucci A, Nulsen J, Benadiva C, Engmann L. Pregnancy rates for single embryo transfer (SET) of day 5 and day 6 blastocysts after cryopreservation by vitrification and slow freeze. J Assist Reprod Genet. 2017;34: 913–919.
Taylor TH, Patrick JL, Gitlin SA, Wilson JM, Crain JL, Griffin DK. Comparison of aneuploidy, pregnancy and live birth rates between day 5 and day 6 blastocysts. Reprod Biomed Online. 2014;29: 305–310.
Bourdon M, Pocate-Cheriet K, Finet de Bantel A, Grzegorczyk-Martin V, Amar Hoffet A, Arbo E, et al. Day 5 versus Day 6 blastocyst transfers: a systematic review and meta-analysis of clinical outcomes. Hum Reprod. 2019;34: 1948–1964.
Barrenetxea G, López de Larruzea A, Ganzabal T, Jiménez R, Carbonero K, Mandiola M. Blastocyst culture after repeated failure of cleavage-stage embryo transfers: a comparison of day 5 and day 6 transfers. Fertil Steril. 2005;83: 49–53.
Yamamoto S, Umeki M, Hamano T, Matsusita F, Kuwahara K. Elective cryopreservation of all day 5 blastocysts is more effective than using day 6 blastocysts for improving pregnancy outcome in stimulated cycles. Reprod Med Biol. 2008;7: 75–83.
Elgindy E, Elsedeek MS-E-A. Day 5 expanded blastocysts transferred on same day have comparable outcome to those left for more extended culture and transferred on day 6. J Assist Reprod Genet. 2012;29: 1111–1115.
Dessolle L, Fréour T, Ravel C, Jean M, Colombel A, Daraï E, et al. Predictive factors of healthy term birth after single blastocyst transfer. Hum Reprod. 2011;26: 1220–1226.
Shapiro BS, Daneshmand ST, Desai J, Garner FC, Aguirre M, Hudson C. The risk of embryo-endometrium asynchrony increases with maternal age after ovarian stimulation and IVF. Reprod Biomed Online. 2016;33: 50–55.
Healy MW, Yamasaki M, Patounakis G, Richter KS, Devine K, DeCherney AH, et al. The slow growing embryo and premature progesterone elevation: compounding
factors for embryo-endometrial asynchrony. Hum Reprod. 2017;32: 362–367.
Irani M, O’Neill C, Palermo GD, Xu K, Zhang C, Qin X, et al. Blastocyst development rate influences implantation and live birth rates of similarly graded euploid blastocysts. Fertility and Sterility. 2018. pp. 95–102.e1. doi:10.1016/j.fertnstert.2018.03.032 17. 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. Human Reproduction. 1998. pp. 3434–3440. doi:10.1093/humrep/13.12.3434
Rienzi L, Gracia C, Maggiulli R, LaBarbera AR, Kaser DJ, Ubaldi FM, et al. Oocyte, embryo and blastocyst cryopreservation in ART: systematic review and meta-analysis comparing slow-freezing versus vitrification to produce evidence for the development of global guidance. Hum Reprod Update. 2017;23: 139–155.
Teh W-T, McBain J, Rogers P. What is the contribution of embryo-endometrial asynchrony to implantation failure? J Assist Reprod Genet. 2016;33: 1419–1430.
Bellver J, Simón C. Implantation failure of endometrial origin: what is new? Curr Opin Obstet Gynecol. 2018;30: 229–236.
Franasiak JM, Ruiz-Alonso M, Scott RT, Simón C. Both slowly developing embryos and a variable pace of luteal endometrial progression may conspire to prevent normal birth in spite of a capable embryo. Fertility and Sterility. 2016. pp. 861–866. doi:10.1016/j.fertnstert.2016.02.030
Paulson RJ. Hormonal induction of endometrial receptivity. Fertil Steril. 2011;96: 530–535.
Sahmay S, Oral E, Saridogan E, Senturk L, Atasu T. Endometrial biopsy findings in infertility: analysis of 12,949 cases. Int J Fertil Menopausal Stud. 1995;40: 316–321.
Barnes R. Histological Dating of Timed Endometrial Biopsy Tissue Is Not Related to Fertility Status. Yearbook of Obstetrics, Gynecology and Women’s Health. 2006. pp. 185–187. doi:10.1016/s1090-798x(08)70422-3
Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Ross R. Contrasting patterns in in vitro fertilization pregnancy rates among fresh autologous, fresh oocyte donor, and cryopreserved cycles with the use of day 5 or day 6 blastocysts may reflect differences in embryo-endometrium synchrony. Fertil Steril. 2008;89: 20–26.
Kaing A, Kroener LL, Tassin R, Li M, Liu L, Buyalos R, et al. Earlier day of blastocyst development is predictive of embryonic euploidy across all ages: essential data for physician decision-making and counseling patients. J Assist Reprod Genet. 2018;35: 119–125.
Escribá M-J, Bellver J, Bosch E, Sánchez M, Pellicer A, Remohí J. Delaying the initiation of progesterone supplementation until the day of fertilization does not compromise cycle outcome in patients receiving donated oocytes: a randomized study. Fertility and Sterility. 2006. pp. 92–97. doi:10.1016/j.fertnstert.2005.12.048