title: Integration of blastocyst transfer for all patients.
abstract: OBJECTIVE
  To evaluate the efficacy of using day-5 embryo transfer (ET) for all patients.
  
  
  METHODS
  Retrospective, non-randomized comparison of day-3 ET versus day-5 ET.
  
  
  METHODS
  Private practice.
  
  
  METHODS
  Women having in vitro fertilization and receiving either day-3 ET or day-5 ET.
  
  
  METHODS
  Extended embryo culture through embryonic genome activation to select those embryos with higher implantation potential.
  
  
  METHODS
  The following parameters were compared for day-3 ET and day-5 ET: clinical and ongoing pregnancy rates, implantation rates, patients having cryopreservation, and liveborn rates.
  
  
  RESULTS
  Blastocyst embryo transfer (day-5 ET) increased the clinical and ongoing pregnancy rate for patients <35 years of age and for the total program. The risk of high order multiple pregnancy was reduced by a decrease in the number of embryos transferred (2.0 vs. 2.7; day-5 ET vs. day-3 ET, respectively). However, the multiple pregnancy rate was not different due to an increase in the implantation rate (day-5 ET 43% vs. day-3 ET 27%). There was no difference in the percent of patients not having an ET (day-5 ET 2.8%; day-3 ET 1.3%).
  
  
  CONCLUSIONS
  Blastocyst ET increased the clinical and ongoing pregnancy rate for patients <35 years of age and for the total program, with a concomitant decrease in the number of embryos transferred. However, the decrease in the number of embryos transferred did not decrease the multiple rate, but did reduce the incidence of high order multiples. Most patients (97%) had an embryo transfer. Therefore, culturing embryos an additional 48 hours through embryonic genome activation allows for selection of the most viable embryos without compromising the patient's opportunity to become pregnant.
authors.affiliation: Reproductive Resource Center of Greater Kansas City, P.A., Overland Park, Kansas 66215, USA. mwilson@rrc.com
authors.forename: Michael
authors.initials: M
authors.lastname: Wilson
authors.forename: Kathy
authors.initials: K
authors.lastname: Hartke
authors.forename: Michelle
authors.initials: M
authors.lastname: Kiehl
authors.forename: Jonetta
authors.initials: J
authors.lastname: Rodgers
authors.forename: Celeste
authors.initials: C
authors.lastname: Brabec
authors.forename: Rodney
authors.initials: R
authors.lastname: Lyles
mesh_terms: D000328:Adult; D001755:Blastocyst; D015925:Cryopreservation; D046508:Culture Techniques; D010064:Embryo Implantation; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D013997:Time Factors; D016896:Treatment Outcome