title: Comparison of blastocyst transfer to day 3 transfer with assisted hatching in the older patient.
abstract: OBJECTIVE
  To compare cycle outcomes in similar populations of women over 40 who underwent blastocyst transfer compared with women who had day 3 embryo transfer with assisted hatching (ET/AH).
  
  
  METHODS
  Retrospective study. STTING: University hospital-based program.
  
  
  METHODS
  Eighty-six IVF cycles in women ages 40 to 43 years who had more than three eight-cell embryos on day 3. On day 3 of embryo culture, patients chose either to undergo blastocyst transfer or day 3 ET/AH.
  
  
  METHODS
  Pregnancy and cryopreservation rates were recorded.
  
  
  RESULTS
  In 48 cycles, blastocyst transfer was performed, and in 38 cycles day 3 ET/AH was performed. There was no statistically significant difference between the blastocyst transfer group and the day 3 ET/AH group with respect to age (41.1 +/- 0.9 years vs. 41.6 +/- 0.8 years), percentage of intracytoplasmic sperm injection cycles (29.2% vs. and 27.6%), number of oocytes (14.9 +/- 5.6 vs. 12.8 +/- 4.0), or number of eight-cell embryos (6.1 +/- 2.2 vs. 5.4 +/- 1.5). Significantly fewers embryos were transferred per cycle with blastocyst transfer (2.6 +/- 1.0) compared with day 3 ET/AH (5.9 +/- 2.0). The viable pregnancy rate was similar in the blastocyst transfer group (29.2%) and in the day 3 ET/AH group (26.3%). Embryos for cryopreservation were available in significantly more cycles in the blastocyst transfer group (52.1%) than in the day 3 ET/AH group (21.1%). Cleavage stage arrest occurred only in one cycle.
  
  
  CONCLUSIONS
  Blastocyst transfer appears to be as effective as day 3 ET/AH in older patients with good embryos. Higher cryopreservation rate in the blastocyst transfer group may represent an advantage over day 3 ET/AH. Older women may also benefit from the information that extended culture provides them regarding their oocyte quality.
authors.affiliation: Department of Gynecology and Obstetrics, Stanford University School of Medicine, Stanford, California 94305, USA. milki4@aol.com
authors.forename: Amin A
authors.initials: AA
authors.lastname: Milki
authors.forename: Mary D
authors.initials: MD
authors.lastname: Hinckley
authors.forename: Barry
authors.initials: B
authors.lastname: Behr
mesh_terms: D000328:Adult; D000375:Aging / Q000502:physiology*; D001755:Blastocyst; D036703:Blastula / Q000637:transplantation*; D015925:Cryopreservation; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013997:Time Factors