In vitro fertilization with single blastocyst-stage versus single cleavage-stage embryos.
BACKGROUND
Single-embryo transfer has been recommended to reduce the incidence of multiple gestations when in vitro fertilization is performed in women under 36 years of age. We designed a prospective, randomized, controlled trial to determine whether there were any differences in the rates of pregnancy and delivery between women undergoing transfer of a single cleavage-stage (day 3) embryo and those undergoing transfer of a single blastocyst-stage (day 5) embryo.


METHODS
We studied 351 infertile women under 36 years of age who were randomly assigned to undergo transfer of either a single cleavage-stage embryo (176 patients) or a single blastocyst-stage embryo (175 patients). Multifollicular ovarian stimulation was performed with a gonadotropin-releasing hormone antagonist and recombinant follicle-stimulating hormone.


RESULTS
The study was terminated early after a prespecified interim analysis (which included 50 percent of the planned number of patients) found a higher rate of pregnancy among women undergoing transfer of a single blastocyst-stage embryo (P=0.02). The rate of delivery was also significantly higher in this group than in the group undergoing transfer of a single cleavage-stage embryo (32.0 percent vs. 21.6 percent; relative risk, 1.48; 95 percent confidence interval, 1.04 to 2.11). Two multiple births occurred, both of monozygotic twins, both of which were in the group undergoing transfer of a single cleavage-stage embryo.


CONCLUSIONS
These findings support the transfer of a single blastocyst-stage (day 5) embryo in infertile women under 36 years of age.
Centre for Reproductive Medicine, Academisch Ziekenhuis, Vrije Universiteit Brussel, Brussels. evangelos.papanikolaou@vub.ac.be
Evangelos G
EG
Papanikolaou
Michel
M
Camus
Efstratios M
EM
Kolibianakis
Lisbet
L
Van Landuyt
Andre
A
Van Steirteghem
Paul
P
Devroey
D000328:Adult; D001755:Blastocyst; D002970:Cleavage Stage, Ovum; D046149:Embryo Culture Techniques; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D006801:Humans; D050498:Live Birth; D010062:Ovulation Induction / Q000379:methods; D011247:Pregnancy; D011272:Pregnancy, Multiple; D011446:Prospective Studies