Optimizing embryo selection with day 5 transfer.
OBJECTIVE
To compare rates of implantation, pregnancy, miscarriage, multiple gestation, and selective reduction between patients undergoing day 5 (d5) and day 3 (d3) ETs.


METHODS
Retrospective cohort study.


METHODS
University-based IVF center.


METHODS
The first d5 ET cycle of patients 42 years of age from 2003 to 2006 was compared with a historical control of first cycle d3 ET patients 42 years of age from 1996 to 1999 who would have met current d5 ET criteria.


METHODS
None.


METHODS
Rates of implantation, clinical pregnancy, miscarriage, live birth, high order multiple pregnancy (HOMP), and selective reduction.


RESULTS
D5 ET patients had higher implantation rates (39% vs. 30%), with no difference in the no-transfer rate. D5 ET patients had lower rates of HOMP (2.5% vs. 11%) and HOMP delivery (0.7% vs. 3.5%), multiple pregnancy (27% vs. 33%), multiple delivery (19% vs. 26%), and twin delivery (18% vs. 23%). There were fewer selective reductions of HOMP with d5 ET (1.7% vs. 3.8%).


CONCLUSIONS
Extended culture improves embryo selection through increased implantation, facilitating fewer embryos per transfer, which lowers multiple gestation rates and the need for HOMP reduction.
Reh
Andrea
A
New York University Fertility Center, New York University School of Medicine, New York, New York, USA.
Fino
Elizabeth
E
Krey
Lewis
L
Berkeley
Alan
A
Noyes
Nicole
N
Grifo
James
J
D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D010064:Embryo Implantation; D004624:Embryo Transfer / Q000379:methods* / Q000592:standards; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods* / Q000592:standards; D005313:Fetal Death / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D050498:Live Birth / Q000453:epidemiology; D010062:Ovulation Induction / Q000379:methods* / Q000592:standards; D011247:Pregnancy; D011256:Pregnancy Outcome; D018607:Pregnancy Reduction, Multifetal / Q000706:statistics & numerical data*; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome