Journal Article

Effect of single blastocyst-stage versus single cleavage-stage embryo transfer on cumulative live births in women with good prognosis undergoing in vitro fertilization: Multicenter Randomized Controlled Trial

Yuan, Yingying, Kong, Pingping, Hu, Zhibin, Liu, Haiying, Mol, Ben Willem J., Guan, Yichun, Chen, Zi-Jiang, Li, Caihua, Wang, Ze, Zhang, Bo, Zhang, Heping, Cao, Yunxia, Ma, Xiang, Zhang, Cuilian, Yi, Honggang, Huang, Ling, Liu, Jiayin, Xin, Xing, Tan, Jichun, Wang, Jing, Shi, Yuhua, Li, Hong, Zhao, Junli, Lu, Yao, Sun, Yun, Chen, Feng, Liu, Jianqiao

2024

Overview

In this multicenter, non-inferiority, randomized trial, we randomly assigned 992 women undergoing in-vitro fertilization (IVF) with a good prognosis (aged 20-40, ≥3 transferrable cleavage-stage embryos) to strategies of blastocyst-stage ( n  = 497) or cleavage-stage ( n  = 495) single embryo transfer. Primary outcome was cumulative live-birth rate after up to three transfers. Secondary outcomes were cumulative live-births after all embryo transfers within 1 year of randomization, pregnancy outcomes, obstetric-perinatal complications, and livebirths outcomes. Live-birth rates were 74.8% in blastocyst-stage group versus 66.3% in cleavage-stage group (relative risk 1.13, 95%CI:1.04-1.22; P non-inferiority  < 0.001, P superiority  = 0.003) (1-year cumulative live birth rates of 75.7% versus 68.9%). Blastocyst transfer increased the risk of spontaneous preterm birth (4.6% vs 2.0%; P  = 0.02) and neonatal hospitalization >3 days. Among good prognosis women, a strategy of single blastocyst transfer increases cumulative live-birth rates over single cleavage-stage transfer. Blastocyst transfer resulted in higher preterm birth rates. This information should be used to counsel patients on their choice between cleavage-stage and blastocyst-stage transfer (NCT03152643, https://clinicaltrials.gov/study/NCT03152643 ). This randomized trial assessed the effectiveness and safety of single blastocyst transfer vs single cleavage-stage embryo transfer among women with good prognosis. Here, the authors show improved cumulative live birth rates and relatively unfavorable perinatal outcomes after blastocyst transfer.

• Publisher: Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 692/308/2779/777 / 692/308/409 / Adult / Birth / Birth rate / Blastocyst / Cleavage / Cleavage Stage, Ovum / Embryo transfer / Embryo Transfer - methods / Embryos / Female / Fertilization in Vitro - methods / Humanities and Social Sciences / Humans / In vitro fertilization / Live Birth - epidemiology / multidisciplinary / Neonates / Pregnancy / Pregnancy complications / Pregnancy Outcome - epidemiology / Pregnancy Rate / Premature birth / Premature Birth - epidemiology / Prognosis / Randomization / Science / Science (multidisciplinary) / Single Embryo Transfer / Young Adult