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Previous Volume 351:2392-2402 December 2, 2004 Number 23 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Davis, O. K. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The risks of premature birth and perinatal death are increased after in vitro fertilization. These risks are mainly due to the high incidence of multiple births, which relates to the number of embryos transferred.

Methods We performed a randomized, multicenter trial to assess the equivalence of two approaches to in vitro fertilization with respect to the rates of pregnancy that result in at least one live birth and to compare associated rates of multiple gestation. Women less than 36 years of age who had at least two good-quality embryos were randomly assigned either to undergo transfer of a single fresh embryo and, if there was no live birth, subsequent transfer of a single frozen-and-thawed embryo, or to undergo a single transfer of two fresh embryos. Equivalence was defined as a difference of no more than 10 percentage points in the rates of pregnancy resulting in at least one live birth.

Results Pregnancy resulting in at least one live birth occurred in 142 of 331 women (42.9 percent) in the double-embryo-transfer group as compared with 128 of 330 women (38.8 percent) in the single-embryo-transfer group (difference, 4.1 percentage points; 95 percent confidence interval, –3.4 to 11.6 percentage points); rates of multiple births were 33.1 percent and 0.8 percent, respectively (P<0.001). These results do not demonstrate equivalence of the two approaches in rates of live births, but they do indicate that any reduction in the rate of live births with the transfer of single embryos is unlikely to exceed 11.6 percentage points.

Conclusions In women under 36 years of age, transferring one fresh embryo and then, if needed, one frozen-and-thawed embryo dramatically reduces the rate of multiple births while achieving a rate of live births that is not substantially lower than the rate that is achievable with a double-embryo transfer.

Source Information

From the Department of Obstetrics and Gynecology, Institute for Health of Women and Children, Sahlgrenska University Hospital, Göteborg, Sweden (A.T., A.S., C.B.); the Fertility Unit, Haugesund Hospital, Haugesund, Norway (J.H.); Fertility Center Scandinavia, Carlanderska Hospital, Göteborg, Sweden (T.H.); the Department of Molecular and Clinical Medicine, Division of Obstetrics and Gynecology, University Hospital, Linköping, Sweden (B.J.); and the Fertility Clinic, Rigshospital, Copenhagen (A.P.).

Address reprint requests to Dr. Bergh at Reproductive Medicine, Department of Obstetrics and Gynecology, Institute for Health of Women and Children, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden, or at christina.bergh{at}vgregion.se.

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