In Vitro Fertilization with Single Blastocyst-Stage versus Single Cleavage-Stage Embryos
Evangelos G. Papanikolaou, M.D., Ph.D., Michel Camus, M.D., Efstratios M. Kolibianakis, M.D., Ph.D., Lisbet Van Landuyt, B.Sc., Andre Van Steirteghem, M.D., Ph.D., and Paul Devroey, M.D., Ph.D.
Background Single-embryo transfer has been recommended to reducethe incidence of multiple gestations when in vitro fertilizationis performed in women under 36 years of age. We designed a prospective,randomized, controlled trial to determine whether there wereany differences in the rates of pregnancy and delivery betweenwomen 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 agewho were randomly assigned to undergo transfer of either a singlecleavage-stage embryo (176 patients) or a single blastocyst-stageembryo (175 patients). Multifollicular ovarian stimulation wasperformed with a gonadotropin-releasing hormone antagonist andrecombinant follicle-stimulating hormone.
Results The study was terminated early after a prespecifiedinterim analysis (which included 50 percent of the planned numberof patients) found a higher rate of pregnancy among women undergoingtransfer of a single blastocyst-stage embryo (P=0.02). The rateof delivery was also significantly higher in this group thanin the group undergoing transfer of a single cleavage-stageembryo (32.0 percent vs. 21.6 percent; relative risk, 1.48;95 percent confidence interval, 1.04 to 2.11). Two multiplebirths occurred, both of monozygotic twins, both of which werein the group undergoing transfer of a single cleavage-stageembryo.
Conclusions These findings support the transfer of a singleblastocyst-stage (day 5) embryo in infertile women under 36years of age.
Source Information
From the Centre for Reproductive Medicine, Academisch Ziekenhuis, Vrije Universiteit Brussel, Brussels.
Address reprint requests to Dr. Papanikolaou at the Academisch Ziekenhuis–Vrije Universiteit Brussel, Centre for Reproductive Medicine, Laarbeeklaan 101, Brussels B-1090, Belgium, or at evangelos.papanikolaou{at}vub.ac.be.
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