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Lai SY, Hsieh CTC, Liao IL, Wu TH, Wu YT, Wu HH, Tsai HD. Monochorionic-triamniotic triplet pregnancy following artificial reproductive technology: Report of a rare case in Taiwan. Taiwan J Obstet Gynecol 2024; 63:409-413. [PMID: 38802209 DOI: 10.1016/j.tjog.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Monochorionic-triamniotic (MCTA) triplet pregnancies following artificial reproductive technologies are uncommon. We report a case in which one of two transferred embryos differentiated into an MCTA triplet. This study aimed to investigate the potential factors contributing to MCTA triplet pregnancy. CASE REPORT A 39-year-old woman underwent her second frozen embryo transfer with hatching blastocysts, which resulted in the detection of an MCTA triplet on ultrasonography. She delivered by cesarean section at 32 weeks of gestation, resulting in the birth of three live male infants. Her medical history and in vitro fertilization treatment were reviewed to identify potential causes. CONCLUSION The etiology of MCTA triplet pregnancy remains multifactorial. In the presented case, prolonged in vitro culture to the blastocyst stage and inner cell mass splitting were potential contributing factors. Further research is needed to fully understand the complexity of MCTA triplet pregnancy.
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Affiliation(s)
- Siew-Yen Lai
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | | | - I-Lin Liao
- In Vitro Fertilization Laboratory, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Tsui-Huang Wu
- In Vitro Fertilization Laboratory, Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Ting Wu
- Nurse Practitioner of Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan
| | - Hsin-Hung Wu
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan; Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taiwan
| | - Hong-Der Tsai
- Department of Obstetrics and Gynecology, Changhua Christian Hospital, Changhua, Taiwan.
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Glujovsky D, Quinteiro Retamar AM, Alvarez Sedo CR, Ciapponi A, Cornelisse S, Blake D. Cleavage-stage versus blastocyst-stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev 2022; 5:CD002118. [PMID: 35588094 PMCID: PMC9119424 DOI: 10.1002/14651858.cd002118.pub6] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Advances in embryo culture media have led to a shift in in vitro fertilisation (IVF) practice from cleavage-stage embryo transfer to blastocyst-stage embryo transfer. The rationale for blastocyst-stage transfer is to improve both uterine and embryonic synchronicity and enable self selection of viable embryos, thus resulting in better live birth rates. OBJECTIVES To determine whether blastocyst-stage (day 5 to 6) embryo transfer improves the live birth rate (LBR) per fresh transfer, and other associated outcomes, compared with cleavage-stage (day 2 to 3) embryo transfer. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL, from inception to October 2021. We also searched registers of ongoing trials and the reference lists of studies retrieved. SELECTION CRITERIA We included randomised controlled trials (RCTs) which compared the effectiveness of IVF with blastocyst-stage embryo transfer versus IVF with cleavage-stage embryo transfer. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Our primary outcomes were LBR per fresh transfer and cumulative clinical pregnancy rates (cCPR). Secondary outcomes were clinical pregnancy rate (CPR), multiple pregnancy, high-order multiple pregnancy, miscarriage (all following first embryo transfer), failure to transfer embryos, and whether supernumerary embryos were frozen for transfer at a later date (frozen-thawed embryo transfer). We assessed the overall quality of the evidence for the main comparisons using GRADE methods. MAIN RESULTS We included 32 RCTs (5821 couples or women). The live birth rate following fresh transfer was higher in the blastocyst-stage transfer group (odds ratio (OR) 1.27, 95% confidence interval (CI) 1.06 to 1.51; I2 = 53%; 15 studies, 2219 women; low-quality evidence). This suggests that if 31% of women achieve live birth after fresh cleavage-stage transfer, between 32% and 41% would do so after fresh blastocyst-stage transfer. We are uncertain whether blastocyst-stage transfer improves the cCPR. A post hoc analysis showed that vitrification could increase the cCPR. This is an interesting finding that warrants further investigation when more studies using vitrification are published. The CPR was also higher in the blastocyst-stage transfer group, following fresh transfer (OR 1.25, 95% CI 1.12 to 1.39; I2 = 51%; 32 studies, 5821 women; moderate-quality evidence). This suggests that if 39% of women achieve a clinical pregnancy after fresh cleavage-stage transfer, between 42% and 47% will probably do so after fresh blastocyst-stage transfer. We are uncertain whether blastocyst-stage transfer increases multiple pregnancy (OR 1.05, 95% CI 0.83 to 1.33; I2 = 30%; 19 studies, 3019 women; low-quality evidence) or miscarriage rates (OR 1.12, 95% CI 0.90 to 1.38; I2 = 24%; 22 studies, 4208 women; low-quality evidence). This suggests that if 9% of women have a multiple pregnancy after fresh cleavage-stage transfer, between 8% and 12% would do so after fresh blastocyst-stage transfer. However, a sensitivity analysis restricted only to studies with low or 'some concerns' for risk of bias, in the subgroup of equal number of embryos transferred, showed that blastocyst transfer probably increases the multiple pregnancy rate. Embryo freezing rates (when there are frozen supernumerary embryos for transfer at a later date) were lower in the blastocyst-stage transfer group (OR 0.48, 95% CI 0.40 to 0.57; I2 = 84%; 14 studies, 2292 women; low-quality evidence). This suggests that if 60% of women have embryos frozen after cleavage-stage transfer, between 37% and 46% would do so after blastocyst-stage transfer. Failure to transfer any embryos was higher in the blastocyst transfer group (OR 2.50, 95% CI 1.76 to 3.55; I2 = 36%; 17 studies, 2577 women; moderate-quality evidence). This suggests that if 1% of women have no embryos transferred in planned fresh cleavage-stage transfer, between 2% and 4% probably have no embryos transferred in planned fresh blastocyst-stage transfer. The evidence was of low quality for most outcomes. The main limitations were serious imprecision and serious risk of bias, associated with failure to describe acceptable methods of randomisation. AUTHORS' CONCLUSIONS There is low-quality evidence for live birth and moderate-quality evidence for clinical pregnancy that fresh blastocyst-stage transfer is associated with higher rates of both than fresh cleavage-stage transfer. We are uncertain whether blastocyst-stage transfer improves the cCPR derived from fresh and frozen-thawed cycles following a single oocyte retrieval. Although there is a benefit favouring blastocyst-stage transfer in fresh cycles, more evidence is needed to know whether the stage of transfer impacts on cumulative live birth and pregnancy rates. Future RCTs should report rates of live birth, cumulative live birth, and miscarriage. They should also evaluate women with a poor prognosis to enable those undergoing assisted reproductive technology (ART) and service providers to make well-informed decisions on the best treatment option available.
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Affiliation(s)
- Demián Glujovsky
- Reproductive Medicine, CEGYR (Centro de Estudios en Genética y Reproducción), Buenos Aires, Argentina
| | - Andrea Marta Quinteiro Retamar
- Eggs donation program - Genetics unit, CEGYR (Centro de Estudios en Ginecologia y Reproducción), Buenos Aires, Argentina
| | | | - Agustín Ciapponi
- Argentine Cochrane Centre, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Simone Cornelisse
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
| | - Deborah Blake
- Repromed Fertility Specialists, Auckland, New Zealand
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3
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Nie Y, Qiao X, Li S, Pan Z, Zhang J, Xu L. Dichorionic quadruplet pregnancy comprising monozygotic triplets and singleton after intracytoplasmic sperm injection and transfer of two fresh embryos: a case report. J Int Med Res 2022; 50:3000605221075506. [PMID: 35118888 PMCID: PMC8819775 DOI: 10.1177/03000605221075506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Monozygotic triplet pregnancies are very rare in assisted reproductive
technology, and the relationship between monozygotic multiple pregnancies and
several assisted reproductive techniques, including blastocyst transfer, remains
unclear. Here, the case of a 28-year-old female patient with dichorionic
quadruplet pregnancy following intracytoplasmic sperm injection and transfer of
two day-3 fresh embryos, without assisted hatching, is reported. At 7 weeks
following embryo transfer, the dichorionic quadruplet pregnancy, comprising
monozygotic monochorionic triamniotic (MCTA) triplets plus a singleton, was
detected by a transabdominal ultrasound scan. After counselling, the patient
underwent selective reduction of the MCTA triplet pregnancy at 7 weeks after
embryo transfer. The remaining singleton pregnancy was uneventful, resulting in
a live birth at 38+ weeks. As the predictors of monozygotic multiple
gestations remain poorly characterized, clinicians and patients should give
great consideration to the risks associated with monozygotic multiple
pregnancies, even if the patient has not undergone blastocyst transfer.
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Affiliation(s)
- Ying Nie
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Joint Laboratory for Reproductive Medicine of Sichuan University-The Chinese University of Hong Kong, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Xiaoyong Qiao
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Joint Laboratory for Reproductive Medicine of Sichuan University-The Chinese University of Hong Kong, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Sicong Li
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Joint Laboratory for Reproductive Medicine of Sichuan University-The Chinese University of Hong Kong, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Zhuo Pan
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Joint Laboratory for Reproductive Medicine of Sichuan University-The Chinese University of Hong Kong, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Jing Zhang
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Joint Laboratory for Reproductive Medicine of Sichuan University-The Chinese University of Hong Kong, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
| | - Liangzhi Xu
- Department of Obstetrics and Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,Reproductive Endocrinology and Regulation Laboratory, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China.,The Joint Laboratory for Reproductive Medicine of Sichuan University-The Chinese University of Hong Kong, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu, Sichuan, China
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4
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Kelly AG, Blakemore JK, McCaffrey C, Grifo JA. Evaluation of clinical parameters as predictors of monozygotic twins after single frozen embryo transfer. F S Rep 2021; 2:428-432. [PMID: 34934983 PMCID: PMC8655405 DOI: 10.1016/j.xfre.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 10/25/2022] Open
Abstract
Objective To determine if recent evolutions in laboratory protocols, including the increased use of natural cycles and the use of a hyaluronan-containing transfer medium, affected the rate of monozygotic twin (MZT) pregnancies after single frozen embryo transfer (FET). Design Retrospective cohort study. Setting Urban university-based fertility center. Patients Patients who underwent single FET between January 2016 and December 2018 resulting in an intrauterine pregnancy. Interventions Transition to a transfer protocol with a hyaluronan-containing transfer medium in July 2017. Main Outcome Measures Number of MZT pregnancies. Results There were 1,619 cycles that met the inclusion criteria and 31 (1.9%) resulted in MZT pregnancies. A hyaluronan-containing transfer medium was used in 875 (54.1%) cycles. Programmed cycles were used for 1,385 (85.5%) FETs and 234 (14.5%) cycles were natural. The mean age at FET, oocyte age, endometrial echo thickness, inner cell mass grade, trophectoderm grade, expansion, and day of blastocyst vitrification were similar between the groups. The use of a hyaluronan-containing transfer medium resulted in fewer MZTs. After controlling potential confounders with a multivariate regression, the use of the hyaluronan-containing medium still resulted in fewer MZTs. Monozygotic twins were colinear with preimplantation genetic testing (PGT), so PGT was excluded as a variable in our regression. A regression of PGT only cycles showed that the use of the hyaluronan-containing medium was still associated with a reduction in MZT pregnancies. Conclusions The use of a hyaluronan-containing transfer medium was associated with a lower rate of MZTs. Other clinical parameters, including cycle type, were not associated with changes in the number of MZTs. The use of PGT needs to be further investigated as a risk factor for MZTs.
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Affiliation(s)
- Amelia G Kelly
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, New York, New York
| | - Jennifer K Blakemore
- Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, New York
| | - Caroline McCaffrey
- Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, New York
| | - James A Grifo
- Division of Reproductive Endocrinology and Infertility, New York University Langone Fertility Center, New York, New York
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5
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Maternal age is associated with embryo splitting after single embryo transfer: a retrospective cohort study. J Assist Reprod Genet 2020; 38:79-83. [PMID: 33098038 DOI: 10.1007/s10815-020-01988-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine whether maternal age has an impact on monozygotic twinning (MZT) rates in women undergoing single embryo transfer (SET). METHODS This is a retrospective cohort study analyzed for the incidence of MZT of all clinical pregnancies after a single embryo transfer was carried out between 2014 and 2018. The effect of different assisted reproductive technology (ART) parameters on the incidence of MZT was evaluated. RESULTS There were a total of 8459 cycles resulting in pregnancy during the study period. Of these pregnancies, 8236 were singletons and 223 were MZT. The preterm birth rate, miscarriage rate, and cesarean section rate were higher in MZT. Birth weight and gestational age at delivery were lower and smaller. In the univariate analysis, the risk of MZT was decreased with frozen embryo transfer (ET). A nonlinear relationship was observed between maternal age and MZT. A negative relationship between maternal age and MZT was observed in the patients' age ≥ 36 years. CONCLUSION Advanced maternal age was associated with a lower rate of MZT. A threshold female age of 36 years existed for lower MZT.
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Liu X, Li P, Shi J. Double trouble? Impact of frozen embryo transfer on the monozygotic twinning rate: a retrospective cohort study from 8459 cycles. J Assist Reprod Genet 2020; 37:3051-3056. [PMID: 33083861 DOI: 10.1007/s10815-020-01985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To compare monozygotic twinning (MZT) rates in patients undergoing fresh embryo transfer (ET) and frozen embryo transfer. METHODS All clinical pregnancies after single ET carried out in our IVF center between 2014 and 2018 (n = 8459) were retrospectively analyzed for the incidence of MZT. MZT rate was compared in women who underwent fresh ET (n = 3876) and frozen ET (n = 4583). RESULTS There was a total of 120 MZT identified in the fresh ET group (3.10%) and 103 MZT in the frozen ET group (2.25%), which was significant (p = 0.015). In the univariate analysis, the risk of MZT was decreased with frozen embryo transfer (OR 0.72; 95% CI, 0.55-0.94, p = 0.016) and increased with mild stimulation protocol in the fresh cycle (OR 1.90; 95% CI, 1.04-3.45, p = 0.036). Multivariable logistic regression revealed that frozen embryo transfer was associated with a significant decrease risk of MZT (adjusted OR 0.66; 95% CI, 0.46-0.90, p = 0.011). CONCLUSIONS Frozen ET is associated with a lower risk of MZT.
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Affiliation(s)
- Xitong Liu
- The Assisted Reproduction Center, The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Ping Li
- The Assisted Reproduction Center, The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Juanzi Shi
- The Assisted Reproduction Center, The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China.
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Monochorionic Triplet Gestation after Single Blastocyst Transfer Using Donor Oocytes: Case Report and Review. Case Rep Obstet Gynecol 2020; 2020:4340617. [PMID: 32774958 PMCID: PMC7407061 DOI: 10.1155/2020/4340617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/05/2020] [Indexed: 11/18/2022] Open
Abstract
We report a case of a 43-year-old patient with a monochorionic triamniotic triplet pregnancy after IVF with donor oocytes. After failed IVF attempts, the patient chose to undergo treatment with donor oocytes. Her 22-year-old oocyte donor underwent standard controlled ovarian hyperstimulation. The retrieved oocytes were fertilized in vitro, and one embryo was transferred at the blastocyst stage. At 6 weeks and 5 days of gestation, an ultrasound revealed monochorionic triamniotic (MCTA) triplets. The risk of monozygotic twinning in women undergoing in vitro fertilization (IVF) is reported to be higher than that in natural conception, although the causes of the phenomenon have not yet been clarified. Efforts still must be made in order to prevent monozygotic multiple pregnancies, associated with much greater chances of obstetric and perinatal morbidity and mortality.
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Monoamniotic twin pregnancy following the transfer of a single blastocyst resulting from intracytoplasmic sperm injection of a single oocyte: a case report. ZYGOTE 2020; 28:344-348. [PMID: 32297587 DOI: 10.1017/s0967199420000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this report we present an unusual case of a couple who achieved a twin pregnancy by intracytoplasmic sperm injection (ICSI) with a single immature oocyte retrieved. The oocyte was at metaphase I at 39 h post human chorionic gonadotrophin (hCG) administration, which is our standard ICSI time. Extended culture allowed the extrusion of the polar body, and sperm injection was performed at 43 h post-trigger. The fertilized egg underwent embryo biopsy on day 3 and preimplantation genetic assessment for three chromosomes (X, Y and 21). The embryo remained in culture until day 5. Later, the biopsy results reported a transferable embryo, which was replaced to the uterine cavity at blastocyst stage. Pregnancy test gave a positive β-hCG result, and the 6 weeks' scan, performed to confirm the fetal heart, revealed the presence of one amniotic sac and two fetal heartbeats, which currently have been so far eventless and smooth, ongoing at 18 weeks of gestation.
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Busnelli A, Dallagiovanna C, Reschini M, Paffoni A, Fedele L, Somigliana E. Risk factors for monozygotic twinning after in vitro fertilization: a systematic review and meta-analysis. Fertil Steril 2019; 111:302-317. [PMID: 30691632 DOI: 10.1016/j.fertnstert.2018.10.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/21/2018] [Accepted: 10/25/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To establish the risk factors for monozygotic twin (MZT) and monochorionic twin (MCT) pregnancies after in vitro fertilization (IVF). DESIGN Systematic review and meta-analysis. SETTING Not applicable. PATIENT(S) Women who achieved MZT and non-MZT pregnancies through IVF. INTERVENTION(S) Systematic search of Medline from January 1995 to October 2018 with cross-checking of references from relevant articles in English. MAIN OUTCOME MEASURE(S) Possible risk factors for MZT or MCT pregnancies after IVF, comprising extended embryo culture, insemination method (conventional IVF and intracytoplasmic sperm injection [ICSI]), embryo biopsy for preimplantation genetic testing for aneuploidies or for monogenic/single-gene defects (PGT-A or PGT-M) programs, assisted hatching (AH), oocytes donation, female age, and embryo cryopreservation. RESULT(S) A total of 40 studies were included. Blastocyst transfer compared with cleavage-stage embryo transfer, and female age <35 years were associated with a statistically significant increase in the MZT and MCT pregnancy rate after IVF: (23 studies, OR 2.16, 95% CI, 1.74-2.68, I2=78%; 4 studies, OR 1.29; 95% CI, 1.03-1.62, I2=62%; and 3 studies, OR 1.90, 95% CI, 1.21-2.98, I2=59%; 2 studies, OR 2.34; 95% CI, 1.69-3.23, I2=0, respectively). Conventional IVF compared with ICSI and assisted hatching were associated with a statistically significantly increased risk of MZT pregnancy (9 studies, OR 1.19, 95% CI, 1.04-1.35, I2=0; 16 studies, OR 1.17, 95% CI, 1.09-1.27, I2=29%, respectively). Embryo biopsy for PGT-A or PGT-M, embryo cryopreservation, and oocytes donation were not associated with MZT pregnancies after IVF. CONCLUSION(S) Blastocyst transfer is associated with an increased risk of both MZT and MCT pregnancies after IVF. Further evidence is needed to clarify the impact of female age, insemination method and AH on the investigated outcomes.
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Affiliation(s)
- Andrea Busnelli
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy.
| | - Chiara Dallagiovanna
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Reschini
- Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Paffoni
- ART Unit, Azienda Socio Sanitaria Territoriale Lariana, Como, Italy
| | - Luigi Fedele
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy; Dipartimento per la Salute della Donna, del Bambino e del Neonato, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
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10
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Hattori H, Kitamura A, Takahashi F, Kobayashi N, Sato A, Miyauchi N, Nishigori H, Mizuno S, Sakurai K, Ishikuro M, Obara T, Tatsuta N, Nishijima I, Fujiwara I, Kuriyama S, Metoki H, Yaegashi N, Nakai K, Arima T. The risk of secondary sex ratio imbalance and increased monozygotic twinning after blastocyst transfer: data from the Japan Environment and Children's Study. Reprod Biol Endocrinol 2019; 17:27. [PMID: 30795788 PMCID: PMC6387559 DOI: 10.1186/s12958-019-0471-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Some studies have suggested that blastocyst transfer is associated with i) imbalance in the secondary sex ratio (SSR) (which favors male offspring), ii) increased incidence of monozygotic twins (MZT). In contrast, others have not found these changes. In this study, we evaluated the association between blastocyst transfer and SSR and MZT, considering potential parental confounders. METHODS The Japan Environment and Children's Study is a large, nationwide longitudinal birth cohort study funded by the Ministry of the Environment of Japan. We used this large dataset, including 103,099 pregnancies, to further investigate the association between blastocyst transfer, SSR and MZT, using spontaneously conceived pregnancies, non-assisted reproductive technology (non-ART) treatment (intrauterine insemination and ovulation induction with timed intercourse) and cleavage stage embryo transfer for comparison. We evaluated the association with each group, the SSR, and the frequency of MZT, calculating the adjusted odds ratio (AOR) using multivariable logistic regression analyses, adjusting for potential parental confounders such as basic health and socioeconomic status. RESULTS For each group (spontaneous conception vs. non-ART treatment vs. cleavage stage embryo transfer vs. blastocyst transfer), the percentages of males were 51.3% vs 50.7% vs 48.9% vs 53.4% and the monozygotic twinning rates per pregnancy were 0.27% vs 0.11% vs 0.27% vs 0.99% respectively. Multivariate logistic regression analyses indicated that blastocyst transfer was significantly associated with a higher SSR and higher incidence of MZT than the other three groups (SSR: AOR 1.095, 95% CI1.001-1.198; MZT: AOR 4.229, 95% CI 2.614-6.684). CONCLUSIONS There are significant relationships between blastocyst transfer and SSR imbalance and a higher occurrence of MZT.
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Affiliation(s)
- Hiromitsu Hattori
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Akane Kitamura
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Fumiaki Takahashi
- 0000 0001 2248 6943grid.69566.3aClinical Reseach, Innovation and Education Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Norio Kobayashi
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Akiko Sato
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Naoko Miyauchi
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Hidekazu Nishigori
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDepartment of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Satoshi Mizuno
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Kasumi Sakurai
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Mami Ishikuro
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Taku Obara
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDepartment of Pharmacy, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Nozomi Tatsuta
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Ichiko Nishijima
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Ikuma Fujiwara
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Shinichi Kuriyama
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDivision of Disaster Public Health, International Research Institute for Disaster Science, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Hirohito Metoki
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDepartment of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Nobuo Yaegashi
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDepartment of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aTohoku Medical Megabank Organization, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Kunihiko Nakai
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
| | - Takahiro Arima
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8573 Japan
- 0000 0001 2248 6943grid.69566.3aDepartment of Informative Genetics, Environment and Genome Research Center, Tohoku University Graduate School of Medicine, 2-1 Seiryo-cho, Aoba-ku, Sendai, 980-8575 Japan
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Hviid KVR, Malchau SS, Pinborg A, Nielsen HS. Determinants of monozygotic twinning in ART: a systematic review and a meta-analysis. Hum Reprod Update 2019. [PMID: 29538675 DOI: 10.1093/humupd/dmy006] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The incidence of monozygotic twins (MZT) after ART appears to be higher than the incidence after spontaneous conceptions contradicting the aim of ART to avoid multiple pregnancies because of the associated risks. OBJECTIVE AND RATIONALE The aim was to study the frequency of MZT after IVF and ICSI and how it is influenced by the day of embryo transfer, maternal age, zona pellucida manipulation, controlled ovarian stimulation, stimulation protocol, culture media and embryo quality. SEARCH METHODS Original studies and reviews were identified by searching the PubMed, Embase and Cochrane databases up to March 2017. The inclusion criterion was publications focusing on the five study questions related to MZT in our study. The exclusion criteria were articles that did not include blastocyst transfer, were on non-humans, were not published in peer-reviewed journals, and were based only on case studies. All of the articles were categorized according to the Oxford Centre for Evidence-based Medicine's 'Levels of Evidence', and quality and risk of bias assessment was performed with 'The Cochrane Collaboration's Risk of Bias Tools'. A meta-analysis was performed to study the impact of the day of embryo transfer on the MZT rate. OUTCOMES The literature search resulted in a total of 42 articles, including 38 original studies, for analysis. The included original studies reported a MZT rate with blastocyst transfer from zero to 13.2%. Our meta-analysis found a higher frequency of MZT after blastocyst transfer compared with cleavage-stage embryos transfer: odds ratio = 2.18, 95% CI: 1.93-2.48 (fixed effect meta-analysis). A younger maternal age may increase the MZT rate, and recent studies regarding the use of zona pellucida manipulating techniques have disagreed with the previous suspicion of a higher MZT rate after the use of these methods. The extended culture to-blastocyst stage is a potential risk factor for MZT, but it is uncertain whether this phenomenon is due to the extended time, culture media or greater likelihood of younger oocytes to reach the blastocyst stage. An increased frequency of MZT following the GnRH-agonist suppression protocol has been suggested, as well as a decreased frequency of MZT with high gonadotrophin doses, which could reflect an age-related effect. Only limited literature has focused on the role of embryo morphology in the MZT rate, therefore, this issue remains unresolved. WIDER IMPLICATIONS We found blastocyst transfer to be a risk factor for MZT. Hence, the results of this meta-analysis may weaken the previously proposed view that greater experience with blastocyst transfer and improved culture media could decrease the high rate of MZT after blastocyst transfer. To minimize the rate of MZT and the associated complications, the mechanisms underlying blastocyst transfer and MZT pregnancy must be elucidated.
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Affiliation(s)
- Kathrine Vauvert R Hviid
- Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen Ø, Denmark
| | - Sara Sofia Malchau
- Fertility Clinic, Hvidovre Hospital, Copenhagen University Hospital, Kettegaard Alle 30, Hvidovre, Denmark
| | - Anja Pinborg
- Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen Ø, Denmark
| | - Henriette Svarre Nielsen
- Fertility Clinic 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen Ø, Denmark
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Sundaram V, Ribeiro S, Noel M. Multi-chorionic pregnancies following single embryo transfer at the blastocyst stage: a case series and review of the literature. J Assist Reprod Genet 2018; 35:2109-2117. [PMID: 30362060 DOI: 10.1007/s10815-018-1329-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/02/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To report cases of in vitro fertilization-frozen embryo transfer (IVF-FET) with single blastocyst transfer resulting in di- or tri-chorionic pregnancies, and to review the literature on monozygotic, multi-chorionic pregnancies originating at the blastocyst stage. DESIGN Retrospective case series and literature review. MATERIALS AND METHODS All in vitro fertilization cycles (fresh, frozen, autologous, and donor oocyte) performed between June 2012 and June 2017 at the University of California, San Francisco Center for Reproductive Health, were reviewed retrospectively. Cycles with cleavage-stage embryos or transfer of more than one blastocyst were excluded. Cycles were analyzed to determine if clinical pregnancy occurred with the presence of two or more gestational sacs noted on initial ultrasound. An in-depth chart review was performed with further exclusions applied that would lend credence to dizygosity rather than monozygosity such as fetal/neonatal sex discordance, fresh embryo transfer, and natural cycle FET (in which concomitant spontaneous pregnancy could have occurred). Demographic, clinical and IVF-FET cycle characteristics of the resulting patients were collected. Additionally, a review of the English language literature was performed (PUBMED, PMC) using the search words monozygotic twins, dichorionic diamniotic, in vitro fertilization, and single embryo transfer in order to identify cases of DC-DA monozygotic twinning from 1978 to 2017. Resulting articles were reviewed to eliminate all cases of dizygosity and day 3 embryo transfers. We obtained the following data from the literature search: basic patient demographics, type of fertilization, type and day of embryo transferred, number of embryos transferred, gestational ultrasound details, presence of any genetic testing if performed after delivery, and number of live births. RESULT(S) Two thousand four hundred thirty-four women underwent fresh or frozen single embryo transfer between June 2012 and June 2017 at the University of California, San Francisco Center for Reproductive Health. Of these, 11 women underwent a single blastocyst transfer with subsequent clinical pregnancies identified as multi-chorionic gestations. Four were in downregulated controlled FET cycles, in which concomitant spontaneous pregnancy could not have been possible. We then reviewed all cases of monozygotic dichorionic-diamniotic (DC-DA) splitting in IVF patients reported in the literature from 1978 to 2017. These eight cases demonstrate monozygotic splitting after the blastocyst stage, which challenges the existing dogma that only monochorionic twins can develop after day 3 post-fertilization. CONCLUSION(S) The accepted theory of monozygotic twinning resulting from the splitting of an embryo per a strict post-fertilization timing protocol must be re-examined with the advent of observed multi-chorionic pregnancies resulting from single blastocyst transfer in the context of IVF.
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Affiliation(s)
- Viji Sundaram
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA.
| | - Salustiano Ribeiro
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA
| | - Martha Noel
- University of California, San Francisco, 499 Illinois St, San Francisco, CA, 94158, USA
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Ding J, Yin T, Zhang Y, Zhou D, Yang J. The effect of blastocyst transfer on newborn sex ratio and monozygotic twinning rate: an updated systematic review and meta-analysis. Reprod Biomed Online 2018; 37:292-303. [PMID: 30314884 DOI: 10.1016/j.rbmo.2018.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 05/15/2018] [Accepted: 05/22/2018] [Indexed: 12/20/2022]
Abstract
RESEARCH QUESTION Is blastocyst transfer (BT) associated with a higher offspring secondary sex ratio and monozygotic twinning (MZT)? DESIGN A systematic search of PubMed/MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar databases was carried out for studies published between 1995 and May 2017 using relevant keywords and a meta-analysis performed on selected studies. The analysis was performed using Stata 12.0; odds ratios (OR) and 95% confidence intervals (CI) were used to assess the results for binary studies. Subgroup analyses and meta-regression were also conducted. RESULTS Twenty-six studies published between 2001 and May 2017 (sex ratio: 13, MZT: 12, and both sex ratio and MZT: 1) were identified. The analysis showed a significantly higher M/F ratio at birth (OR = 0.89, 95% CI: 0.86 to 0.93, I2 = 19.8%) and a higher risk of MZT (OR = 0.37, 95% CI: 0.22 to 0.60, I2 = 75.2%) after BT compared with cleavage-stage embryo transfer (CT). Furthermore, a subgroup analysis was performed based on studies published after 2009; results were found to be consistent with the 2009 meta-analysis. CONCLUSIONS This meta-analysis provides an update and stronger evidence to support the observation that BT is associated with a higher proportion of males and an increased risk of MZT. In clinical practice, these BT-associated neonatal outcomes should be taken into account when counselling infertility patients.
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Affiliation(s)
- Jinli Ding
- Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina; Hubei Clinic Research Centre for Assisted Reproductive Technology and Embryonic DevelopmentWuhanChina
| | - Tailang Yin
- Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina; Hubei Clinic Research Centre for Assisted Reproductive Technology and Embryonic DevelopmentWuhanChina
| | - Yi Zhang
- Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina; Hubei Clinic Research Centre for Assisted Reproductive Technology and Embryonic DevelopmentWuhanChina
| | - Danni Zhou
- Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina; Hubei Clinic Research Centre for Assisted Reproductive Technology and Embryonic DevelopmentWuhanChina
| | - Jing Yang
- Reproductive Medical CentreRenmin Hospital of Wuhan UniversityWuhanChina; Hubei Clinic Research Centre for Assisted Reproductive Technology and Embryonic DevelopmentWuhanChina.
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Liu H, Liu J, Chen S, Kang X, Du H, Li L. Elevated incidence of monozygotic twinning is associated with extended embryo culture, but not with zona pellucida manipulation or freeze-thaw procedure. Fertil Steril 2018; 109:1044-1050. [DOI: 10.1016/j.fertnstert.2018.01.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 01/08/2018] [Accepted: 01/28/2018] [Indexed: 11/29/2022]
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Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev 2016:CD002118. [PMID: 27357126 DOI: 10.1002/14651858.cd002118.pub5] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Advances in cell culture media have led to a shift in in vitro fertilisation (IVF) practice from cleavage stage embryo transfer to blastocyst stage transfer. The rationale for blastocyst transfer is to improve both uterine and embryonic synchronicity and enable self selection of viable embryos, thus resulting in better live birth rates. OBJECTIVES To determine whether blastocyst stage (day 5 to 6) embryo transfers improve the live birth rate, and other associated outcomes, compared with cleavage stage (day 2 to 3) embryo transfers. SEARCH METHODS We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library; 2016, Issue 4), MEDLINE, EMBASE, PsycINFO, CINAHL, and Bio extracts from inception to 4th April 2016. We also searched registers of ongoing trials and the reference lists of studies retrieved. SELECTION CRITERIA We included randomised controlled trials (RCTs) which compared the effectiveness of blastocyst versus cleavage stage transfers. DATA COLLECTION AND ANALYSIS We used standard methodological procedures recommended by Cochrane. Our primary outcomes were live birth and cumulative clinical pregnancy rates. Secondary outcomes were clinical pregnancy, multiple pregnancy, high order pregnancy, miscarriage, failure to transfer embryos, and embryo freezing. We assessed the overall quality of the evidence for the main comparisons using GRADE methods. MAIN RESULTS We included 27 RCTs (4031 couples or women).The live birth rate following fresh transfer was higher in the blastocyst transfer group (odds ratio (OR) 1.48, 95% confidence interval (CI) 1.20 to 1.82; 13 RCTs, 1630 women, I(2) = 45%, low quality evidence) following fresh transfer. This suggests that if 29% of women achieve live birth after fresh cleavage stage transfer, between 32% and 42% would do so after fresh blastocyst stage transfer.There was no evidence of a difference between the groups in rates per couple of cumulative pregnancy following fresh and frozen-thawed transfer after one oocyte retrieval (OR 0.89, 95% CI 0.64 to 1.22; 5 RCTs, 632 women, I(2) = 71%, very low quality evidence).The clinical pregnancy rate was also higher in the blastocyst transfer group, following fresh transfer (OR 1.30, 95% CI 1.14 to 1.47; 27 RCTs, 4031 women, I(2) = 56%, moderate quality evidence). This suggests that if 36% of women achieve clinical pregnancy after fresh cleavage stage transfer, between 39% and 46% would do so after fresh blastocyst stage transfer.There was no evidence of a difference between the groups in rates of multiple pregnancy (OR 1.05, 95% CI 0.83 to 1.33; 19 RCTs, 3019 women, I(2) = 30%, low quality evidence), or miscarriage (OR 1.15, 95% CI 0.88 to 1.50; 18 RCTs, 2917 women, I(2) = 0%, low quality evidence). These data are incomplete as under 70% of studies reported these outcomes.Embryo freezing rates were lower in the blastocyst transfer group (OR 0.48, 95% CI 0.40 to 0.57; 14 RCTs, 2292 women, I(2) = 84%, low quality evidence). This suggests that if 60% of women have embryos frozen after cleavage stage transfer, between 37% and 46% would do so after blastocyst stage transfer. Failure to transfer any embryos was higher in the blastocyst transfer group (OR 2.50, 95% CI 1.76 to 3.55; 17 RCTs, 2577 women, I(2) = 36%, moderate quality evidence). This suggests that if 1% of women have no embryos transferred in (planned) fresh cleavage stage transfer, between 2% and 4% will have no embryos transferred in (planned) fresh blastocyst stage transfer.The evidence was of low quality for most outcomes. The main limitation was serious risk of bias, associated with failure to describe acceptable methods of randomisation, and unclear or high risk of attrition bias. AUTHORS' CONCLUSIONS There is low quality evidence for live birth and moderate quality evidence for clinical pregnancy that fresh blastocyst stage transfer is associated with higher rates than fresh cleavage stage transfer. There was no evidence of a difference between the groups in cumulative pregnancy rates derived from fresh and frozen-thawed cycles following a single oocyte retrieval, but the evidence for this outcome was very low quality. Thus, although there is a benefit favouring blastocyst transfer in fresh cycles, it remains unclear whether the day of transfer impacts on cumulative live birth and pregnancy rates. Future RCTs should report rates of live birth, cumulative live birth, and miscarriage to enable couples or women undergoing assisted reproductive technology (ART) and service providers to make well informed decisions on the best treatment option available.
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Affiliation(s)
- Demián Glujovsky
- Reproductive Medicine, CEGYR (Centro de Estudios en Genética y Reproducción), Viamonte 1432,, Buenos Aires, Argentina
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Eight-Shaped Hatching Increases the Risk of Inner Cell Mass Splitting in Extended Mouse Embryo Culture. PLoS One 2015; 10:e0145172. [PMID: 26680631 PMCID: PMC4682972 DOI: 10.1371/journal.pone.0145172] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022] Open
Abstract
Increased risk of monozygotic twinning (MZT) has been shown to be associated with assisted reproduction techniques, particularly blastocyst culture. Interestingly, inner cell mass (ICM) splitting in human ‘8’-shaped hatching blastocysts that resulted in MZT was reported. However, the underlying cause of MZT is not known. In this study, we investigated in a mouse model whether in vitro culture leads to ICM splitting and its association with hatching types. Blastocyst hatching was observed in: (i) in vivo developed blastocysts and (ii–iii) in vitro cultured blastocysts following in vivo or in vitro fertilization. We found that ‘8’-shaped hatching occurred with significantly higher frequency in the two groups of in vitro cultured blastocysts than in the group of in vivo developed blastocysts (24.4% and 20.4% versus 0.8%, respectively; n = 805, P < 0.01). Moreover, Oct4 immunofluorescence staining was performed to identify the ICM in the hatching and hatched blastocysts. Scattered and split distribution of ICM cells was observed around the small zona opening of ‘8’-shaped hatching blastocysts. This occurred at a high frequency in the in vitro cultured groups. Furthermore, we found more double OCT4-positive masses, suggestive of increased ICM splitting in ‘8’-shaped hatching and hatched blastocysts than in ‘U’-shaped hatching and hatched blastocysts (12.5% versus 1.9%, respectively; n = 838, P < 0.01). Therefore, our results demonstrate that extended in vitro culture can cause high frequencies of ‘8’-shaped hatching, and ‘8’-shaped hatching that may disturb ICM herniation leading to increased risk of ICM splitting in mouse blastocysts. These results may provide insights into the increased risk of human MZT after in vitro fertilization and blastocyst transfer.
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Thomas A, Balakrishnan BK, Batra M, Kuriakose RR, Gopinathan KK. Conjoined Twins Following Assisted Reproduction Technique. JOURNAL OF FETAL MEDICINE 2015. [DOI: 10.1007/s40556-015-0069-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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18
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Monochorionic quadramniotic and triamniotic pregnancies following single embryo transfers: two case reports and a review of the literature. J Assist Reprod Genet 2015; 33:27-32. [PMID: 26564016 PMCID: PMC4717140 DOI: 10.1007/s10815-015-0611-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
Purpose The purpose of this study is to report two cases of monozygotic quadruplet and triplet pregnancies following single embryo transfer (ET). Methods A 29-year-old woman and a 34-year-old woman underwent ART treatment in two affiliated University based ART units. The first woman underwent ICSI with day 3 embryo biopsy for pre-implantation genetic diagnosis (PGD) followed by day 4 transfer, which resulted in a monochorionic quadramniotic (MCQA) quadruplet pregnancy. The second woman underwent conventional IVF with transfer of a single blastocyst, which resulted in a monochorionic triamniotic (MCTA) triplet pregnancy. Results The first patient underwent successful selective foetal reduction at 16 + 3 and 17 + 4 weeks of gestation. Two healthy twin girls were delivered by elective caesarean section at 35 + 6 weeks of gestation. The second patient underwent successful selective foetal reduction at 14 + 1 weeks of gestation. The remaining monochorionic diamniotic (MCDA) twins are well at the time of writing this article. Conclusions To our knowledge, these cases represent the first case of viable MCQA pregnancy following single ET in the world and the third case of a viable MCTA pregnancy following conventional IVF with single ET. Several factors including blastocyst stage transfer and zona pellucida manipulation have been thought to contribute to monozygotic twinning in the context of ART. These two cases add to the growing literature of monozygotic multiple pregnancies following ART.
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Gurunath S, Makam A, Vinekar S, Biliangady RH. Monochorionic triamniotic triplets following conventional in vitro fertilization and blastocyst transfer. J Hum Reprod Sci 2015; 8:54-7. [PMID: 25838751 PMCID: PMC4381385 DOI: 10.4103/0974-1208.153131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/11/2015] [Accepted: 03/05/2015] [Indexed: 11/04/2022] Open
Abstract
Multiple pregnancy in in vitro fertilization (IVF) is on the decline with a reduction in number of embryos transferred. But the risk of monozygotic splitting persists. The risk of monozygotic twinning in women undergoing IVF is reported to be twice that of natural conception, and monochorionic triplets are even rarer at 100 times more than natural conception. We report a case of monochorionic triamniotic (MCTA) triplets following conventional IVF and blastocyst transfer without zona manipulation. This report highlights the possibility of zygotic splitting in IVF in young couples with no family history, in centers with good experience with blastocyst transfer. MCTA triplets carry a high risk of perinatal mortality and morbidity and need multidisciplinary care. Prevention and prediction of zygotic splitting ought to be realized with better reporting and identification of possible risk factors.
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Affiliation(s)
- Sumana Gurunath
- Department of Reproductive Medicine, Cloudnine Hospitals, Malleshwaram, Karnataka, India
| | - Adinarayana Makam
- Department of Fetal Medicine, People Tree Hospitals, Bengaluru, Karnataka, India
| | - Sriprada Vinekar
- Department of Gynaecology, Cloudnine Hospitals, Malleshwaram, Karnataka, India
| | - Reeta H Biliangady
- Department of Reproductive Medicine, Cloudnine Hospitals, Malleshwaram, Karnataka, India
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Wu D, Huang SY, Wu HM, Chen CK, Soong YK, Huang HY. Monozygotic twinning after in vitro fertilization/intracytoplasmic sperm injection treatment is not related to advanced maternal age, intracytoplasmic sperm injection, assisted hatching, or blastocyst transfer. Taiwan J Obstet Gynecol 2014; 53:324-9. [DOI: 10.1016/j.tjog.2014.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2013] [Indexed: 10/24/2022] Open
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What makes them split? Identifying risk factors that lead to monozygotic twins after in vitro fertilization. Fertil Steril 2014; 102:82-9. [DOI: 10.1016/j.fertnstert.2014.03.039] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/06/2014] [Accepted: 03/18/2014] [Indexed: 11/22/2022]
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Osianlis T, Rombauts L, Gabbe M, Motteram C, Vollenhoven B. Incidence and zygosity of twin births following transfers using a single fresh or frozen embryo. Hum Reprod 2014; 29:1438-43. [DOI: 10.1093/humrep/deu064] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Nakasuji T, Saito H, Araki R, Nakaza A, Nakashima A, Kuwahara A, Ishihara O, Irahara M, Kubota T, Yoshimura Y, Sakumoto T. The incidence of monozygotic twinning in assisted reproductive technology: analysis based on results from the 2010 Japanese ART national registry. J Assist Reprod Genet 2014; 31:803-7. [PMID: 24722789 DOI: 10.1007/s10815-014-0225-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 03/17/2014] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To assess the incidence of monozygotic twinning (MZT) among cases undergoing assisted reproductive technology (ART) treatment. METHODS We performed a retrospective observational study and analyzed the data of patients who were registered in the national ART registry system of Japan from January to December 2010; only the data of patients with single embryo transfer (ET) were included. RESULTS Of 30,405 pregnancies, 425 resulted in MZT following fresh and frozenthawed ET. The MZT incidence among women undergoing ART was 1.4 %. Multiple logistic regression analysis indicated that cases undergoing fresh and frozen-thawed ET, blastocyst transfer had a significantly increased MZT rate (P < 0.01). Assisted hatching (AH) and frozen-thawed ET and maternal age did not significantly affect the MZT incidence. Of 8510 fresh ET pregnancies, 104 resulted in MZT. Multiple logistic regression analysis indicated that blastocyst transfer significantly increased the MZT rate in cases undergoing fresh ET. Ovarian stimulation, intracytoplasmic sperm injection, AH, and maternal age did not significantly affect the MZT incidence. CONCLUSIONS Blastocyst transfer was associated with an increased MZT incidence. We have to be aware of the potential risk of MZT caused by blastocyst transfer. However, further studies are required to assess the correlation among specific AH types, embryo culture conditions, and MZT incidence.
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Affiliation(s)
- Takashi Nakasuji
- Division of Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan,
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Luke B, Brown MB, Wantman E, Stern JE. Factors associated with monozygosity in assisted reproductive technology pregnancies and the risk of recurrence using linked cycles. Fertil Steril 2014; 101:683-9. [PMID: 24388206 PMCID: PMC3936194 DOI: 10.1016/j.fertnstert.2013.11.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 11/02/2013] [Accepted: 11/22/2013] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate factors associated with monozygosity (MZ) (number of fetal heartbeats on early ultrasound greater than the number of embryos transferred) and the risk of recurrence in subsequent pregnancies using a national assisted reproduction database. DESIGN Historical cohort study. SETTING Clinic-based data. PATIENT(S) 197,327 pregnancies (including 2,824 with evidence of MZ) from cycles reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) between 2004 and 2010. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Evidence of MZ, adjusted odds ratios and their 95% confidence intervals computed from logistic regression models. RESULT(S) In the univariate analysis, the risk of MZ was increased with ovulation disorders, donor oocytes, gonadotropin-releasing hormone agonist (GnRH-a) suppression, assisted hatching (AZH), and day 5-6 transfer, and was decreased with higher follicle-stimulating hormone (FSH) doses (≥3,000 IU). In the multivariate analysis, the risk of MZ was increased with GnRH-a suppression, AZH, and decreased with intracytoplasmic sperm injection (ICSI) and higher FSH dose. The interaction showed that although MZ was more likely with day 5-6 embryos, AZH had a minimal nonsignificant effect, whereas in day 2-3 embryos, AZH had a substantial statistically significant effect. Only one woman had a recurrence of MZ in a subsequent assisted reproduction pregnancy, which is consistent with randomness. CONCLUSION(S) The risk of MZ was higher with fresh day 5-6 embryos, donor oocytes, GnRH-a suppression, lower FSH doses, and AZH (particularly with day 2-3 embryos).
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Affiliation(s)
- Barbara Luke
- Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing, Michigan.
| | - Morton B Brown
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | | | - Judy E Stern
- Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Knopman JM, Krey LC, Oh C, Lee J, McCaffrey C, Noyes N. WITHDRAWN: What makes them split? Identifying risk factors that lead to monozygotic twins after in vitro fertilization. Fertil Steril 2013:S0015-0282(13)03019-7. [PMID: 24112530 DOI: 10.1016/j.fertnstert.2013.08.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/20/2013] [Accepted: 08/30/2013] [Indexed: 12/01/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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The Precise Timing of Embryo Splitting for Monozygotic Dichorionic Diamniotic Twins: When Does Embryo Splitting for Monozygotic Dichorionic Diamniotic Twins Occur? Evidence for Splitting at the Morula/Blastocyst Stage From Studies of In Vitro Fertilization. Twin Res Hum Genet 2013; 16:827-32. [DOI: 10.1017/thg.2013.32] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is a long-held credo, as illustrated in Langman's Medical Embryology (11th ed., Sadler, 2010), that dichorionic diamniotic (DD) twins develop after embryo splitting in the early stages of embryonic development. However, from our clinical experiences of the examination of data from single-embryo transfers in 16 fertility clinics in Japan and from various reports, the majority of occurrences of DD twins have been found in the blastocyst stages.
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Delrieu D, Himaya E, Phillips S, Kadoch IJ. Monozygotic multiple pregnancies following IVF: a case report series of rare experience. Reprod Biomed Online 2012; 25:460-5. [DOI: 10.1016/j.rbmo.2012.06.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 05/21/2012] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
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Glujovsky D, Blake D, Farquhar C, Bardach A. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev 2012:CD002118. [PMID: 22786480 DOI: 10.1002/14651858.cd002118.pub4] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Advances in cell culture media have led to a shift in in vitro fertilization (IVF) practice from early cleavage embryo transfer to blastocyst stage transfer. The rationale for blastocyst culture is to improve both uterine and embryonic synchronicity and enable self selection of viable embryos thus resulting in higher implantation rates. OBJECTIVES To determine if blastocyst stage (Day 5 to 6) embryo transfers (ETs) improve live birth rate and other associated outcomes compared with cleavage stage (Day 2 to 3) ETs. SEARCH METHODS Cochrane Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and Bio extracts. The last search date was 21 February 2012. SELECTION CRITERIA Trials were included if they were randomised and compared the effectiveness of early cleavage versus blastocyst stage transfers. DATA COLLECTION AND ANALYSIS Of the 50 trials that were identified, 23 randomised controlled trials (RCTs) met the inclusion criteria and were reviewed (five new studies were added in this update). The primary outcome was rate of live birth. Secondary outcomes were rates per couple of clinical pregnancy, cumulative clinical pregnancy, multiple pregnancy, high order pregnancy, miscarriage, failure to transfer embryos and cryopreservation. Quality assessment, data extraction and meta-analysis were performed following Cochrane guidelines. MAIN RESULTS Twelve RCTs reported live birth rates and there was evidence of a significant difference in live birth rate per couple favouring blastocyst culture (1510 women, Peto OR 1.40, 95% CI 1.13 to 1.74) (Day 2 to 3: 31%; Day 5 to 6: 38.8%, I(2) = 40%). This means that for a typical rate of 31% in clinics that use early cleavage stage cycles, the rate of live births would increase to 32% to 42% if clinics used blastocyst transfer.There was no difference in clinical pregnancy rate between early cleavage and blastocyst transfer in the 23 RCTs (Peto OR 1.14, 95% CI 0.99 to 1.32) (Day 2 to 3: 38.6%; Day 5 to 6: 41.6%) and no difference in miscarriage rate (13 RCTs, Peto OR 1.18, 95% CI 0.86 to 1.60). The four RCTs that reported cumulative pregnancy rates (266 women, Peto OR 1.58, 95% CI 1.11 to 2.25) (Day 2 to 3: 56.8%; Day 5 to 6: 46.3%) significantly favoured early cleavage. Embryo freezing rates (11 RCTs, 1729 women, Peto OR 2.88, 95% CI 2.35 to 3.51) and failure to transfer embryos (16 RCTs, 2459 women, OR 0.35, 95% CI 0.24 to 0.51) (Day 2 to 3: 3.4%; Day 5 to 6: 8.9%) favoured cleavage stage transfer. AUTHORS' CONCLUSIONS This review provides evidence that there is a small significant difference in live birth rates in favour of blastocyst transfer (Day 5 to 6) compared to cleavage stage transfer (Day 2 to 3). However, cumulative clinical pregnancy rates from cleavage stage (derived from fresh and thaw cycles) resulted in higher clinical pregnancy rates than from blastocyst cycles. The most likely explanation for this is the higher rates of frozen embryos and lower failure to transfer rates per couple obtained from cleavage stage protocols. Future RCTs should report miscarriage, live birth and cumulative live birth rates to enable ART consumers and service providers to make well informed decisions on the best treatment option available.
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Affiliation(s)
- Demián Glujovsky
- Reproductive Medicine, CEGYR (Centro de Estudios en Ginecologia y Reproduccion), Buenos Aires, Argentina.
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Abstract
The incidence of monozygotic twinning in pregnancies achieved with assisted reproductive technologies (ART) is significantly higher than spontaneously conceived pregnancies. The factors associated with ART that predispose the embryos to splitting are not well-characterized. Assisted hatching and extended embryo culture are two ART laboratory methods that have been risk factors for monozygotic twinning. The methods and strategies that may be employed to avoid monozygotic twinning are discussed in this chapter.
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Affiliation(s)
- Amy E Sparks
- IVF and Reproductive Testing Laboratories, Department of Obstetrics and Gynecology, Center for Advanced Reproductive Care, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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Dessolle L, Allaoua D, Fréour T, Le Vaillant C, Philippe HJ, Jean M, Barrière P. Monozygotic triplet pregnancies after single blastocyst transfer: two cases and literature review. Reprod Biomed Online 2010; 21:283-9. [DOI: 10.1016/j.rbmo.2010.04.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 03/31/2010] [Accepted: 04/07/2010] [Indexed: 11/29/2022]
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Knopman J, Krey LC, Lee J, Fino ME, Novetsky A, Noyes N. Monozygotic twinning: an eight-year experience at a large IVF center. Fertil Steril 2010; 94:502-10. [DOI: 10.1016/j.fertnstert.2009.03.064] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/21/2009] [Accepted: 03/13/2009] [Indexed: 11/24/2022]
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Sugawara N, Fukuchi H, Maeda M, Komaba R, Araki Y. Sex-discordant twins despite single embryo transfer: a report of two cases. Reprod Med Biol 2010; 9:169-172. [PMID: 29699339 DOI: 10.1007/s12522-010-0048-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2009] [Accepted: 02/18/2010] [Indexed: 10/19/2022] Open
Abstract
We report two extremely rare cases in which the patients delivered male and female infants that were dizygotic twins (DZT) despite single embryo transfer. Case 1: The patient was a 35-year-old woman with a 9-year history of unexplained infertility. In an oocyte retrieval cycle, one blastocyst was transferred; at 26 weeks of gestation, she delivered a 704-g female infant and a 420-g male infant by cesarean section. Because both infants were of extremely low birth weight, they were placed in the neonatal intensive care unit. Congenital anomalies were not found in either infant. Case 2: The patient was a 30-year-old woman with a 1-year history of infertility. Hysterosalpingogram revealed bilateral tubal occlusion. In a frozen/thawed cycle one blastocyst was transferred during her natural ovulation cycle. She achieved a pregnancy and delivered a 2,877-g female infant and a 2,544-g male infant at 36 weeks of gestation by cesarean section. The female infant was diagnosed with a neural tube defect. No congenital anomalies were detected in the male infant. We hypothesize that the DZTs might have been the result of concurrent embryo transfer and natural ovulation and intercourse.
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Affiliation(s)
- Nobuo Sugawara
- Iwaki Women's Clinic 3-2 Okishita, Uchigo 973-8403 Iwaki Fukushima Japan
| | - Hideyuki Fukuchi
- Fukuchi Ladies' Clinic 2-17-4 Kashimamachi 317-0071 Hitachi Ibaraki Japan
| | - Machiko Maeda
- Iwaki Women's Clinic 3-2 Okishita, Uchigo 973-8403 Iwaki Fukushima Japan
| | - Rie Komaba
- Iwaki Women's Clinic 3-2 Okishita, Uchigo 973-8403 Iwaki Fukushima Japan
| | - Yasuhisa Araki
- The Institute for ARMT 909-21 Ishii, Fujimi 371-0105 Maebashi Gunma Japan
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Sharara FI, Abdo G. Incidence of monozygotic twins in blastocyst and cleavage stage assisted reproductive technology cycles. Fertil Steril 2010; 93:642-5. [DOI: 10.1016/j.fertnstert.2008.12.130] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 11/27/2008] [Accepted: 12/22/2008] [Indexed: 11/24/2022]
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Geyter CD, Geyter MD, Behre HM. Assisted Reproduction. Andrology 2010. [DOI: 10.1007/978-3-540-78355-8_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Shapiro BS, Daneshmand ST, Garner FC, Aguirre M, Hudson C, Thomas S. High ongoing pregnancy rates after deferred transfer through bipronuclear oocyte cryopreservation and post-thaw extended culture. Fertil Steril 2009; 92:1594-9. [DOI: 10.1016/j.fertnstert.2008.08.103] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2008] [Revised: 08/06/2008] [Accepted: 08/18/2008] [Indexed: 10/21/2022]
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Monozygotic multiple gestation after intracytoplasmic sperm injection and preimplantation genetic diagnosis. Fertil Steril 2009; 92:2037.e11-7. [PMID: 19819442 DOI: 10.1016/j.fertnstert.2009.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2009] [Revised: 08/31/2009] [Accepted: 09/01/2009] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To report a possible association between intracytoplasmic sperm injection (ICSI)-preimplantation genetic diagnosis (PGD) and monozygotic multiple gestation. DESIGN Small case series. SETTING In vitro fertilization unit in an academic medical center. PATIENT(S) Three patients were treated with ICSI-PGD for sexing as well as selection against a known translocation. INTERVENTION(S) Transfer of day 4 embryos to the uterus. MAIN OUTCOME MEASURE(S) Clinical pregnancy. RESULT(S) Two pairs of monozygotic twins and a triplet pregnancy. CONCLUSION(S) Repeated manipulation of the zona pellucida as well as extended embryo culture during ICSI-PGD treatments may result in monozygotic twin and triplet pregnancies.
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Verpoest W, Van Landuyt L, Desmyttere S, Cremers A, Devroey P, Liebaers I. The incidence of monozygotic twinning following PGD is not increased. Hum Reprod 2009; 24:2945-50. [PMID: 19661123 DOI: 10.1093/humrep/dep280] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Monozygotic (MZ) twin pregnancies are associated with increased perinatal mortality and morbidity, and risk of congenital anomalies. The causes of MZ twinning in humans are unclear but the incidence may increase after PGD, for example, as a result of holes created in the zona pellucida. We compared the incidence of MZ twin pregnancies in ICSI cycles with PGD, versus ICSI cycles without PGD. METHODS In this retrospective comparative cohort study, we analysed incidence of twin pregnancies in unselected patients undergoing ICSI and PGD (group A; 1992 cycles) with blastocyst transfer at Day 5, versus a period-matched control population of unselected patients undergoing ICSI and blastocyst transfer at Day 5 without PGD (group B; 2429 cycles) from January 2001 to December 2006. RESULTS Clinical pregnancy per embryo transfer was established in 618/1992 (31.0%) and 947/2429 (39.0%) in group A versus B, respectively (P < 0.01). Overall MZ twin rate was 29/4421 (0.7%) per embryo transfer and 29/1565 (1.9%) per established clinical pregnancy. The incidence of MZ twinning per established clinical pregnancy did not differ between groups (1.5 versus 2.1%, group A and B, respectively). In group A, seven MZ twins were born versus 19 MZ twins in group B. In group B, one MZ twin pregnancy resulted in two stillbirths. In group A, two MZ twins had severe congenital malformations versus none in group B. CONCLUSIONS The incidence of MZ twinning was not increased in PGD compared with regular ICSI with blastocyst transfer. This information is useful in counselling patients about potential risks of PGD.
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Affiliation(s)
- W Verpoest
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101 Laarbeeklaan, B-1090 Brussel, Belgium.
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Granne I, Child T, Hartshorne G, (on behalf of the British Fertility. Embryo cryopreservation: Evidence for practice. HUM FERTIL 2009; 11:159-72. [DOI: 10.1080/14647270802242205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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39
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Pauli SA, Berga SL, Shang W, Session DR. Current status of the approach to assisted reproduction. Pediatr Clin North Am 2009; 56:467-88, Table of Contents. [PMID: 19501687 DOI: 10.1016/j.pcl.2009.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Assisted reproductive technologies are important tools in the clinical armamentarium used to treat both female and male infertility disorders. Pre-implantation genetic diagnosis offers couples at risk of having children with inheritable disorders the ability to analyze the genetic make-up of embryos before transfer. For patients undergoing treatment of cancer with chemotherapy or radiation therapy, these technologies offer the potential for the preservation of future fertility. As technology evolves, it is likely the clinical applications of assisted reproduction will continue to develop and expand in the future to enhance fertility.
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Affiliation(s)
- Samuel A Pauli
- Department of Gynecology and Obstetrics, Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Emory Reproductive Center, Medical Office Tower, Atlanta, GA 30308, USA.
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Noyes N, Reh A, McCaffrey C, Tan O, Krey L. Impact of developmental stage at cryopreservation and transfer on clinical outcome of frozen embryo cycles. Reprod Biomed Online 2009; 19 Suppl 3:9-15. [DOI: 10.1016/s1472-6483(10)60279-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Stern JE, Goldman MB, Hatasaka H, MacKenzie TA, Racowsky C, Surrey ES. Optimizing the number of blastocyst stage embryos to transfer on day 5 or 6 in women 38 years of age and older: a Society for Assisted Reproductive Technology database study. Fertil Steril 2009; 91:157-66. [PMID: 18222441 DOI: 10.1016/j.fertnstert.2007.11.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2007] [Revised: 11/09/2007] [Accepted: 11/12/2007] [Indexed: 11/19/2022]
Affiliation(s)
- Judy E Stern
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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LEE SF, CHAPMAN M, BOWYER L. Monozygotic triplets after single blastocyst transfer: Case report and literature review. Aust N Z J Obstet Gynaecol 2008; 48:583-6. [DOI: 10.1111/j.1479-828x.2008.00926.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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43
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Vitthala S, Gelbaya T, Brison D, Fitzgerald C, Nardo L. The risk of monozygotic twins after assisted reproductive technology: a systematic review and meta-analysis. Hum Reprod Update 2008; 15:45-55. [DOI: 10.1093/humupd/dmn045] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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44
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Guilherme R, Drunat S, Delezoide AL, Oury JF, Luton D. Zygosity and chorionicity in triplet pregnancies: new data. Hum Reprod 2008; 24:100-5. [DOI: 10.1093/humrep/den364] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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45
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Aston KI, Peterson CM, Carrell DT. Monozygotic twinning associated with assisted reproductive technologies: a review. Reproduction 2008; 136:377-86. [DOI: 10.1530/rep-08-0206] [Citation(s) in RCA: 168] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Twin birth rates have increased markedly in developed countries since the 1970s for two primary reasons: increasing maternal age and the advent and increasing use of fertility treatments. In addition, monozygotic (MZ) twin pregnancies have been reported to occur at a significantly higher rate following assisted reproductive technologies (ART) procedures compared with the natural incidence. Twin pregnancies are of concern due to a dramatically increased risk of associated complications. Monozygotic twin pregnancies carry a 10–20% risk of twin–twin transfusion syndrome, and monoamniotic monochorionic twins are additionally at risk for cord entanglement. While the mechanisms and contributory factors for dizygotic twinning are well established, very little is known about the mechanisms involved in MZ twinning or the factors that contribute to its occurrence. In this review, we will discuss a number of potential mechanisms involved in MZ twinning and explore factors that may be contributing to the increased incidence of ART-associated MZ twins. An improved understanding of the factors that contribute to increased MZ twinning associated with ART will help to elucidate the poorly understood mechanisms involved in the process and will further aid in reducing the overall incidence of multiple pregnancies with their associated risks following ART procedures.
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Chang HJ, Lee JR, Jee BC, Suh CS, Kim SH. Impact of blastocyst transfer on offspring sex ratio and the monozygotic twinning rate: a systematic review and meta-analysis. Fertil Steril 2008; 91:2381-90. [PMID: 18718582 DOI: 10.1016/j.fertnstert.2008.03.066] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 03/25/2008] [Accepted: 03/25/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the sex ratio and risk of monozygotic twinning (MZT) after blastocyst transfer compared with cleavage-stage embryo transfer (ET) in fresh IVF cycles. DESIGN Systematic review and meta-analysis. SETTING University hospital center for reproductive medicine and IVF. PATIENT(S) Results of all reports from January 1995 to November 2007 with women undergoing nondonor fresh IVF. The sex ratio of 2,587 offspring and MZT rate in 40,917 cycles were included. INTERVENTION(S) Cleavage or blastocyst stage for embryo transfer. MAIN OUTCOME MEASURE(S) Sex ratio and rate of MZT. RESULT(S) A meta-analysis was performed using four studies for sex ratio and nine studies for MZT. The results of the meta-analysis using a fixed effect model demonstrated a higher male-female ratio after blastocyst transfer compared with cleavage-stage ET (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.10-1.51), and this difference was statistically significant. The risk of MZT after blastocyst transfer was significantly higher compared with cleavage-stage ET (OR 3.04, 95% CI 1.54-6.01). CONCLUSION(S) The combined data presented in this meta-analysis suggest that blastocyst transfer appears to be associated with a sex ratio skewed in favor of males and an increased risk of MZT. The clinicians should provide this information to their infertility patients awaiting blastocyst transfer.
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Affiliation(s)
- Hye Jin Chang
- Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, South Korea
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47
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Blake DA, Farquhar CM, Johnson N, Proctor M. Cleavage stage versus blastocyst stage embryo transfer in assisted conception. Cochrane Database Syst Rev 2007:CD002118. [PMID: 17943767 DOI: 10.1002/14651858.cd002118.pub3] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Recent advances in cell culture media have led to a shift in IVF practice from early cleavage embryo transfer to blastocyst stage transfer. The rationale for blastocyst culture is to improve both uterine and embryonic synchronicity and self selection of viable embryos thus resulting in higher implantation rates. OBJECTIVES To determine if blastocyst stage embryo transfers (ETs) affect live birth rate and associated outcomes compared with cleavage stage ETs and to investigate what factors may influence this. SEARCH STRATEGY Cochrane Menstrual Disorders and Subfertility Group Specialised Register of controlled trials, Cochrane Controlled Trials Register (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and Bio extracts. The last search date was January 2007. SELECTION CRITERIA Trials were included if they were randomised and compared the effectiveness of early cleavage versus blastocyst stage transfers. DATA COLLECTION AND ANALYSIS Of the 50 trials that were identified, 18 randomised controlled trials (RCTs) met the inclusion criteria and were reviewed. The primary outcome was rate of live birth. Secondary outcomes were rates per couple of clinical pregnancy, multiple pregnancy, high order pregnancy, miscarriage, failure to transfer embryos and cryopreservation. Quality assessment, data extraction and meta-analysis were performed following Cochrane guidelines. MAIN RESULTS Evidence of a significant difference in live-birth rate per couple between the two treatment groups was detected in favour of blastocyst culture (9 RCTs; OR 1.35, 95% CI 1.05 to 1.74 (Day 2/3: 29.4% versus Day 5/6: 36.0%)). This was particularly for trials with good prognosis patients, equal number of embryos transferred (including single embryo transfer) and those in which the randomisation took place on Day 3. Rates of embryo freezing per couple was significantly higher in Day 2 to 3 transfers (9 RCTs; OR 0.45, 95% CI 0.36 to 0.56). Failure to transfer any embryos per couple was significantly higher in the Day 5 to 6 group (16 RCTs; OR 2.85, 95% CI 1.97 to 4.11 (Day 2/3: 2.8% versus Day 5/6: 8.9%)) but was not significantly different for good prognosis patients (9 RCTs; OR 1.50, 95% CI 0.79 to 2.84). AUTHORS' CONCLUSIONS This review provides evidence that there is a significant difference in pregnancy and live birth rates in favour of blastocyst transfer with good prognosis patients with high numbers of eight-cell embryos on Day three being the most favoured in subgroup for whom there is no difference in cycle cancellation. There is emerging evidence to suggest that in selected patients, blastocyst culture maybe applicable for single embryo transfer.
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Affiliation(s)
- D A Blake
- Auckland University of Technology, Biotechnology Research Institute, Private Bag 92006, Auckland, New Zealand, 1020.
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Grifo JA, Flisser E, Adler A, McCaffrey C, Krey LC, Licciardi F, Noyes N, Kump LM, Berkeley AS. Programmatic implementation of blastocyst transfer in a university-based in vitro fertilization clinic: maximizing pregnancy rates and minimizing triplet rates. Fertil Steril 2007; 88:294-300. [PMID: 17531995 DOI: 10.1016/j.fertnstert.2006.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2006] [Revised: 09/18/2006] [Accepted: 10/11/2006] [Indexed: 11/20/2022]
Abstract
To assess whether the use of extended embryo culture can reduce the incidence of high-order multiple gestations, a retrospective analysis of 7,418 fresh ETs performed in a university-based IVF clinic from 1997-2003 was conducted, comparing program results before and after institution of a protocol to select patients for extended culture of in vitro fertilized embryos. The incidence of triplet pregnancies was significantly reduced in patients at highest risk for high-order multiple gestations, i.e., those at <35 years of age (16.8% versus 6.8%), those at 35-37 years of age (13.0% versus 5.6%), and recipients of donated oocytes (11.2% versus 4.5%).
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Affiliation(s)
- James A Grifo
- New York University Fertility Center, New York University School of Medicine, New York, New York 10016, USA.
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Moayeri SE, Behr B, Lathi RB, Westphal LM, Milki AA. Risk of monozygotic twinning with blastocyst transfer decreases over time: an 8-year experience. Fertil Steril 2007; 87:1028-32. [PMID: 17343858 DOI: 10.1016/j.fertnstert.2006.09.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Revised: 09/01/2006] [Accepted: 09/01/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The purpose of our study is to compare the occurrence of monozygotic twinning (MZT) from blastocyst transfer (BT) in our program between an earlier and more recent time period. DESIGN Retrospective. SETTING Academic IVF practice. PATIENT(S) All pregnancies conceived between March 2002 and December 2005 (N = 932) in our program were compared to pregnancies conceived before March 2002 (N = 554), which were the subject of a previous study. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) The incidence of MZT with day 3 embryo transfer and BT were compared between the study and control groups. RESULT(S) During the study period, the rate of MZT was not significantly different for BT at 2.3% (9/385) compared to day 3 embryo transfer at 1.8% (10/547). This rate of 2.3% for BT was significantly lower than the rate of 5.6% (11/197) reported at our institution for BT before March 2002. CONCLUSION(S) Our study suggests that the risk of MZT with BT is significantly lower in the more recent time period and is in the range of what is seen with cleavage stage transfer. It is likely that improvements in culture systems as experience is gained with BT played a role.
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Affiliation(s)
- Sharon E Moayeri
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Stanford University Medical Center, Stanford, California, USA
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