One Plus One is Better than Two: An Approach Towards a Single Blastocyst Transfer Policy for All IVF Patients

Peregrino, Pedro Felipe Magalhães; Bonetti, Tatiana Carvalho de Souza; Gomes, Alecsandra Prado; Martin, Hamilton de; Soares Júnior, José Maria; Baracat, Edmund Chada; Monteleone, Pedro Augusto Araújo

doi:10.1055/s-0042-1743096

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Original Article • Rev Bras Ginecol Obstet. 44 (6) • 2022 • https://doi.org/10.1055/s-0042-1743096 linkcopy

One Plus One is Better than Two: An Approach Towards a Single Blastocyst Transfer Policy for All IVF Patients

Um mais um é melhor que dois: Uma abordagem pela prática da transferência de embrião único para todos os pacientes de FIV

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective It is known that the single embryo transfer (SET) is the best choice to reduce multiples and associated risks. The practice of cryopreserving all embryos for posterior transfer has been increasingly performed for in vitro fertilization (IVF) patients at the risk of ovarian hyperstimulation syndrome or preimplantation genetic testing for aneuploidy. However, its widespread practice is still controverse. The aim of this study was to evaluate how effective is the transfer of two sequential SET procedures compared with a double embryo transfer (DET) in freeze-only cycles.

Methods This retrospective study reviewed 5,156 IVF cycles performed between 2011 and 2019, and 506 cycles using own oocytes and freeze-only policy with subsequent elective frozen-thawed embryo transfers (eFET) were selected for this study. Cycles having elective SET (eSET, n = 209) comprised our study group and as control group we included cycles performed with elective DET (eDET, n = 291). In the eSET group, 57 couples who had failed in the 1_^st eSET had a 2_^nd eFET, and the estimated cumulative ongoing pregnancy rate was calculated and compared with eDET.

Results After the 1_^st eFET, the ongoing pregnancy rates were similar between groups (eSET: 35.4% versus eDET: 38.5%; p =0.497), but the estimated cumulative ongoing pregnancy rate after a 2_^nd eFET in the eSET group (eSET + SET) was significantly higher (48.8%) than in the eDET group (p < 0.001). Additionally, the eSET +SET group had a 2.7% rate of multiple gestations, which is significantly lower than the eDET group, with a 30.4% rate (p < 0.001).

Conclusion Our study showed the association of freeze-only strategy with until up to two consecutive frozen-thawed eSETs resulted in higher success rates than a frozenthawed DET, while drastically reducing the rate of multiple pregnancies.

Keywords
single embryo transfer; freeze-only; multiple pregnancy; in vitro fertilization; pregnancy rate

n	eSET	eDET	p
n	209	291
Age (years)	35.4±3.9	34.9 ±4.2	0.155
Body mass index (kg/m2)	22.5 ±2.9	23.1 ±3.6	0.092
Infertility time (years)	2.5 ±1.7	2.9±2.2	0.053
Basal FSH (IU/mL)	6.3 ± 5.0	6.3 ±3.2	0.959
Total gonadotropin dose administered (IU)	1.809.4± 372.2	1.869.9±481.4	0.129
Number of collected oocytes	20.0±11.5	17.0±9.2	0.002
Number of collected MII oocytes	15.2 ±8.5	13.3 ±7.4	0.008
Number of cryopreserved embryos	9.1 ±4.5	8.8±4.5	0.381

	eSET	eDET	p
Number of transfers	209	291
Implantation rate (%)	44.4%	29.7%	< 0.001
Ongoing pregnancy rate (%)	74/209 (35.4%)	112/291 (38.5%)	0.497
Miscarriage rate (%)	20/94 (21.3%)	26/138 (18.8%)	0.648
Multiple pregnancies rate (%)	2/74 (2.7%)	34/112 (30.4%)	< 0.001

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[TFN1] Note: According to the Student t-test. Abbreviations: eDET, elective double-embryo transfer; eSET, elective single-embryo transfer; FSH, follicle-stimulating hormone; MII, metaphase II.