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

• Published in: Revista Brasileira de ginecologia e obstetrícia Vol. 44; no. 6; pp. 578 - 585
• Main Authors: Peregrino, Pedro Felipe Magalhães, Bonetti, Tatiana Carvalho de Souza, Gomes, Alecsandra Prado, de Martin, Hamilton, Soares Júnior, José Maria, Baracat, Edmund Chada, Monteleone, Pedro Augusto Araújo
• Format: Journal Article
• Language: English
• Published: Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil Thieme Revinter Publicações Ltda 01.06.2022; Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
• Subjects: Embryo Transfer; Female; Fertilization in Vitro; freeze-only; Humans; in vitro fertilization; multiple pregnancy; OBSTETRICS & GYNECOLOGY; Original; Original Article; Policy; Pregnancy; Pregnancy Rate; Retrospective Studies; single embryo transfer; criopreservação de todos os embriões; pregnancy rate; single embryo transfer; freeze-only; multiple pregnancy; in vitro fertilization; taxas de gravidez; transferência de embrião único; gestação múltipla; fertilização in vitro
• ISSN: 0100-7203; 1806-9339; 1806-9339
• DOI: 10.1055/s-0042-1743096

Abstract 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 frozen-thawed DET, while drastically reducing the rate of multiple pregnancies.