Download fulltext
Homayoon, N., Arabian, S., Mangoli, E., Bayati, F., & Eftekhar, M. (2024). Effect of sequential cleavage and blastocyst embryo transfer compared to single cleavage stage embryo transfer on assisted reproductive technology outcome: An RCT. International Journal of Reproductive BioMedicine (IJRM), 22(6), 433–440. https://doi.org/10.18502/ijrm.v22i6.16793

https://doi.org/10.18502/ijrm.v22i6.16793

statistics

  • 13 Abstract Views
  • 13 PDF Views

authors

  • Nahid Homayoon

    Nahid Homayoon

    Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
  • Sahereh Arabian

    Sahereh Arabian

    Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran.
  • Esmat Mangoli

    Esmat Mangoli

    Department of Reproductive Biology, Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
  • Fatemeh Bayati

    Fatemeh Bayati

    Department of Obstetrics and Gynecology, Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran.
  • Maryam Eftekhar

    Maryam Eftekhar

    Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Published Date

  • Jul 31, 2024

Effect of sequential cleavage and blastocyst embryo transfer compared to single cleavage stage embryo transfer on assisted reproductive technology outcome: An RCT

International Journal of Reproductive BioMedicine (IJRM) / International Journal of Reproductive BioMedicine (IJRM): Volume 22, Issue No. 6 / Pages 433–440

Abstract

Background: Assisted reproductive technology (ART), offers hope for many infertile couples by increasing the chance of successful pregnancy. The success of in vitro fertilization depends on various factors, in which embryo transfer (ET) is one of the critical steps influencing in vitro fertilization success rates. Extended embryo culture and blastocyst-stage ET have been considered in ART due to their potential benefits including improved implantation rates.


Objective: This study aimed to compare the outcomes of sequential ET vs single cleavage-stage ET in women undergoing a fresh ET cycle with a limited number of embryos.


Materials and Methods: This randomized clinical trial was conducted on 140 women undergoing infertility treatments and candidates for fresh ET at the Research and Clinical Center for Infertility, Yazd, Iran from August 2023 to January 2024. Women with a number of embryos from 2–5 (≥ 2 and ≤ 5 available embryos) were randomly divided into 2 groups: One group underwent sequential ET (one cleavage-stage ET followed by one blastocyst ET) and the other group underwent single-step 2 cleavage-stage ET. The primary outcome was clinical pregnancy, and the secondary outcome included chemical pregnancy and early abortion rates.


Results: Our findings showed significantly higher rates of clinical (33.5% vs 13.6%, p = 0.003) and chemical (41.3% vs 18.2%, p = 0.004) pregnancies in the sequential ET group compared to the single-step cleavage ET group. The early abortion rate was higher in single-step cleavage ET (13% vs 44.4%, p = 0.053).


Conclusion: Sequential fresh ET is a useful choice in women who have a limited number of embryos and can improve ART outcomes.


Key words: Blastocyst transfer, In vitro fertilization, Embryo transfer.

References
[1] Smeenk J, Wyns C, De Geyter C, Kupka M, Bergh C, Cuevas Saiz I, et al. ART in Europe, 2019: Results generated from European registries by ESHRE. Hum Reprod 2023; 38: 2321–2338.

[2] ESHRE Working Group on Recurrent Implantation Failure, Cimadomo D, de Los Santos MJ, Griesinger G, Lainas G, Le Clef N, et al. ESHRE good practice recommendations on recurrent implantation failure. Hum Reprod Open 2023; 2023: hoad023.

[3] Aldemir O, Ozelci R, Baser E, Kaplanoglu I, Dilbaz S, Dilbaz B, et al. Impact of transferring a poor quality embryo along with a good quality embryo on pregnancy outcomes in IVF/ICSI cycles: A retrospective study. Geburtshilfe Frauenheilkd 2020; 80: 844–850.

[4] Madkour WA, Noah B, Zaheer H, Al-Bahr A, Abdelhamid AM, Shaeer M, et al. Does sequential embryo transfer improve pregnancy rate in patients with repeated implantation failure? A randomized control study. Middle East Fertil Soc J 2015; 20: 255–261.

[5] Practice Committee of the American Society for Reproductive Medicine. Blastocyst culture and transfer in clinically assisted reproduction: A committee opinion. Fertil Steril 2018; 110: 1246–1252.

[6] Glujovsky D, Retamar AMQ, Sedo CRA, Ciapponi A, Cornelisse S, Blake D. Cleavage-stage versus blastocyst-stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev 2022; 5: CD002118.

[7] Li Y, Liu S, Lv Q. Single blastocyst stage versus single cleavage stage embryo transfer following fresh transfer: A systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2021; 267: 11–17.

[8] Hu Y-L, Wang Y, Geng L-H, Meng X-Q, Xu H-J, Adu-Gyamfi EA, et al. Effects of sequential cleavage and blastocyst embryo transfer on pregnancy outcomes in patients with poor ovarian response. J Reprod Immunol 2023; 155: 103780.

[9] Abramovici H, Dirnfeld M, Weisman Z, Sorokin Y, Lissak A, Rofe A, et al. Pregnancies following the interval double-transfer technique in an in vitro fertilization-embryo transfer program. J In Vitro Fert Embryo Transf 1988; 5: 175–176.

[10] Zhang J, Wang C, Zhang H, Zhou Y. Sequential cleavage and blastocyst embryo transfer and IVF outcomes: A systematic review. Reprod Biol Endocrinol 2021; 19: 142.

[11] Gao J, Yuan Y, Li J, Tian T, Lian Y, Liu P, et al. Sequential embryo transfer versus double cleavage-stage embryo or double blastocyst transfer in patients with recurrent implantation failure with frozen-thawed embryo transfer cycles: A cohort study. Front Endocrinol 2023; 14: 1238251.

[12] Torky H, Ahmad A, Hussein A, El-Desouky E-S, Aly R, Ragab M, et al. Comparing sequential vs day 3 vs day 5 embryo transfers in cases with recurrent implantation failure: Randomized controlled trial. JBRA Assist Reprod 2021; 25: 185–192.

[13] Shahrokh Tehraninejad E, Raisi E, Bakhtiyari Ghaleh F, Hossein Rashidi B, Aziminekoo E, Kalantari V, et al. The sequential embryo transfer compared to blastocyst embryo transfer in in vitro fertilization (IVF) cycle in patients with the three repeated consecutive IVF. A randomized controlled trial. Gynecol Endocrinol 2019; 35: 955–959.

[14] Ji M, Zhang L, Fu X, Xie W, Wu X, Shu J. The outcomes of sequential embryo transfer in patients undergoing in vitro fertilization with frozen-thawed embryos: A retrospective study. J Obstet Gynaecol Res 2022; 48: 2563–2570.

[15] Eftekhar M, Mohammadi B, Tabibnejad N, Mortazavi Lahijani M. Frozen-thawed cleavage stage versus blastocyst stage embryo transfer in high responder patients. Zygote 2020; 28: 511–515.

[16] Kasaven LS, Marcus D, Theodorou E, Jones BP, Saso S, Naja R, et al. Systematic review and meta-analysis: does pre-implantation genetic testing for aneuploidy at the blastocyst stage improve live birth rate? J Assist Reprod Genet 2023; 40: 2297–2316.

[17] Irani M, O’Neill C, Palermo GD, Xu K, Zhang C, Qin X, et al. Blastocyst development rate influences implantation and live birth rates of similarly graded euploid blastocysts. Fertil Steril 2018; 110: 95–102. e1.

[18] Ali S, Majid S, Ali MN, Taing S, Rehman MU, Arafah A. Cytokine imbalance at materno-embryonic interface as a potential immune mechanism for recurrent pregnancy loss. Int Immunopharmacol 2021; 90: 107118.

[19] Robertson SA, Care AS, Moldenhauer LM. Regulatory T cells in embryo implantation and the immune response to pregnancy. J Clin Invest 2018; 128: 4224–4235.