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Blastocyst culture using single versus sequential media in clinical IVF: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Purpose

The purpose of this study was to undertake a review of the available evidence comparing the use of a single medium versus sequential media for embryo culture to the blastocyst stage in clinical IVF.

Methods

We searched the Cochrane Central, PubMed, Scopus, ClinicalTrials.gov, Current Controlled Trials and WHO International Clinical Trials Registry Platform to identify randomized controlled trials comparing single versus sequential media for blastocyst culture and ongoing pregnancy rate. Included studies randomized either oocytes/zygotes or women. Eligible oocyte/zygote studies were analyzed to assess the risk difference (RD) and 95 % confidence intervals (CI) between the two media systems; eligible woman-based studies were analyzed to assess the risk ratio (RR) and 95 % CI for clinical pregnancy rate.

Results

No differences were observed between single and sequential media for either ongoing pregnancy per randomized woman (relative risk (RR) = 0.9, 95 % CI = 0.7 to 1.3, two studies including 246 women, I 2 = 0 %) or clinical pregnancy per randomized woman (RR = 1.0, 95 % CI = 0.7 to 1.4, one study including 100 women); or miscarriage per clinical pregnancy: RR = 1.3, 95 % CI = 0.4 to 4.3, two studies including 246 participants, I 2 = 0 %). Single media use was associated with an increase blastocyst formation per randomized oocyte/zygote (relative distribution (RD) = +0.06, 95 % CI = +0.01 to +0.12, ten studies including 7455 oocytes/zygotes, I 2 = 83 %) but not top/high blastocyst formation (RD = +0.05, 95 % CI = −0.01 to +0.11, five studies including 3879 oocytes/zygotes, I 2 = 93 %). The overall quality of the evidence was very low for all these four outcomes.

Conclusions

Although using a single medium for extended culture has some practical advantages and blastocyst formation rates appear to be higher, there is insufficient evidence to recommend either sequential or single-step media as being superior for the culture of embryos to days 5/6. Future studies comparing these two media systems in well-designed trials should be performed.

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Authors and Affiliations

  1. Division of Child Health, Obstetrics and Gynaecology, School of Medicine, University of Nottingham, Nottingham, UK

    Ioannis A. Sfontouris & Nick Raine-Fenning

  2. Eugonia Assisted Reproduction Unit, Athens, Greece

    Ioannis A. Sfontouris

  3. Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil

    Wellington P. Martins, Carolina O Nastri, Iara G. R. Viana & Paula A. Navarro

  4. SEMEAR fertilidade, Reproductive Medicine, Ribeirao Preto, Brazil

    Carolina O Nastri & Iara G. R. Viana

  5. HRP (the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Geneva, Switzerland

    Sheryl van der Poel

  6. Population Council, Reproductive Health Programme, New York, USA

    Sheryl van der Poel

  7. GENERA Centre for Reproductive Medicine, Clinica Valle Giulia, via de Notaris 2b, Rome, Italy

    Laura Rienzi

  8. Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Womenʼs Hospital, Harvard Medical School, 75 Francis Street, Boston, 02115, MA, USA

    Catherine Racowsky

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  1. Ioannis A. Sfontouris
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  2. Wellington P. Martins
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  3. Carolina O Nastri
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  4. Iara G. R. Viana
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Correspondence to Catherine Racowsky.

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Declaration of Authors’ Roles

Conception and design (CR, LR, WPM, IAS, and NR-F); search strategy (WPM, IAS); data extraction (WPM, PAN, IGRV, CON), analysis, and interpretation (all authors); writing the article (all authors). All authors had full access to all the data in the study and approved the final manuscript.

Capsule

In conclusion, there is insufficient evidence to recommend either sequential or single-step media as being superior for the culture of embryos to days 5/6 blastocyst stage.

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Sfontouris, I.A., Martins, W.P., Nastri, C.O. et al. Blastocyst culture using single versus sequential media in clinical IVF: a systematic review and meta-analysis of randomized controlled trials. J Assist Reprod Genet 33, 1261–1272 (2016). https://doi.org/10.1007/s10815-016-0774-5

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