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Blastocyst Versus Cleavage Stage Embryo Transfer: Maximizing Success Rates

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Book cover Principles of Oocyte and Embryo Donation

Abstract

Over the last decade, progressive refinements in the evaluation of ovarian reserve, controlled ovarian hyperstimulation regimens, embryology laboratory culture systems, as well as embryo transfer and cryopreservation techniques have resulted in significant improvements in assisted reproductive technology (ART) outcomes. With these advances, an emerging need to maximize the likelihood of a live birth while minimizing the risk of multiple gestations has attained paramount importance, particularly in the case of oocyte donation. Recently published guidelines from the American Society for Reproductive Medicine have stated that in the case of a young oocyte donor with favorable prognosis, only a single blastocyst stage or no more than two cleavage stage embryos be transferred. However, in a recent analysis, Martin et al. suggested that even in “best” prognosis oocyte donors from whom at least two donations had resulted in live birth, the live birth rates per oocyte retrieved and per embryo transferred were only 7.3 and 24.6 %, respectively. Given this staggering degree of attrition even in the best prognosis patients and the need to decrease the numbers of embryos transferred, it is critical that clinicians and embryologists obtain as much information as possible about the developmental and implantation potential of embryos considered for transfer.

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References

  1. Practice Committee of the Society for Assisted Reproductive Technology and the Practice Committee of the American Society for Reproductive Medicine. Guidelines on number of embryos transferred. Fertil Steril. 2008;90 Suppl 3:S163–4.

    Google Scholar 

  2. Martin J, Bromer J, Sakkas D, Patritizio P. Live babies born per oocyte retrieved in a subpopulation of oocyte donors with repetitive reproductive success. Fertil Steril. 2010;94:2064–8.

    Article  PubMed  Google Scholar 

  3. Gardner D, Lane M, Schoolcraft W. Culture and transfer of viable blastocysts: a feasible proposition for human IVF. Hum Reprod. 2000;15 Suppl 6:9–23.

    PubMed  Google Scholar 

  4. Fanchin R, Ayoubi J-M, Righini C, et al. Uterine contractility decreases at the time of blastocyst transfers. Hum Reprod. 2001;16:1115–9.

    Article  PubMed  CAS  Google Scholar 

  5. Braude P, Bolton V, Moore S. Human gene expression first occurs between the four and eight cell stages of preimplantation development. Nature. 1988;322:459–61.

    Article  Google Scholar 

  6. Johnson M, Gardner D. Embryo culture in the twenty-first century. In: Gardner D, Rizk B, Falcone T, editors. Human assisted reproductive technology: future trends in laboratory and clinical practice. Cambridge: Cambridge University Press; 2011. p. 232–47.

    Chapter  Google Scholar 

  7. Thurin A, Hausken J, Hillensjö T, et al. Elective single embryo transfer versus double embryo transfer in in vitro fertilization. N Engl J Med. 2004;35:2392–402.

    Article  Google Scholar 

  8. Gardner D, Surrey E, Minijarez D, et al. Single blastocyst transfer: a prospective randomized trial. Fertil Steril. 2004;81:551–5.

    Article  PubMed  CAS  Google Scholar 

  9. Gardner D, Schoolcraft W, Wagley L, et al. A prospective randomized trial of blastocyst culture and transfer in in-vitro fertilization. Hum Reprod. 1998;13:3434–40.

    Article  PubMed  CAS  Google Scholar 

  10. Coskun S, Hollanders J, Al-Hassan S, et al. Day 5 versus 3 embryo transfer: a controlled randomized trial. Hum Reprod. 2000;15:1947–52.

    Article  PubMed  CAS  Google Scholar 

  11. Van der Auwera I, Debrock S, Spiessans C, et al. A prospective randomized study: day 2 versus day 5 embryo transfer. Hum Reprod. 2002;17:1507–12.

    Article  PubMed  Google Scholar 

  12. Levron J, Shulman A, Bider D, et al. A prospective randomized study comparing day 3 with blastocyst-stage embryo transfer. Fertil Steril. 2002;77:1310–1.

    Article  Google Scholar 

  13. Margreiter M, Weghofer A, Kogosowski A, et al. A prospective randomized multicenter study to evaluate the best day of embryo transfer: does the outcome justify prolonged embryo culture? J Assist Reprod Genet. 2003;20:91–4.

    Article  PubMed  Google Scholar 

  14. Papanikolaou E, D’haeseleer E, Verheyen G, et al. Live birth rate is significantly higher after blastocyst transfer when at least four embryos are available on day 3 of embryo culture: a randomized prospective study. Hum Reprod. 2005;20:3198–203.

    Article  PubMed  Google Scholar 

  15. Pantos K, Makrakis E, Stavrou D, et al. Comparison of embryo transfer on day 2, day 3, and day 6: a prospective randomized study. Fertil Steril. 2004;81:454–5.

    Article  PubMed  Google Scholar 

  16. Karaki R, Samarraie S, Younis N, et al. Blastocyst culture and transfer: a step toward improved in-vitro fertilization outcome. Fertil Steril. 2002;77:114–8.

    Article  PubMed  Google Scholar 

  17. Utsunomiya T, Naitou T, Nagaki M. A prospective trial of blastocyst culture and transfer. Hum Reprod. 2002;17:1846–51.

    Article  PubMed  Google Scholar 

  18. Rienzi L, Ubaldi F, Iacobelli M, et al. Day 3 embryo transfer with combined evaluation at the pronuclear and cleavage stages compares favorably with day 5 blastocyst transfer. Hum Reprod. 2002;17:1852–5.

    Article  PubMed  Google Scholar 

  19. Frattarelli J, Leondires M, McKeeby J, et al. Blastocyst transfer decreases multiple pregnancy rates in in vitro fertilization cycles: a randomized controlled trial. Fertil Steril. 2003;79:228–30.

    Article  PubMed  Google Scholar 

  20. Emiliani S, Delbaere A, Vannin A, et al. Similar delivery rates in a selected group of patients for day 2 and day 5 embryos both cultured in sequential medium: a randomized study. Hum Reprod. 2003;18:2145–50.

    Article  PubMed  Google Scholar 

  21. Bungum M, Bungum L, Humaidan P, et al. Day 3 versus 5 embryo transfer: a prospective randomized study. Reprod Biomed Online. 2003;7:98–104.

    Article  PubMed  CAS  Google Scholar 

  22. Levitas E, Lunenfeld E, Har-Vardi I, et al. Blastocyst-stage embryo transfer in patients who failed to conceive in three or more day 2–3 embryo transfer cycles: a prospective randomized study. Fertil Steril. 2004;81:567–71.

    Article  PubMed  Google Scholar 

  23. Kolibianakis E, Zikopoulos K, Verpoest W, et al. Should we advise patients undergoing IVF to start a cycle leading to a day 3 or a day 5 transfer? Hum Reprod. 2004;19:2550–4.

    Article  PubMed  CAS  Google Scholar 

  24. Hreinson J, Rosenlund B, Fridstron M, et al. Embryo transfer is equally effective at cleavage and blastocyst stage: a randomized prospective study. Eur J Obstet Gynecol Reprod Biol. 2004;117:194–200.

    Article  Google Scholar 

  25. Shapiro B, Richter K, Harris D, et al. A comparison of day 5 and day 6 transfers. Fertil Steril. 2001;75:1126–30.

    Article  PubMed  CAS  Google Scholar 

  26. Shapiro B, Daneshmand S, Garner F, et al. Contrasting patterns in in vitro fertilization pregnancy rates among fresh autologous, fresh oocyte donor and cryopreserved cycles with the use of day 5 or day 6 blastocysts may reflect differences in embryo-endometrium synchrony. Fertil Steril. 2008;89:20–6.

    Article  PubMed  Google Scholar 

  27. Papanikolaou E, Camus M, Kolibianakis E, et al. In vitro fertilization with single blastocyst stage versus single cleavage-stage embryos. N Engl J Med. 2006;354:1139–46.

    Article  PubMed  CAS  Google Scholar 

  28. Zech N, Lejeune B, Puissant F, et al. Prospective evaluation of the optimal time for selecting a single embryo for transfer: day 3 versus day 5. Fertil Steril. 2007;88:244–6.

    Article  PubMed  Google Scholar 

  29. Guerif F, Lemseffer M, Bidault R, et al. Single day 2 embryo versus blastocyst-stage transfer: a prospective study integrating fresh and frozen embryo transfer. Hum Reprod. 2009;24:1051–8.

    Article  PubMed  CAS  Google Scholar 

  30. Gelbaya T, Tsoumpou I, Nardo L. The likelihood of live birth and multiple birth after single versus double embryo transfer of the cleavage stage: a systematic review and meta-analysis. Fertil Steril. 2010;94:936–45.

    Article  PubMed  Google Scholar 

  31. Blake D, Proctor M, Johnson N, et al. Cleavage stage versus blastocyst stage embryo transfer in assisted conception. Cochrane Database Syst Rev. 2005;(4), Art No:CD002118. Pub 2.

    Google Scholar 

  32. Papanikolaou E, Kolibianakis E, Tournaye H, et al. Live birth rates after transfer of equal number of blastocysts or cleavage stage embryos in IVF. A systematic review and meta-analysis. Hum Reprod. 2008;23:91–9.

    Article  PubMed  Google Scholar 

  33. Schoolcraft W, Gardner D. Blastocyst culture and transfer increase the efficiency of oocyte donation. Fertil Steril. 2000;74:482–6.

    Article  PubMed  CAS  Google Scholar 

  34. Shapiro B, Richter K, Harris D, et al. Implantation and pregnancy rates are higher for oocyte donor cycles after blastocyst transfer. Fertil Steril. 2002;77:1296–7.

    Article  PubMed  Google Scholar 

  35. Porat N, Boehrlein L, Barker M, et al. Blastocyst embryo transfer is the primary determinant for improved outcomes in oocyte donation cycles. J Obstet Gynaecol Res. 2010;36:357–63.

    Article  PubMed  Google Scholar 

  36. Garcia J, Noriega-Portella L, Noriega-Hoces L. Efficacy of oocyte vitrification combined with blastocyst stage transfer in an egg donation program. Hum Reprod. 2011;26:782–90.

    Article  PubMed  Google Scholar 

  37. Söderström-Antilla V, Vilska S. Five years of single embryo transfer with anonymous and non-anonymous oocyte donation. Reprod Biomed Online. 2007;15:428–33.

    Article  Google Scholar 

  38. Mirkin S, Gimeno T, Bovea C, et al. Factors associated with an optimal pregnancy outcome in an oocyte donation program. J Assist Reprod Genet. 2003;10:400–8.

    Article  Google Scholar 

  39. Luna M, Finkler E, Barritt J, et al. Paternal age and assisted reproductive technology outcome in ovum recipients. Fertil Steril. 2009;92:1772–5.

    Article  PubMed  Google Scholar 

  40. Frattarelli J, Miller K, Miller B, et al. Male age negatively impacts embryo development and reproductive outcome in donor oocyte assisted reproductive technology cycles. Fertil Steril. 2003;90:97–103.

    Article  Google Scholar 

  41. Duran E, Dowling-Lacey D, Bocca S, et al. Impact of male age on the outcome of assisted reproductive technology cycles using donor oocytes. Reprod Biomed Online. 2010;20:848–56.

    Article  PubMed  CAS  Google Scholar 

  42. Neuber E, Rinaudo P, Trimarchi J, et al. Sequential assessment of individually cultured human embryos as an indication of subsequent good quality blastocyst development. Hum Reprod. 2003;18:1307–12.

    Article  PubMed  CAS  Google Scholar 

  43. Dessolle L, Freour T, Barrière D, et al. A cycle-based model to predict blastocyst transfer cancellation. Hum Reprod. 2010;25:588–604.

    Article  Google Scholar 

  44. Guerif F, Le Gouge A, Giraudeau B, et al. Limited value of morphological assessment at day 1 and 2 to predict blastocyst developmental potential: a prospective study based on 4042 embryos. Hum Reprod. 2007;22:1973–81.

    Article  PubMed  CAS  Google Scholar 

  45. Graham J, Han T, Porter R, et al. Day 3 morphology is a poor predictor of blastocyst quality in extended culture. Fertil Steril. 2000;74:495–7.

    Article  PubMed  CAS  Google Scholar 

  46. Veeck L, Bodine R, Clarke R, et al. High pregnancy rates can be achieved after freezing and thawing human blastocysts. Fertil Steril. 2004;82:1418–27.

    Article  PubMed  Google Scholar 

  47. Veeck L. Does the developmental stage at freeze impact on clinical results post-thaw? Reprod Biomed Online. 2003;6:367–74.

    Article  PubMed  Google Scholar 

  48. Levens E, Whitcomb B, Hennessy S, et al. Blastocyst development rate impacts outcome in cryopreserved blastocyst transfer cycles. Fertil Steril. 2008;9012: 2138–43.

    Article  Google Scholar 

  49. Shapiro B, Daneshmand S, Garner F, et al. Similar ongoing pregnancy rates after blastocyst transfer in fresh donor cycles and autologous cycles using cryopreserved bipronuclear oocytes suggest similar viability of transferred blastocysts. Fertil Steril. 2010;93:319–21.

    Article  PubMed  Google Scholar 

  50. Lane M, Schoolcraft W, Gardner D. Vitrification of mouse and human blastocyst using a novel cryoloop container-less technique. Fertil Steril. 1999;72:1073–8.

    Article  PubMed  CAS  Google Scholar 

  51. Mukaida T, Takahashi K, Kasai M. Blastocyst cryopreservation: ultrarapid vitrification using a cryoloop technique. Reprod Biomed Online. 2003;6:221–5.

    Article  PubMed  Google Scholar 

  52. Loutradi K, Kolibianakis E, Venetis C, et al. Cryopreservation of human embryos by vitrification or slow freezing: a systematic review and meta-analysis. Fertil Steril. 2008;90:186–93.

    Article  PubMed  Google Scholar 

  53. Schlenker T, Stevens J, Rawlins M, et al. Healthy deliveries following vitrification of biopsied blastocysts. Fertil Steril. 2010;94:S35. Abstract O-118.

    Article  Google Scholar 

  54. Zhu D, Zhang J, Cao S, et al. Vitrified-warmed blastocyst transfer cycles yield higher pregnancy and implantation rates compared with fresh blastocyst transfer cycles – time for a new embryo transfer strategy? Fertil Steril. 2011;95:1691–5.

    Article  PubMed  Google Scholar 

  55. Wright V, Schieve L, Vahratian A, et al. Monozygotic twinning associated with day 5 embryo transfer in pregnancies after IVF. Hum Reprod. 2004;8:1831–6.

    Article  Google Scholar 

  56. Milki A, Jun S, Hinckley M, et al. Incidence of monozygotic twinning with blastocyst transfer compared to cleavage-stage transfer. Fertil Steril. 2003;79:503–6.

    Article  PubMed  Google Scholar 

  57. da Costa A, Abdelmassih S, Olivera F, et al. Monozygotic twins and transfer at the blastocyst stage after ICSI. Hum Reprod. 2001;10:333–6.

    Article  Google Scholar 

  58. Papanikolaou E, Fatemi H, Venetis C, et al. Monozygotic twinning is not increased after single blastocyst transfer compared with single cleavage-stage embryo transfer. Fertil Steril. 2010;93:592–7.

    Article  PubMed  Google Scholar 

  59. Moayein S, Behr B, Lathi R, et al. Risk of monozygotic twinning with blastocyst transfer decreases over time: an 8-year experience. Fertil Steril. 2007;87: 1028–32.

    Article  Google Scholar 

  60. Gardner D, Lane M, Stevens J, et al. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000;73:1155–8.

    Article  PubMed  CAS  Google Scholar 

  61. Fragouli E, Escalona A, Gutierrez-Mateo C, et al. Comparative genomic hybridization of oocytes and first polar bodies from young donors. Reprod Biomed Online. 2009;19:228–37.

    Article  PubMed  CAS  Google Scholar 

  62. Treff N, Su J, Tao X, et al. Accurate single cell 24 chromosome aneuploidy screening using whole genome amplification and single nucleotide polymorphism microarrays. Fertil Steril. 2010;94:2017–21.

    Article  PubMed  CAS  Google Scholar 

  63. Schoolcraft W, Fragouli E, Stevens J, et al. Clinical applications of comprehensive chromosomal screening at the blastocyst stage. Fertil Steril. 2010;94:1700–6.

    Article  PubMed  Google Scholar 

  64. Fragouli E, Lenzi M, Ross R, et al. Comprehensive molecular cytogenetic analysis of the human blastocyst stage. Hum Reprod. 2008;23:2596–608.

    Article  PubMed  CAS  Google Scholar 

  65. Parks J, McCallie B, Janesch A, et al. Blastocyst gene expression correlates with implantation potential. Fertil Steril. 2011;95:1367–72.

    Article  PubMed  CAS  Google Scholar 

  66. Katz-Jaffe M, McReynolds S, Gardner D, et al. The role of proteomics in defining the human embryonic secretome. Mol Hum Reprod. 2009;15:271–7.

    Article  PubMed  CAS  Google Scholar 

  67. Botros L, Sakkas D, Seli E. Metabolomics and its application for non-invasive embryonic assessment in IVF. Mol Hum Reprod. 2008;14:679–90.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Colorado Center for Reproductive Medicine, 10290 RidgeGate Circle, Lone Tree, CO, 80124, USA

    Eric S. Surrey M.D. & William B. Schoolcraft M.D., HCLD

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  1. Eric S. Surrey M.D.
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  2. William B. Schoolcraft M.D., HCLD
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Correspondence to Eric S. Surrey M.D. .

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  1. , Center for Women’s Reproductive Care, Columbia University, 1790 Broadway, New York, 10019, New York, USA

    Mark V. Sauer

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Surrey, E.S., Schoolcraft, W.B. (2013). Blastocyst Versus Cleavage Stage Embryo Transfer: Maximizing Success Rates. In: Sauer, M. (eds) Principles of Oocyte and Embryo Donation. Springer, London. https://doi.org/10.1007/978-1-4471-2392-7_10

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  • DOI: https://doi.org/10.1007/978-1-4471-2392-7_10

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