Journal of Assisted Reproduction and Genetics

, Volume 29, Issue 8, pp 783–788 | Cite as

Supernumerary Blastocyst Cryopreservation: A key Prognostic Indicator for Patients Opting for an Elective Single Blastocyst Transfer (eSBT)

  • Christine Mullin
  • Alan S. Berkeley
  • Jamie A. Grifo



To determine if patients, less than 40 years of age with or without day 5 cryopreservation (d5 cryo), compromise their pregnancy rate (PR) by choosing an eSBT.


Retrospective analysis


University IVF center


2,203 non-donor fresh IVF cycles in women <40 years of age from January 2004 to January 2010.



Main outcome measure(s)

Eggs retrieved, Embryos cryopreserved, Implantation Rates, Clinical Pregnancy Rates, Live Birth Rates, Spontaneous Abortion Rates


Pregnancy outcomes in women <40 years with or without d5 cryo were compared according to whether patients underwent an eSBT versus a 2BT in non-donor fresh IVF cycles. Overall, eSBT was associated with elimination of twinning while maintaining a high clinical pregnancy rate in both groups with d5 cryo (75 % eSBT versus 72 % 2BT) and groups without d5 cryo (48 % eSBT versus 56 % 2BT).


In this study, patients <40 years of age have eliminated twinning by electively choosing to transfer a single blastocyst without compromising their PR if embryos are available for d5 cryo, and suffer only a non-statistically significant drop in their PR if there are no embryos available for d5 cryo in exchange for the benefit of eliminating the obstetrical risk of twinning.


Single blastocyst transfer Blastocyst Cryopreservation 



The authors wish to thank the embryology staff and physicians at the NYU Fertility Center who have contributed to the art of IVF.


  1. 1.
    Kirby T. Robert Edwards: Nobel Prize for father of in-vitro fertilization. Lancet. 2010;376(9749):1293.PubMedCrossRefGoogle Scholar
  2. 2.
    Pinborg A, Loft A, Schmidt L, Andersen AN. Morbidity in a Danish national cohort of 472 IVF/ICSI twins, 1132 nonIVF/ICSI twins and 634 IVF/ICSI singletons: health related and social implications for the children and their families. Hum Reprod. 2003;18:1234–43.PubMedCrossRefGoogle Scholar
  3. 3.
    Kogan MD, Alexander GR, Kotelchuck M, MacDorman MF, Buekens P, Martin JA, et al. Trends in twin birth outcomes and prenatal care utilization in the United States, 1981–1997. JAMA. 2000;19:335–41.CrossRefGoogle Scholar
  4. 4.
    Scher AI, Petterson B, Blair E, Ellenberg JH, Grether JK, Haan E, et al. The risk of mortality or cerebral palsy in twins: a collaborative population based study. Pediatr Res. 2002;52:671–81.PubMedGoogle Scholar
  5. 5.
    Cramer DW, Liberman RF, Powers D, Hornstein MD, McShane P, Barbieri RL. Recent trends in assisted reproductive techniques and associated outcomes. Obstet Gynecol. 2000;95(1):61–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Reh A, Fino E, Krey L, Berkeley A, Noyes N, Grifo J. Optimizing embryo selection with day 5 transfer. Fertil Steril. 2010;93(2):609–15.PubMedCrossRefGoogle Scholar
  7. 7.
    Gerris J, DeNeubourg D, Margelschots K, Van Royen E, Vercruyssen M, Barudy-Vasquez J, et al. Elective single day 3 embryo transfer halves the twinning rate without a decrease in the ongoing pregnancy rate of an IVF/ICSI programme. Hum Reprod. 2002;17(10):2626–31.PubMedCrossRefGoogle Scholar
  8. 8.
    Veleva Z, Vilska S, Hyden-Granskog C, Tiitinen A, Tapanainen JS, Martikainen H. Elective Single Embryo transfer in women aged 36–39 years. Hum Reprod. 2006;21(8):2098–102.PubMedCrossRefGoogle Scholar
  9. 9.
    Thurin A, Hausken J, Hillensjo T, Jablonowska B, Pinborg A, Strandell A, et al. Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med. 2004;351(23):2392–402.PubMedCrossRefGoogle Scholar
  10. 10.
    Mullin CM, Fino ME, Talebian S, Krey L, Licciardi F, Grifo J. Comparison of pregnancy outcomes in elective single blastocyst versus double blastocyst transfer stratified by age. Fertil Steril. 2010;93(6):1837–43.PubMedCrossRefGoogle Scholar
  11. 11.
    Martikainen H, Tiitinen A, Tomas C, Tapanainen J, Orava M, Tuomivaara L, et al. One versus two embryo transfer after IVF and ICSI: a randomized study. Hum Reprod. 2001;16(9):1900–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Debrock S, et al. New Belgian legislation regarding the limitation of transferable embryos in in vitro fertilization cycles does not significantly influence the pregnancy rate but reduces the multiple pregnancy rate in a threefold way in the Leuven University Fertility Center. Fertil Steril. 2005;83:1572–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Karlstrom PO, Bergh C. Reducing the number of embryos transferred in Sweden-impact on delivery and multiple birth rates. Hum Reprod. 2007;22:2202–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Nyboe A, et al. Assisted reproductive technology in Europe, 2000. Results generated from European registers by ESHRE. Hum Reprod. 2004;19:490.CrossRefGoogle Scholar
  15. 15.
    Veleva Z, Karinen P, Tomas C, Tapanainen JS, Martikainen H. Elective single embryo transfer with cryopreservation improves the outcome and diminishes the costs of IVF/ICSI. Hum Reprod. 2009;24(7):1632–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2003 assisted reproductive technology success rates. Atlanta: U. S. Department of Health and Human Services; 2005.Google Scholar
  17. 17.
    Crowther CA. Multiple pregnancies. In: James DK, Steer PJ, Weinger CP, Gonik B, editors. High risk pregnancy: management options. 2nd ed. Philadelphia: Saunders; 2002. p. 129–52.Google Scholar
  18. 18.
    Grifo JA, Flisser E, Adler A, McCaffrey C, Krey LC, Licciardi F, et al. Programmatic implementation of blastocyst transfer in IVF, maximizing pregnancy rates and minimizing triplet rates. Fertil Steril. 2006;88(2):294–300.CrossRefGoogle Scholar
  19. 19.
    Gardner DK, Lane M. Culture and selection of viable blastocysts: a feasible proposition for human IVF? Hum Reprod Update. 1997;3:367–82.PubMedCrossRefGoogle Scholar
  20. 20.
    ASRM. Guidelines on the number of embryos transferred. Fertil Steril. 2009;92(5):1518–9.CrossRefGoogle Scholar
  21. 21.
    Menezo Y, Nicollet B, Herbaut N, Andre D. Freezing co-cultured human blastocyst. Fertil Steril. 1992;59:977–80.Google Scholar
  22. 22.
    National Center for Chronic Disease Prevention and Health Promotion, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2001 Assisted reproductive technology success rates: national summary and fertility clinic reports. Atlanta: Centers for Disease Control and Prevention, December 2003.Google Scholar
  23. 23.
    Adashi EY, Barri PN, Berkowitz R, Braude P, Bryan E, Carr J, et al. Infertility therapy-associated multiple pregnancies (births): an ongoing epidemic. Reprod Biomed Online. 2003;7:515–42.PubMedCrossRefGoogle Scholar
  24. 24.
    Land JA, Evers JL. Risks and complications in assisted reproduction techniques: report of an ESHRE consensus meeting. Hum Reprod. 2003;18:455–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Ryan GL, Sparks AET, Sipe CS, Syrop CH, Dokras A, Van Voorhis BJ. A mandatory single blastocyst transfer policy with educational campaign in a United States IVF program reduces multiple gestation rates without sacrificing pregnancy rates. Fertil Steril. 2007;88:354–60.PubMedCrossRefGoogle Scholar
  26. 26.
    Hamberger L, Hardarson T, Nygren KG. Avoidance of multiple pregnancy by use of single embryo transfer. Minerva Ginecol. 2005;57(1):15–9.PubMedGoogle Scholar
  27. 27.
    Coskun S, Hollanders J, Al Hassan S, Al Sufyan H, Al Mayman H, Jaroudi K. Day 5 versus day 3 embryo transfer: a controlled randomized trial. Hum Reprod. 2000;15:1947–52.PubMedCrossRefGoogle Scholar
  28. 28.
    Karaki RZ, Samarraie SS, Younis NA, Lahloub TM, Ibrahim MH. Blastocyst culture and transfer: a step toward improved in vitro fertilization outcome. Fertil Steril. 2002;77:114–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Papanikolaou EG, Camus D, Kolibianakis EM, Van Landuyt L, Van Steirteghem A, Devroey P. In vitro fertilization with single blastocyst-stage versus cleavage-stage embryos. N Engl J Med. 2006;354:1139–46.PubMedCrossRefGoogle Scholar
  30. 30.
    Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril. 2000;73:1155–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Gardner DK, Schoolcraft WB, Wagley L, Schlenker T, Stevens J, Hesla J. A prospective randomized trial of blastocyst culture and transfer in in-vitro fertilization. Hum Reprod. 1998;12:3434–40.CrossRefGoogle Scholar
  32. 32.
    Levron J, Schulman A, Bider D, Seidman D, Levin T, Dor J. A prospective randomized study comparing day 3 with balstocyst-stage embryo transfer. Fertil Steril. 2002;77:1300–1.PubMedCrossRefGoogle Scholar
  33. 33.
    Criniti A, Thyer A, Chow G, Lin P, Klein N, Soules M. Elective single blastocyst transfer reduces twin rates without compromising pregnancy rates. Fertil Steril. 2005;84:1613–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Utsunomomiya T, Naitou T, Nagaki M. A prospective trial of blastocyst culture and transfer. Hum Reprod. 2002;17:1846–51.CrossRefGoogle Scholar
  35. 35.
    Rienzi L, Ubaldi F, Iacobeli M, Ferrero S, Minasi MG, Martinez F, et al. Day 3 embryo transfer with combined evaluation at the pronuclear and cleavage stages compare favorably with day 5 blastocyst transfer. Hum Reprod. 2002;17:1507–12.CrossRefGoogle Scholar
  36. 36.
    Fraattarelli JL, Leondires M, McKeeby JL, Miller BT, Segars JH. Blastocyst transfer decreases multiple pregnancy rates in in vitro fertilization cycles: a randomized controlled trial. Fertil Steril. 2003;79:228–30.CrossRefGoogle Scholar
  37. 37.
    Margreiter M, Weghofer A, Kogosowski A, Mahmoud KZ, Feichtinger W. A prospective randomized multicenter study to evaluate the best day for embryo transfer: does the outcome justify prolonged embryo culture? J Assist Reprod Genet. 2003;20:91–3.PubMedCrossRefGoogle Scholar
  38. 38.
    Blake DA, Farquhar CM, Johnson N, Proctor M. Cleavage stage versus blastocyst stage embryo transfer in assisted conception. Cochrane Database Syst Rev. 2007;17(4):CD002118.Google Scholar
  39. 39.
    Milki AA, Jun SH, Hinckley MD, Behr B, Giudice LC, Westphal LM. Incidence of monozygotic twinning with blastocyst transfer compared to cleavage-stage transfer. Fertil Steril. 2003;79:503–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Behr B, Fisch JD, Racowsky C, Miller K, Pool TB, Milki AA. Blastocyst-ET and monozygotic twinning. J Assist Reprod Genet. 2000;17:349–51.PubMedCrossRefGoogle Scholar
  41. 41.
    The practice committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Blastocyst culture and transfer in clinical assisted reproduction. Fertil Steril. 2008;90(3):S174–7.Google Scholar
  42. 42.
    Newton CR, McBride J, Feyles V, Tekpetey F, Power S. Factors affecting patients’ attitudes toward single- and multiple-embryo transfer. Fertil Steril. 2007;87(2):269–78.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Christine Mullin
    • 1
  • Alan S. Berkeley
    • 1
  • Jamie A. Grifo
    • 1
  1. 1.NYU Fertility CenterNew York University, Langone Medical CenterNew YorkUSA

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