Skip to main content

Elective single blastocyst transfer in advanced maternal age



The purpose of this study was to investigate reproductive outcomes following elective single blastocyst transfer (eSBT) compared with those of double blastocyst transfer (DBT) in advanced maternal age.


This was a retrospective cohort study performed at an academic fertility center. All women aged 40 and over for whom in vitro fertilization (IVF) cycles were performed and in whom embryo culture was extended to the blastocyst stage were reviewed for possible inclusion. Exclusion criteria included the following: women with >3 previous IVF cycles, the use of donor or frozen oocytes, preimplantation genetic diagnosis/preimplantation genetic screening cycles, and cycles in which embryos did not reach the blastocyst stage on day 5. The study included 310 women; 148 were included in the eSBT group and 162 were included in the DBT group. Live birth rate (LBR) was the main outcome. Outcomes were analyzed using logistic regression, controlling for confounders. These confounders were embryo expansion, embryo quality, and the number of previous IVF cycles.


The mean age of the whole group was 41 ± 0.91 years, and the LBR was 21.6%. The eSBT group and the DBT group achieved similar clinical pregnancy rates (33 vs. 33%) (OR 1.04; 95%CI, 0.62–1.75) and LBRs (20 vs. 22.8%) (OR 1.43; 95% CI, 0.78–2.64). The multiple birth rate was lower in the eSBT group (0 vs. 16%, p = 0.02). The subgroup of women who had elective DBT (eDBT) achieved a higher LBR (20 vs. 30.6%) (OR 2.32; 95% CI, 1.16–4.68) and a higher multiple birth rate (0 vs. 22%, p = 0.001). Cycles with early blastocyst transfers were associated with lower LBRs compared with cycles with fully expanded blastocyst transfers (11 vs. 24%, p = 0.02).


The results of this study indicate that eSBT is associated with similar LBRs compared to the entire DBT cohort; however, when supernumerary blastocysts are available for cryopreservation, eDBT is associated with both higher LBRs and a higher number of multiple births. Studies assessing the cumulative LBR in advanced maternal age after single blastocyst transfer and subsequent frozen-thawed blastocyst transfers are needed.

This is a preview of subscription content, access via your institution.


  1. Roque M, Valle M, Guimaraes F, Sampaio M, Geber S. Freeze-all policy: fresh vs. frozen-thawed embryo transfer. Fertil Steril. 2015;103:1190–3.

    Article  PubMed  Google Scholar 

  2. Wirleitner B, Schuff M, Stecher A, Murtinger M, Vanderzwalmen P. Pregnancy and birth outcomes following fresh or vitrified embryo transfer according to blastocyst morphology and expansion stage, and culturing strategy for delayed development. Human reproduction (Oxford, England) 2016

  3. ACOG Practice Bulletin No. 144: Multifetal gestations: twin, triplet, and higher-order multifetal pregnancies. Obstetrics and gynecology 2014;123:1118–32.

  4. Elective single-embryo transfer. Fertility and sterility 2012;97:835–42.

  5. Sullivan EA, Wang YA, Hayward I, Chambers GM, Illingworth P, McBain J, et al. Single embryo transfer reduces the risk of perinatal mortality, a population study. Human reproduction (Oxford, England). 2012;27:3609–15.

    Article  Google Scholar 

  6. Mancuso AC, Boulet SL, Duran E, Munch E, Kissin DM, Van Voorhis BJ. Elective single embryo transfer in women less than age 38 years reduces multiple birth rates, but not live birth rates, in United States fertility clinics. Fertility and sterility 2016.

  7. Sunderam S, Kissin DM, Crawford SB, Folger SG, Jamieson DJ, Warner L, et al. Assisted reproductive technology surveillance—United States, 2013. Morbidity and mortality weekly report Surveillance summaries (Washington, DC : 2002). 2015;64:1–25.

    Google Scholar 

  8. Pandian Z, Marjoribanks J, Ozturk O, Serour G, Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev 2013:Cd003416.

  9. Styer AK, Luke B, Vitek W, Christianson MS, Baker VL, Christy AY, et al. Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012. Fertil Steril. 2016;106:80–9.

    Article  PubMed  Google Scholar 

  10. Prapas N, Kalogiannidis I, Prapas I, Xiromeritis P, Karagiannidis A, Makedos G. Twin gestation in older women: antepartum, intrapartum complications, and perinatal outcomes. Arch Gynecol Obstet. 2006;273:293–7.

    Article  CAS  PubMed  Google Scholar 

  11. Harton GL, Munne S, Surrey M, Grifo J, Kaplan B, McCulloh DH, et al. Diminished effect of maternal age on implantation after preimplantation genetic diagnosis with array comparative genomic hybridization. Fertil Steril. 2013;100:1695–703.

    Article  CAS  PubMed  Google Scholar 

  12. Shapiro BS, Richter KS, Harris DC, Daneshmand ST. Influence of patient age on the growth and transfer of blastocyst-stage embryos. Fertil Steril. 2002;77:700–5.

    Article  PubMed  Google Scholar 

  13. Papanikolaou EG, D’Haeseleer E, Verheyen G, Van de Velde H, Camus M, Van Steirteghem A, et al. Live birth rate is significantly higher after blastocyst transfer than after cleavage-stage embryo 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 

  14. 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. Human reproduction (Oxford, England). 1998;13:3434–40.

    Article  CAS  Google Scholar 

  15. Kroener L, Ambartsumyan G, Briton-Jones C, Dumesic D, Surrey M, Munne S, et al. The effect of timing of embryonic progression on chromosomal abnormality. Fertil Steril. 2012;98:876–80.

    Article  PubMed  Google Scholar 

  16. Niinimaki M, Suikkari AM, Makinen S, Soderstrom-Anttila V, Martikainen H. Elective single-embryo transfer in women aged 40–44 years. Human reproduction (Oxford, England). 2013;28:331–5.

    Article  CAS  Google Scholar 

  17. Fujimoto A, Morishima K, Harada M, Hirata T, Osuga Y, Fujii T. Elective single-embryo transfer improves cumulative pregnancy outcome in young patients but not in women of advanced reproductive age. J Assist Reprod Genet. 2015;32:1773–9.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Braude P, Bolton V, Moore S. Human gene expression first occurs between the four- and eight-cell stages of preimplantation development. Nature. 1988;332:459–61.

    Article  CAS  PubMed  Google Scholar 

  19. Vega M, Breborowicz A, Moshier EL, McGovern PG, Keltz MD. Blastulation rates decline in a linear fashion from euploid to aneuploid embryos with single versus multiple chromosomal errors. Fertil Steril. 2014;102:394–8.

    Article  PubMed  Google Scholar 

  20. Fernandez-Shaw S, Cercas R, Brana C, Villas C, Pons I. Ongoing and cumulative pregnancy rate after cleavage-stage versus blastocyst-stage embryo transfer using vitrification for cryopreservation: impact of age on the results. J Assist Reprod Genet. 2015;32:177–84.

    Article  CAS  PubMed  Google Scholar 

  21. Fragouli E, Alfarawati S, Spath K, Wells D. Morphological and cytogenetic assessment of cleavage and blastocyst stage embryos. Mol Hum Reprod. 2014;20:117–26.

    Article  CAS  PubMed  Google Scholar 

  22. Capalbo A, Rienzi L, Cimadomo D, Maggiulli R, Elliott T, Wright G, et al. Correlation between standard blastocyst morphology, euploidy and implantation: an observational study in two centers involving 956 screened blastocysts. Human reproduction (Oxford, England). 2014;29:1173–81.

    Article  Google Scholar 

  23. Kort JD, Lathi RB, Brookfield K, Baker VL, Zhao Q, Behr BR. Aneuploidy rates and blastocyst formation after biopsy of morulae and early blastocysts on day 5. J Assist Reprod Genet. 2015;32:925–30.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Piccolomini MM, Nicolielo M, Bonetti TC, Motta EL, Serafini PC, Alegretti JR. Does slow embryo development predict a high aneuploidy rate on trophectoderm biopsy? Reproductive biomedicine online 2016.

  25. Lee HL, McCulloh DH, Hodes-Wertz B, Adler A, McCaffrey C, Grifo JA. In vitro fertilization with preimplantation genetic screening improves implantation and live birth in women age 40 through 43. J Assist Reprod Genet. 2015;32:435–44.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Samer Tannus.

Ethics declarations

The study was performed in accordance with the guidelines of the local ethics committee.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Tannus, S., Son, Wy. & Dahan, M.H. Elective single blastocyst transfer in advanced maternal age. J Assist Reprod Genet 34, 741–748 (2017).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Elective single blastocyst transfer
  • Advanced maternal age
  • Multiple birth rate
  • Live birth rate