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Building a model to increase live birth rate through patient-specific optimization of embryo transfer day

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

Many practices are moving away from cleavage-stage transfer in favor of blastocyst transfer. The purpose of this study is to evaluate how the overall live birth rate for fresh IVF cycles may increase by optimizing the day of transfer for each patient.

Methods

This is a retrospective cohort study of 1225 first fresh autologous IVF cycles performed between May 2012 and November 2013. Stepwise logistic regression was used to determine characteristics associated with live birth following cleavage-stage versus blastocyst transfer. The optimal transfer day (i.e., the day that maximized the odds of live birth) was determined for each patient, and the actual live birth rate was compared with the projected rate had each patient undergone transfer on her optimal day.

Results

With transfer on the optimal day for each patient, the overall birth rate would have increased from its actual value of 34.8 % to a projected 43.0 %, a 24 % increase. The majority of this increase (21 %) was due to optimization of patients who underwent cleavage-stage transfer but had a higher projected birth rate from blastocyst transfer. These patients were older (37.8 versus 36.0 years, p < 0.01) and had more follicles ≥18 mm than patients who should have remained with a cleavage-stage transfer.

Conclusions

A model can be built enabling patient-specific identification of optimal transfer day; within this discovery cohort, such optimization was estimated to increase live birth following a fresh transfer by 24 %. This study suggests blastocyst transfer should be more widely offered; however, there remain patients for whom a cleavage-stage transfer may yield better outcomes.

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Author information

Authors and Affiliations

  1. Center for Infertility and Reproductive Surgery, Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    R. H. Goldman, D. J. Kaser, S. A. Missmer, S. S. Srouji, L. V. Farland & C. Racowsky

  2. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, 02115, USA

    S. A. Missmer & L. V. Farland

  3. Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    S. A. Missmer

Authors
  1. R. H. Goldman
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  2. D. J. Kaser
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  3. S. A. Missmer
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  4. S. S. Srouji
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  5. L. V. Farland
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  6. C. Racowsky
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Corresponding author

Correspondence to R. H. Goldman.

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Funding

LF is supported by T32HD060454 in reproductive, perinatal, and pediatric epidemiology from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institute of Health.

Ethical approval

For this type of study, formal consent is not required.

Conflict of interest

The authors declare that they have no conflicts of interest.

Additional information

Capsule By optimizing the day of embryo transfer for individual patients, overall live birth rate can be significantly increased.

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Goldman, R.H., Kaser, D.J., Missmer, S.A. et al. Building a model to increase live birth rate through patient-specific optimization of embryo transfer day. J Assist Reprod Genet 33, 1525–1532 (2016). https://doi.org/10.1007/s10815-016-0803-4

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  • DOI: https://doi.org/10.1007/s10815-016-0803-4

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