Effect of single blastocyst-stage versus single cleavage-stage embryo transfer on cumulative live births in women with good prognosis undergoing in vitro fertilization: Multicenter Randomized Controlled Trial

In this multicenter, non-inferiority, randomized trial, we randomly assigned 992 women undergoing in-vitro fertilization (IVF) with a good prognosis (aged 20-40, ≥3 transferrable cleavage-stage embryos) to strategies of blastocyst-stage (n = 497) or cleavage-stage (n = 495) single embryo transfer. Primary outcome was cumulative live-birth rate after up to three transfers. Secondary outcomes were cumulative live-births after all embryo transfers within 1 year of randomization, pregnancy outcomes, obstetric-perinatal complications, and livebirths outcomes. Live-birth rates were 74.8% in blastocyst-stage group versus 66.3% in cleavage-stage group (relative risk 1.13, 95%CI:1.04-1.22; P<sub>non-inferiority</sub> < 0.001, P<sub>superiority</sub> = 0.003) (1-year cumulative live birth rates of 75.7% versus 68.9%). Blastocyst transfer increased the risk of spontaneous preterm birth (4.6% vs 2.0%; P = 0.02) and neonatal hospitalization >3 days. Among good prognosis women, a strategy of single blastocyst transfer increases cumulative live-birth rates over single cleavage-stage transfer. Blastocyst transfer resulted in higher preterm birth rates. This information should be used to counsel patients on their choice between cleavage-stage and blastocyst-stage transfer (NCT03152643, https://clinicaltrials.gov/study/NCT03152643 ).

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Publication Details

Journal
Nature Communications
Published
2024-09-05
DOI
https://doi.org/10.1038/s41467-024-52008-y
Citations
17
Primary Topic
Assisted Reproductive Technology and Twin Pregnancy
Type
article
Field-Weighted Citation Impact
18.86

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article

Effect of single blastocyst-stage versus single cleavage-stage embryo transfer on cumulative live births in women with good prognosis undergoing in vitro fertilization: Multicenter Randomized Controlled Trial

Yuhua Shi, Feng Chen, Yichun Guan, Yingying Yuan et al.
17 citations
Nature Communications
Assisted Reproductive Technology and Twin Pregnancy
18.86
article

Effect of single blastocyst-stage versus single cleavage-stage embryo transfer on cumulative live births in women with good prognosis undergoing in vitro fertilization: Multicenter Randomized Controlled Trial

Yuhua Shi, Feng Chen, Yichun Guan, Yingying Yuan, Junli Zhao, Caihua Li, Jichun Tan, Pingping Kong, Honggang Yi, Cuilian Zhang, Jiaoyan Liu, Zhibin Hu, Ben W. Mol, Bo Zhang, Hong Li, Jing Wang, Haiying Liu, Yao Lu, Yunxia Cao, Yun Sun, Heping Zhang, Xiang Ma, Ling Huang, Jianqiao Liu, Xing Xin, Zi‐Jiang Chen, Ze Wang
article en
17 citations

Abstract

In this multicenter, non-inferiority, randomized trial, we randomly assigned 992 women undergoing in-vitro fertilization (IVF) with a good prognosis (aged 20-40, ≥3 transferrable cleavage-stage embryos) to strategies of blastocyst-stage (n = 497) or cleavage-stage (n = 495) single embryo transfer. Primary outcome was cumulative live-birth rate after up to three transfers. Secondary outcomes were cumulative live-births after all embryo transfers within 1 year of randomization, pregnancy outcomes, obstetric-perinatal complications, and livebirths outcomes. Live-birth rates were 74.8% in blastocyst-stage group versus 66.3% in cleavage-stage group (relative risk 1.13, 95%CI:1.04-1.22; P<sub>non-inferiority</sub> < 0.001, P<sub>superiority</sub> = 0.003) (1-year cumulative live birth rates of 75.7% versus 68.9%). Blastocyst transfer increased the risk of spontaneous preterm birth (4.6% vs 2.0%; P = 0.02) and neonatal hospitalization >3 days. Among good prognosis women, a strategy of single blastocyst transfer increases cumulative live-birth rates over single cleavage-stage transfer. Blastocyst transfer resulted in higher preterm birth rates. This information should be used to counsel patients on their choice between cleavage-stage and blastocyst-stage transfer (NCT03152643, https://clinicaltrials.gov/study/NCT03152643 ).

Nature CommunicationsVol. 15(1)
Shandong University (CN), Shanghai Jiao Tong University (CN), Anhui Medical University (CN), Renji Hospital (CN), Yale University (US), Third Affiliated Hospital of Guangzhou Medical University (CN), Suzhou Municipal Hospital (CN), Monash Health (AU), Ningxia Medical University (CN), Guangxi Maternal and Child Health Hospital (CN), Henan Provincial People's Hospital (CN), First Affiliated Hospital of Anhui Medical University (CN), Institut de Médecine de la Reproduction (FR), Ningxia Medical University General Hospital (CN), Third Affiliated Hospital of Zhengzhou University (CN), State Key Laboratory of Reproductive Medicine, Monash University (AU), Nanjing Medical University (CN), China Medical University (CN), Guangzhou Medical University (CN)
University of Pennsylvania, Pennsylvania State University, Shandong University, National Natural Science Foundation of China, Nanjing Medical University, Penn State College of Medicine, National Key Research and Development Program of China
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Assisted Reproductive Technology and Twin Pregnancy
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