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

• Published in: Nature communications 2024-09, Vol.15 (1), p.7747-13, Article 7747
• Main Authors: Ma, Xiang, Wang, Jing, Shi, Yuhua, Tan, Jichun, Guan, Yichun, Sun, Yun, Zhang, Bo, Zhao, Junli, Liu, Jianqiao, Cao, Yunxia, Li, Hong, Zhang, Cuilian, Chen, Feng, Yi, Honggang, Wang, Ze, Xin, Xing, Kong, Pingping, Lu, Yao, Huang, Ling, Yuan, Yingying, Liu, Haiying, Li, Caihua, Mol, Ben Willem J., Hu, Zhibin, Zhang, Heping, Chen, Zi-Jiang, Liu, Jiayin
• Format: Article
• Language: English
• Subjects: 692/308/2779/777; 692/308/409; Adult; Birth; Birth rate; Blastocyst; Cleavage; Cleavage Stage, Ovum; Embryo transfer; Embryo Transfer - methods; Embryos; Female; Fertilization in Vitro - methods; Humanities and Social Sciences; Humans; In vitro fertilization; Live Birth - epidemiology; multidisciplinary; Neonates; Pregnancy; Pregnancy complications; Pregnancy Outcome - epidemiology; Pregnancy Rate; Premature birth; Premature Birth - epidemiology; Prognosis; Randomization; Science; Science (multidisciplinary); Single Embryo Transfer; Young Adult
• ISSN: 2041-1723; 2041-1723
• DOI: 10.1038/s41467-024-52008-y

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 non-inferiority  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 ). This randomized trial assessed the effectiveness and safety of single blastocyst transfer vs single cleavage-stage embryo transfer among women with good prognosis. Here, the authors show improved cumulative live birth rates and relatively unfavorable perinatal outcomes after blastocyst transfer.