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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front. Med.    2017, Vol. 11 Issue (4) : 563-569    https://doi.org/10.1007/s11684-017-0535-6
RESEARCH ARTICLE |
Propensity score-matched study and meta-analysis of cumulative outcomes of day 2/3 versus day 5/6 embryo transfers
Ye Yin1, Ge Chen1, Kezhen Li2, Qiuyue Liao1, Sijia Zhang1, Nieying Ma1, Jing Chen2, Yan Zhang2, Jihui Ai1()
1. Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
2. Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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Abstract

The superiority of the cumulative outcomes of day 5/6 embryo transfer to those of day 2/3 embryo transfer in infertile couples has been debated. This retrospective study included data collected from 1051 patients from July 2011 to June 2014. Multiple maternal baseline covariates were subjected to propensity score matching analysis, and each day 5/6 group woman was matched to one day 2/3 group woman. A systematic meta-analysis was conducted to validate the results. After matching was completed, 217 patients on the day 2/3 group were matched with those on the day 5/6 group, and no significant differences in the baseline characteristics were observed between the two groups. The cumulative pregnancy rate (57.14% vs. 53.46%, OR 1.16, 95% CI 0.79–1.70) and cumulative live birth rate (53.00% vs. 49.77%, OR 1.14, 95% CI 0.78–1.66) of day 5/6 embryo transfers were higher than those of day 2/3 embryo transfers, but this difference was not significant. The mean cycles per live birth and mean days per live birth in the day 5/6 group were significantly lower than those in the day 2/3 group. This study demonstrated that day 5/6 embryo transfer is a more cost-effective and time-efficient policy than day 2/3 embryo transfer to produce a live baby.

Keywords blastocyst      embryo transfer      cumulative pregnancy rate      cumulative live birth rate      IVF     
Corresponding Authors: Jihui Ai   
Just Accepted Date: 08 June 2017   Online First Date: 25 July 2017    Issue Date: 04 December 2017
 Cite this article:   
Ye Yin,Ge Chen,Kezhen Li, et al. Propensity score-matched study and meta-analysis of cumulative outcomes of day 2/3 versus day 5/6 embryo transfers[J]. Front. Med., 2017, 11(4): 563-569.
 URL:  
http://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0535-6
http://academic.hep.com.cn/fmd/EN/Y2017/V11/I4/563
Fig.1  Study design.
CharacteristicsDay 5/6 groupBefore matchingAfter matching
Day 2/3 groupP valueDay 2/3 groupP value
No. of patients217834217
No. of cycles (mean±SD)1.28±0.6521.26±0.5420.5701.29±0.5660.814
Female age (year, mean±SD)30.86±4.6031.75±4.650.01230.19±4.150.113
Basal FSH (mIU/ml, mean±SD)6.67±1.737.24±2.09<0.0016.58±1.470.562
Duration of infertility
(year, mean±SD)
4.7±3.25.0±3.90.274.9±3.90.48
Primary infertility (%)51.551.40.3551.60.923
Diagnosis
Tubal factor (%)40.043.90.9544.00.437
Anovulation (%)5.55.80.896.00.84
Male factor (%)20.014.70.06815.00.20
Idiopathic (%)6.44.50.255.00.53
Mix (%)28.231.00.42300.67
Tab.1  Baseline characteristics of patients before and after the propensity score matching
CharacteristicsDay 5/6 groupBefore matchingAfter matching
Day 2/3 groupP valueDay 2/3 groupP value
E2 value on hCG day4709±23204056±25090.0014548±23020.469
P value on hCG day1.20±0.471.14±0.640.2071.16±0.520.496
No. of oocytes retrieved15.87±5.2513.10±5.23<0.00114.93±5.120.062
No. of mature oocytes13.04±4.1511.15±3.35<0.00112.85±3.220.594
No. of 2PN9.42±5.627.66±4.82<0.0018.62±4.410.100
No. of embryos5.87±3.914.75±3.82<0.0015.32±3.710.076
No. of vitrified embryos2.73±2.412.27±2.190.0112.78±2.210.803
Tab.2  Ovarian stimulation outcomes of patients before and after the propensity score matching
CharacteristicsDay 5/6 groupBefore matchingAfter matching
Day 2/3 groupP valueDay 2/3 groupP value
No. of patients76573146
No. of embryos transferred (mean±SD)1.89±0.51.99±0.380.3012.00±0.40.081
PR per transfer cycle, n (%)38 (50.00)266 (46.42)0.55769 (47.26)0.698
BR per transfer cycle, n (%)35 (46.05)227 (39.61)0.28459 (40.41)0.420
Abortion rate, n (%)3 (7.89)34 (12.78)0.3949 (13.04)0.424
Ectopic pregnancy rate, n (%)0 (0)5 (1.88)0.7461 (1.45)0.751
Tab.3  Clinical outcome of patients in fresh cycle before and after the propensity score matching
CharacteristicsDay 5/6 groupBefore matchingAfter matching
Day 2/3 groupP valueDay 2/3 groupP value
No. of patients148508112
No. of transfer cycles171684160
Embryo survival rate, n/n (%)332/342
(97.08)
1340/1380
(97.10)
0.980312/321
(97.20)
0.926
PR per transfer cycle, n(%)92 (53.80)244 (35.67)<0.00168 (42.50)<0.001
BR per transfer cycle, n(%)80 (46.78)172 (25.15)<0.00149 (30.63)<0.001
Tab.4  Clinical outcome of patients in frozen cycles before and after the propensity score matching
CharacteristicsDay 5/6 groupBefore matchingAfter matching
Day 2/3 groupP valueDay 2/3 groupP value
No. of patients217834217
CPR, n (%)124 (57.14)434 (52.04)0.180116 (53.46)0.440
CBR, n (%)115 (53.00)399 (47.84)0.177108 (49.77)0.502
Mean cycles per live birth (mean±SD)1.11±0.321.32±0.55<0.0011.50±0.65<0.001
Mean days per live birth (mean±SD)336.33±60.07358.13±105.660.035373.67±129.960.006
Tab.5  Cumulative clinical outcomes of patients before and after the propensity score matching
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