Please wait a minute...
Shopping Cart Email List Chinese
Advanced Search Fig/Tab
Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Featured Articles  |  Most Downloaded  |  Most Reading
Online Submission Subscribe to Our RSS Content Feed
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
 Download: PDF(142 KB)   HTML
 Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks
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 Author(s): 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:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0535-6
https://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
1 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. Hum Reprod 1998; 13(12): 3434–3440
pmid: 9886530
2 Hsieh YY, Tsai HD, Chang FC. Routine blastocyst culture and transfer: 201 patients’ experience. J Assist Reprod Genet 2000; 17(8): 405–408
https://doi.org/10.1023/A:1009458215962 pmid: 11062848
3 Van der Auwera I, Debrock S, Spiessens C, Afschrift H, Bakelants E, Meuleman C, Meeuwis L, D’Hooghe TM. A prospective randomized study: day 2 versus day 5 embryo transfer. Hum Reprod 2002; 17(6): 1507–1512
https://doi.org/10.1093/humrep/17.6.1507 pmid: 12042269
4 Smith LP, Oskowitz SP, Dodge LE, Hacker MR. Risk of ectopic pregnancy following day-5 embryo transfer compared with day-3 transfer. Reprod Biomed Online 2013; 27(4): 407–413
https://doi.org/10.1016/j.rbmo.2013.06.015 pmid: 23953586
5 Huang B, Hu D, Qian K, Ai J, Li Y, Jin L, Zhu G, Zhang H. Is frozen embryo transfer cycle associated with a significantly lower incidence of ectopic pregnancy? An analysis of more than 30,000 cycles. Fertil Steril 2014; 102(5): 1345–1349
https://doi.org/10.1016/j.fertnstert.2014.07.1245 pmid: 25241365
6 Alper MM, Brinsden P, Fischer R, Wikland M. To blastocyst or not to blastocyst? That is the question. Hum Reprod 2001; 16(4): 617–619
https://doi.org/10.1093/humrep/16.4.617 pmid: 11278206
7 Tsirigotis M. Blastocyst stage transfer: pitfalls and benefits. Too soon to abandon current practice? Hum Reprod 1998; 13(12): 3285–3289
https://doi.org/10.1093/humrep/13.12.3285 pmid: 9886498
8 Glujovsky D, Blake D, Farquhar C, Bardach A. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev 2012; 7(7): CD002118
pmid: 22786480
9 Barnhart KT. Introduction: are we ready to eliminate the transfer of fresh embryos in in vitro fertilization? Fertil Steril 2014; 102(1): 1–2
https://doi.org/10.1016/j.fertnstert.2014.05.024 pmid: 24890272
10 Lintsen AME, Braat DDM, Habbema JDF, KremerJ AM, Eijkemans MJC. Can differences in IVF success rates between centres be explained by patient characteristics and sample size? Hum Reprod 2010; 25(1): 110–117
https://doi.org/10.1093/humrep/dep358 pmid: 19837684
11 Bodri D, Kawachiya S, De Brucker M, Tournaye H, Kondo M, Kato R, Matsumoto T. Cumulative success rates following mild IVF in unselected infertile patients: a 3-year, single-centre cohort study. Reprod Biomed Online 2014; 28(5): 572–581
https://doi.org/10.1016/j.rbmo.2014.01.002 pmid: 24631167
12 Trokoudes KM, Pavlides C, Zhang X. Comparison outcome of fresh and vitrified donor oocytes in an egg-sharing donation program. Fertil Steril 2011; 95(6): 1996–2000
https://doi.org/10.1016/j.fertnstert.2011.02.035 pmid: 21406304
13 Cobo A, de los Santos MJ, Castellò D, Gámiz P, Campos P, Remohí J. Outcomes of vitrified early cleavage-stage and blastocyst-stage embryos in a cryopreservation program: evaluation of 3,150 warming cycles. Fertil Steril 2012; 98(5): 1138–1146.e1
https://doi.org/10.1016/j.fertnstert.2012.07.1107 pmid: 22862909
14 Loutradi KE, Kolibianakis EM, Venetis CA, Papanikolaou EG, Pados G, Bontis I, Tarlatzis BC. Cryopreservation of human embryos by vitrification or slow freezing: a systematic review and meta-analysis. Fertil Steril 2008; 90(1): 186–193
https://doi.org/10.1016/j.fertnstert.2007.06.010 pmid: 17980870
15 AbdelHafez FF, Desai N, Abou-Setta AM, Falcone T, Goldfarb J. Slow freezing, vitrification and ultra-rapid freezing of human embryos: a systematic review and meta-analysis. Reprod Biomed Online 2010; 20(2): 209–222
https://doi.org/10.1016/j.rbmo.2009.11.013 pmid: 20113959
16 Gleicher N, Kushnir VA, Barad DH. Is it time for a paradigm shift in understanding embryo selection? Reprod Biol Endocrinol 2015; 13(1): 3
https://doi.org/10.1186/1477-7827-13-3 pmid: 25577140
17 Xi QS, Zhu LX, Hu J, Wu L, Zhang HW. Should few retrieved oocytes be as an indication for intracytoplasmic sperm injection? J Zhejiang Univ Sci B 2012; 13(9): 717–722
https://doi.org/10.1631/jzus.B1100370 pmid: 22949362
18 Yu Z, Dong X, Rui W, Wei Y, Zhang H, Zhu G, Ai J. The criteria for optimal down-regulation with gonadotropin-releasing hormone-agonist: a retrospective cohort study. Gynecol Endocrinol 2015; 31(12): 959–965 
https://doi.org/10.3109/09513590.2015.1101437
19 Papanikolaou EGD, D’haeseleer E, Verheyen G, Van de Velde H, Camus M, Van Steirteghem A, Devroey P, Tournaye H. 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(11): 3198–3203
https://doi.org/10.1093/humrep/dei217 pmid: 16055454
20 Yu Z, Dong X, Wei Y, Zhang H, Ai J. The artificial cycle method improves the pregnancy outcome in freeze–thawed embryo transfer: a retrospective cohort study. Gynecol Endocrinol 2015; 31(1): 70–74 
https://doi.org/10.3109/09513590.2014.958988
21 Huang B, Ren X, Wu L, Zhu L, Xu B, Li Y, Ai J, Jin L. Elevated progesterone levels on the day of oocyte maturation may affect top quality embryo IVF cycles. PLoS One 2016; 11(1): e0145895
pmid: 26745711
22 Elgindy EA, Abou-Setta AM, Mostafa MI. Blastocyst-stage versus cleavage-stage embryo transfer in women with high oestradiol concentrations: randomized controlled trial. Reprod Biomed Online 2011; 23(6): 789–798
https://doi.org/10.1016/j.rbmo.2011.08.011 pmid: 22050864
23 Emiliani S, Delbaere A, Vannin AS, Biramane J, Verdoodt M, Englert Y, Devreker F. Similar delivery rates in a blastocyst cryopreservation to optimize outcomes of warming cycles 159 selected group of patients, for day 2 and day 5 embryos both cultured in sequential medium: a randomized study. Hum Reprod 2003; 18(10): 2145–2150
https://doi.org/10.1093/humrep/deg394 pmid: 14507836
24 Rienzi L, Ubaldi F, Iacobelli M, Ferrero S, Minasi MG, Martinez F, Tesarik J, Greco E. Day 3 embryo transfer with combined evaluation at the pronuclear and cleavage stages compares favourably with day 5 blastocyst transfer. Hum Reprod 2002; 17(7): 1852–1855
https://doi.org/10.1093/humrep/17.7.1852 pmid: 12093851
25 Fernández-Shaw S, Cercas R, Braña 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(2): 177–184
pmid: 25403438
[1] FMD-17020-OF-AJH_suppl_1 Download
[1] Qiaohong Lai, Wenpei Xiang, Qing Li, Hanwang Zhang, Yufeng Li, Guijin Zhu, Chengliang Xiong, Lei Jin. Oxidative stress in granulosa cells contributes to poor oocyte quality and IVF-ET outcomes in women with polycystic ovary syndrome[J]. Front. Med., 2018, 12(5): 518-524.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed