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Is it time for a paradigm shift in understanding embryo selection?

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Blastocyst stage embryo transfer (BSET) offers limited benefits for most in vitro fertilization (IVF) patients and may decrease pregnancy chances. Newer selection methods relying on BSET also require reevaluation for effectiveness and cost.

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Area of Science:

  • Reproductive Medicine
  • Embryology
  • In Vitro Fertilization

Background:

  • Embryo selection is a key component of in vitro fertilization (IVF).
  • Extended blastocyst culture and elective single embryo transfer (eSET) have made embryo selection routine.
  • Blastocyst stage embryo transfer (BSET) is increasingly common in IVF practices.

Purpose of the Study:

  • To evaluate the effectiveness of blastocyst stage embryo transfer (BSET) in improving IVF outcomes.
  • To assess the impact of BSET on IVF pregnancy chances for different patient groups.
  • To reconsider newer embryo selection methods dependent on BSET.

Main Methods:

  • Analysis of IVF outcomes related to blastocyst stage embryo transfer (BSET).
  • Evaluation of the efficacy of prolonged embryo culture.
  • Review of newer embryo selection techniques like preimplantation genetic screening (PGS) and time-lapse photography in the context of BSET.

Main Results:

  • BSET benefits only a small minority of IVF patients.
  • For most patients, BSET is ineffective or reduces IVF pregnancy chances.
  • Prolonged embryo culture benefits a limited number of patients.

Conclusions:

  • BSET as currently practiced offers limited advantages and may harm IVF outcomes for many.
  • Newer embryo selection methods, reliant on BSET, inherit its limitations and raise cost-effectiveness concerns.
  • The routine use of BSET and associated advanced selection techniques in IVF requires critical reassessment.