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Is there still a role for a cleavage-stage embryo transfer?
Michael F Neblett1,2, Tana Kim3, Tiffanny L Jones4
1Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota.
Objective:
To determine whether pregnancy outcomes are poor or futile when an intended day 5 transfer is converted to a cleavage-stage transfer because of poor embryo development or a lower number of embryos.
Design:
Retrospective cohort study.
Setting:
Academic medical center.
Patients:
Women with a limited number of embryos, defined as ≤6 two pronuclear embryos, after in vitro fertilization.
Interventions:
Patients who had a cleavage-stage transfer were age matched with patients who had a day 5 transfer.
Main Outcome Measures:
Live birth rate.
Results:
A total of 146 women were included in the study with 73 women in each group. Cleavage-stage transfer was associated with significantly lower implantation and clinical pregnancy rates compared with those of day 5 transfer. Although the live birth rate of the cleavage-stage transfer group was lower than that of the day 5 transfer group (25% vs. 40%, respectively), the cleavage-stage transfer still resulted in a live birth rate of 25%. A subanalysis comparing women who did and did not achieve live birth after cleavage-stage transfer demonstrated a live birth rate of 27% when at least one grade A embryo was transferred vs. 17% when a lesser quality embryo (grade B or C) was transferred.
Conclusions:
As expected, the live birth rate after cleavage-stage transfer was lower than that after day 5 transfer. However, the live birth rate of cleavage-stage transfer still fell into acceptable practice, >5%, for patients who were otherwise at very high risk of having no day 5 embryo transfer. Extended culture may not be necessary for all patients.
