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Hum. Reprod. Advance Access originally published online on July 29, 2005
Human Reproduction 2005 20(11):3198-3203; doi:10.1093/humrep/dei217
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org

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

Evangelos G. Papanikolaou1,2, Elke D’haeseleer1, Greta Verheyen1, Hilde Van de Velde1, Michael Camus1, Andre Van Steirteghem1, Paul Devroey1 and Herman Tournaye1

1 Centre for Reproductive Medicine, University Hospital, Vrije Univestiteit Brussel (Free University of Brussels), Laarbeeklaaan 101, B-1090, Brussels, Belgium

2To whom correspondence should be addressed. E-mail: Evangelos.Papanikolaou{at}vub.ac.be or drvagpapanikolaou{at}yahoo.gr

INTRODUCTION: In a randomized controlled trial, we assessed whether pregnancy outcome would be improved by extending embryo culture to day 5 and transferring a blastocyst in patients with at least four good-quality embryos on day 3. METHODS: Multifollicular ovarian stimulation was performed with a GnRH agonist in 44% of patients and with a GnRH antagonist in 56%. Overall, 164 patients younger than 37 years fulfilled embryo quality criteria (at least four having at least six cells on the morning of day 3, maximum 20% anucleate fragments) on the third day of culture and were randomized to the day 3 (n = 84) or day 5 (n = 80) groups. Equal numbers of embryos (n = 2) were transferred in each group. RESULTS: Demographics, stimulation parameters and embryological data were comparable in the two groups. Blastocyst-stage transfer resulted in a significantly higher ongoing pregnancy rate [51.3 versus 27.4%; odds ratio (OR) 2.78, 95% confidence interval (CI) 1.45–5.34] and live birth rate (47.5 versus 27.4%; OR 2.40, 95% CI 1.25–4.59) compared with day-3 embryo transfer. A high twin birth rate was observed in both groups (36.8 versus 30.4%; P > 0.05). CONCLUSIONS: A threshold of four good embryos on the third day of embryo culture appears to indicate that the patient will benefit from embryo transfer at the blastocyst stage and have a better chance of achieving a live delivery than with cleavage-stage embryo transfer.

Key words: blastocyst/cleavage-stage embryo/embryo transfer/GnRH antagonist/pregnancy rate


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