COCHRANE REVIEW |
Number of embryos for transfer after IVF and ICSI: a Cochrane review
1 Department of Obstetrics & Gynaecology, Aberdeen Maternity Hospital, Aberdeen AB25 2ZD, UK and 2 Egyptian IVF & ET Center, Maadi, Cairo, Egypt
3 To whom correspondence should be addressed. E-mail: ogy211{at}abdn.ac.uk
This paper is based on a Cochrane review (Pandian Z, Bhattacharya S, Ozturk O, Serour GI, Templeton A. Number of embryos for transfer following in vitro fertilization or intra-cytoplasmic sperm injection) published in the Cochrane Library, issue 4, 2004 (updated issue 2, 2005, see www.CochraneLibrary.net for information) reproduced with permission from The Cochrane Collaboration and John Wiley and Son Ltd. Cochrane reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and The Cochrane Library should be consulted for the most recent version of the review.
BACKGROUND: The most common complication of IVF is multiple pregnancy, which occurs in 25% of pregnancies following the transfer of two embryos. Single embryo transfer can minimize twin pregnancies but could also lower live birth rates. Our aim was to perform a systematic review of randomized trials to determine the effectiveness of single versus double embryo transfer. METHODS: Cochrane Collaboration review methods were followed. Randomized controlled trials comparing single and double embryo transfers were identified by searching Medline, EMBASE and the Cochrane register of controlled trials. Contents of specialist journals and proceedings from meetings of relevant societies were hand searched. Data were pooled with Rev Man software using the Peto-modified Mantel–Hanzel method. RESULTS: Pooled results from four trials indicate that although double embryo transfer leads to a higher live birth rate per woman [odds ratio (OR) 1.94, 95% confidence interval (CI) 1.47–2.55] in a fresh IVF cycle, comparable results are obtained by subsequent transfer of a frozen embryo (OR 1.19, 95% CI 0.87–1.62). The multiple pregnancy rate is significantly higher (OR 62.83, 95% CI 8.52–463.57) after double embryo transfer. CONCLUSIONS: Single embryo transfer significantly reduces the risk of multiple pregnancy, but also decreases the chance of live birth in a fresh IVF cycle. Subsequent replacement of a single frozen embryo achieves a live birth rate comparable with double embryo transfer.
Key words: double embryo transfer/IVF/multiple pregnancies/single embryo transfer
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