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Hum. Reprod. Advance Access published online on October 26, 2007
Human Reproduction, doi:10.1093/humrep/dem339
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© The Author 2007. 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@oxfordjournals.org

Live birth rates after transfer of equal number of blastocysts or cleavage-stage embryos in IVF. A systematic review and meta-analysis

Evangelos G. Papanikolaou1, Efstratios M. Kolibianakis, Herman Tournaye, Christos A Venetis, Human Fatemi, Basil Tarlatzis and Paul Devroey

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

1Correspondence address. Tel: +32-2-4261042/4776607; E-mail: evangelos.papanikolaou{at}vub.ac.be/ drvagpapanikolaou{at}yahoo.gr

BACKGROUND: Both cleavage-stage and blastocyst-stage embryo transfer policies have advantages and drawbacks. The number of embryos transferred, however, is a crucial parameter that needs to be considered before attempting any comparison.

METHODS: An extensive literature search yielded initially 282 studies from which 8 randomized controlled trials met the inclusion criteria: (i) truly randomized design (ii) policy to transfer equal number of embryos in both the cleavage-stage and the blastocyst-stage groups and (iii) published as full text in a peer-review journal. Primary outcome was the live birth rate and secondary outcomes were clinical pregnancy rate, multiple pregnancy rate, cancellation rate and cryopreservation rate.

RESULTS: A total of 1654 patients were reviewed. Live birth rate per randomized patient was significantly higher (n = 6 studies) in patients who had a blastocyst-stage transfer as compared to patients with cleavage-stage embryo transfer [odds ratio (OR): 1.39, 95% confidence interval (CI): 1.10–1.76; P = 0.005]. Clinical pregnancy rate (OR: 1.27, 95% CI: 1.03–1.55; P = 0.02) and cancellation rate per patient randomized (OR: 2.21, 95% CI: 1.47–3.32; P = 0.0001) were significantly higher in patients with a blastocyst-stage embryo transfer as compared to patients in whom a cleavage-stage embryo transfer was performed. The cryopreservation rate was significantly higher in the cleavage-stage group (OR: 0.28, 95% CI: 0.14–0.55; P = 0.0002).

CONCLUSIONS: The best available evidence suggests that the probability of live birth after fresh IVF is significantly higher after blastocyst-stage embryo transfer as compared to cleavage-stage embryo transfer when equal number of embryos are transferred in the two groups compared.

Key words: meta-analysis/live birth rate/blastocyst/embryo transfer/cleavage stage

Submitted on May 30, 2007; resubmitted on August 24, 2007; accepted on September 27, 2007.


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