Patients of Advanced Maternal Age Should Only Transfer a Single Euploid Blastocyst
Catherine Gordon1, John B Whitney2, Ilene Hatch3, Nancy L Nugent2, Shane Zozula2, Robert E Anderson4 and Mitchel C Schiewe2*
1University of California-Irvine, Department of OB – GYN, Orange, CA 92868, USA
2Ovation Fertility/SCIRS, ART Lab, Newport Beach, CA 92663, USA
3Fertility Center of Southern California, Irvine, CA 92612, USA
4Southern California Center for Reproductive Medicine, Newport Beach, CA 92663, USA
Background: The IVF industry has been trying to reduce high order multiple pregnancies by promoting single embryo transfer for nearly two decades. Although improvements in embryo culture practices concurrently occurred, poor prognosis patients and those of advanced maternal age (≥38 years old) proved to be challenging cases when determining the number of embryos to transfer and yet still optimize pregnancy success. It was not until preimplantation genetic screening (PGS) of blastocysts was coupled with conservative embryo transfer decisions that worldwide progress occurred. The objective of this study was to determine the efficacy of single embryo transfer (SET) compared to dual embryo transfer (DET) in older patients (age ≥38) performing vitrified-warmed, euploid ET cycles.
Methods and findings: Retrospective cohort analysis was performed on 140 vitrified-warmed euploid blastocyst transfers of patients ≥38 years old performing either a SET (n=122) or DET (n=18). All full to hatched blastocysts were initially biopsied on Days 5, 6 or 7, and the trophectoderm samples were analyzed using NGS or aCGH. All transfers represented the patients first transfer attempt following PGS between January 2013 to June 2015. Implantation and live birth results per ET treatment were evaluated and compared using Chi-squared analysis (p<0.05). The average patient age was 39.7 years old, achieving a clinical pregnancy rate of 83% (116/140) and a live birth rate of 80% (112/140). SET achieved a live birth rate of 79.5% (97/122) similar to DET (15/18, 83.3%). Although pregnancy outcome comparisons were not different between age groups or treatments, a trend (p<0.10) toward higher implantation for SET was observed. Most significantly, the twinning rate was appreciably higher (p<0.001) with DET at 73% (11/15) compared to 1% for SET (1/97).
Conclusions: Independent of age, when using euploid blastocysts, we believe that SET should be adopted as the standard of care for clinics utilizing PGS. This is especially true for the first ET attempt by patients of advanced maternal age to optimize implantation rates and reduce the potential wastage of precious euploid embryos.