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Maximizing pregnancy rates and limiting higher-order multiple conceptions by determining the optimal number of embryos to transfer based on quality
Article
Objective: To define statistical thresholds for the number of embryos to be transferred to achieve an optimal pregnancy rate and keep higher-order multiple conceptions (pregnancy with more than two fetal sacs with cardiac activity) within an acceptable limit. Design: A retrospective review of patient records. Setting: Private practice assisted reproductive technology (ART) facility. Patient(s): Seven hundred fifty-four consecutive patients who underwent IVF-ET from 1994-1996. Intervention(s): Embryo grading and score system used on day 3 of embryo transfer. Main Outcome Measure(s): Implantation, pregnancy, and multiple conception rates. Result(s): For women ≤35 years old, transfer of up to four poor-quality, two fair-quality, or two good-quality embryos is optimal to eliminate any risk of higher-order multiple pregnancies. Transfer of four poor-quality, three fair-quality, or two good-quality embryos is recommended for women 36 to 39 years old. In women who are ≤40 years old, five embryos need to be transferred regardless of embryo quality. Conclusion(s): The mean cumulative embryo score can be used as a reference to determine an optimal number of embryos to transfer and to predict pregnancy outcome.
