Building a model to increase live birth rate through patient-specific optimization of embryo transfer day

Abstract

Purpose Many practices are moving away from cleavagestage transfer in favor of blastocyst transfer. The purpose of this study is to evaluate how the overall live birth rate for fresh IVF cycles may increase by optimizing the day of transfer for each patient. Methods This is a retrospective cohort study of 1225 first fresh autologous IVF cycles performed between May 2012 and November 2013. Stepwise logistic regression was used to determine characteristics associated with live birth following cleavage-stage versus blastocyst transfer. The optimal transfer day (i.e., the day that maximized the odds of live birth) was determined for each patient, and the actual live birth rate was compared with the projected rate had each patient undergone transfer on her optimal day. Results With transfer on the optimal day for each patient, the overall birth rate would have increased from its actual value of 34.8 % to a projected 43.0 %, a 24 % increase. The majority of this increase (21 %) was due to optimization of patients who underwent cleavage-stage transfer but had a higher projected birth rate from blastocyst transfer. These patients were older (37.8 versus 36.0 years, p < 0.01) and had more follicles ≥18 mm than patients who should have remained with a cleavage-stage transfer. Conclusions A model can be built enabling patient-specific identification of optimal transfer day; within this discovery cohort, such optimization was estimated to increase live birth following a fresh transfer by 24 %. This study suggests blastocyst transfer should be more widely offered; however, there remain patients for whom a cleavage-stage transfer may yield better outcomes.

Cumulative live birth rates following blastocyst- versus cleavage-stage embryo transfer in the first complete cycle of IVF: a population-based retrospective cohort study

“…A. et al, 2010), our study was able to link embryo transfer episodes together to give a clear picture of the chance of success over a complete cycle of IVF/ICSI. The use of national linked data gives our study increased power and generalisability to expand upon the findings of smaller single-site studies that have estimated CLBRs for blastocyst and cleavage stage transfers (De Vos et al, 2016, Goldman et al, 2016, Yin et al, 2017.…”

Use of imaging software for assessment of the associations among zona pellucida thickness variation, assisted hatching, and implantation of day 3 embryos

“…Investigation of less studied characteristics of day 3 embryos such as the ZPTV is vital as we continually try to improve our ability to hone noninvasive approaches for assessment of developmental competency. Indeed, for patients who are unable to develop blastocysts in culture, and for older patients who have decreased ovarian response, cleavage stage embryo transfer might be the patient's best and only option [31].…”

Estimating the causal effect of embryo transfer day on clinical in vitro fertilization outcomes using propensity score matching

“…Embryo transfer day was regressed on a series of observed baseline covariates to derive a propensity score for each IVF cycle. The baseline covariates selected in the propensity score model were based on the literature as well as their clinical implications [ 18 ]. The variables ( X j i , j =1,..., J ) contributed to the propensity score included: age (linear and quadratic terms), body mass index (BMI), AMH, tubal factor (divided into six categories: undecided, removed, patent, sticking, ligation and obstructed for both left and right side of Fallopian tubes), sperm motility, sperm count, normal sperm morphology, azoospermia, polycystic ovarian syndrome (PCOS), Gonal-F, menotropin, rLH, peak estradiol, day of trigger, number of follicles, number of oocytes retrieved, number of embryos transferred, number of embryos frozen, number of mature oocytes and ICSI vs. IVF.…”