Comparison of perinatal outcomes following blastocyst and cleavage-stage embryo transfer: analysis of 10 years’ data from a single centre

Shi, Wenhao; Zhang, Wei; Li, Na; Xue, Xia; Liu, Chen; Qu, Pengfei; Shi, Juanzi; Huang, Chen

doi:10.1016/j.rbmo.2018.12.031

Cited by 28 publications

(46 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A similar result has been found in the recent single centre study by Shi and colleagues (aOR 1.17, 95% CI 1.07-1.30). (Shi et al, 2019). However, in both cases, the association was weak as that reported in our main analysis and likely referable to residual confounding (Ginström Ernstad et al, 2016).…”

Section: Comparison With Other Studiescontrasting

confidence: 57%

“…Three recent register-based studies concurred with our results in reporting no increased risk of PTB and VPTB in singleton pregnancies following blastocyst-stage embryo transfer as compared to cleavage-stage embryo transfer (Ishihara et al, 2014;Chambers et al, 2015;Ginström Ernstad et al, 2016). Another study published in 2019 (Shi et al, 2019), analysing data of IVF/ICSI cycles performed in a single Chinese centre between January 2006 and December 2015, did not find any significant differences in the proportions of PTB (aOR 0.99, 95% CI 0.71-1.37) and VPTB (aOR 2.56, 95% CI 0.97-6.78) between singleton pregnancies after fresh blastocyst-stage and those after fresh cleavage-stage embryo transfer. On the other hand, three older register-based studies reported a higher risk of PTB and VPTB in singleton pregnancies following blastocyst-stage embryo transfer as compared to cleavage-stage embryo transfer (Källén et al, 2010a;Kalra et al, 2012;Dar et al, 2013).…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…Although there are a number of advantages, there are conflicting data on perinatal outcomes of singleton pregnancies resulting from blastocyst-stage embryo transfer. Some studies are suggesting a higher risk of preterm birth (PTB), very preterm birth (VPTB) and large for gestational age (LGA) babies, after blastocyst-stage embryo transfer as compared to cleavagestage embryo transfer (Maheshwari et al, 2013;Wang et al, 2017;Alviggi et al, 2018), whereas others have shown no difference (Litzky et al, 2018;Shi et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Perinatal outcomes in singleton live births after fresh blastocyst-stage embryo transfer: a retrospective analysis of 67 147 IVF/ICSI cycles

et al. 2019

View full text Add to dashboard Cite

STUDY QUESTION Are perinatal outcomes different between singleton live births conceived from fresh blastocyst transfer and those following the transfer of fresh cleavage-stage embryos? SUMMARY ANSWER Fresh blastocyst transfer does not increase risks of preterm birth (PTB), low/high birth weight or congenital anomaly and does not alter the sex ratio at birth or prejudice the chance of having a healthy baby. WHAT IS KNOWN ALREADY Extended embryo culture is currently considered the best option for embryo selection, but concerns have been raised about increased risks of preterm delivery and large-for-gestational-age (LGA) babies. STUDY DESIGN, SIZE, DURATION We conducted a retrospective cohort study based on data from the Human Fertilisation and Embryology Authority (HFEA) anonymised and cycle-based dataset in the UK between 1999 and 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS Baseline characteristics were compared between in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) blastocyst-stage and cleavage-stage embryo transfer cycles using the χ2 test for categorical/dichotomised covariates and the Mann–Whitney test for continuous covariates. Statistical significance was set at <0.005. Poisson regression and multinomial logistic regression were used to establish relationships between perinatal outcomes and blastocyst-stage embryo transfer or cleavage-stage embryo transfer. Risk ratios (RRs), adjusted risk ratios (aRRs) and their 99.5% confidence intervals (CIs) were calculated as a measure of strength of associations. Results were adjusted for clinically relevant covariates. A sub-group analysis included women undergoing their first IVF/ICSI treatment. The level of significance was set at <0.05, and 95% CIs were calculated in the sub-group analysis. MAIN RESULTS AND THE ROLE OF CHANCE Of a total of 67 147 IVF/ICSI cycles, 11 152 involved blastocyst-stage embryo(s) and 55 995 involved cleavage-stage embryo(s). The two groups were comparable with regards to the risk of PTB (aRR, 1.00; 99.5% CI, 0.79–1.25), very-preterm birth (VPTB) (aRR, 1.00; 99.5% CI, 0.63–1.54), very-low birth weight (VLBW) (aRR, 0.84; 99.5% CI, 0.53–1.34), low birth weight (LBW) (aRR, 0.92; 99.5% CI, 0.73–1.16), high birth weight (HBW) (aRR, 0.94; 99.5% CI, 0.75–1.18) and very-high birth weight (VHBW) (aRR, 1.05; 99.5% CI, 0.66–1.65). The risk of congenital anomaly was 16% higher in the blastocyst-stage group than in the cleavage-stage group, but this was not statistically significant (aRR, 1.16; 99.5% CI, 0.90–1.49). The chance of having a healthy baby (born at term, with a normal birth weight and no congenital anomalies) was not altered by extended culture (aRR, 1.00; 99.5% CI, 0.93–1.07). Extended culture was associated with a marginal increase in the chance having a male baby in the main cycle-based analysis (aRR, 1.04; 99.5% CI, 1.01–1.09) but not in the sub-group analysis of women undergoing their first cycle of treatment (aRR, 1.04; 95% CI, 1.00–1.08). In the sub-group analysis, the risk of congenital anomalies was significantly higher after blastocyst-stage embryo transfer (aRR, 1.42; 95% CI, 1.12–1.81). LIMITATIONS, REASONS FOR CAUTION This study is limited by the use of observational data and inability to adjust for key confounders, such as maternal smoking status and body mass index (BMI), which were not recorded in the HFEA dataset. As the main analysis was cycle-based and we were unable to link cycles within women undergoing more than one IVF/ICSI cycle, we undertook a sub-group analysis on women undergoing their first treatment cycle. WIDER IMPLICATIONS OF THE FINDINGS Our findings should reassure women undergoing blastocyst-stage embryo transfer. For the first time, we have shown that babies born after blastocyst transfer have a similar chance of being healthy as those born after cleavage-stage embryos transfer. STUDY FUNDING/COMPETING INTEREST(S) The research activity of Dr Nicola Marconi was funded by the scholarship ‘A. Griffini-J. Miglierina’, Fondazione Comunitaria del Varesotto, Provincia di Varese, Italy. The authors do not have any competing interests to disclose. TRIAL REGISTRATION NUMBER N/A

show abstract

Section: Comparison With Other Studiescontrasting

confidence: 57%

Section: Comparison With Other Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Perinatal outcomes in singleton live births after fresh blastocyst-stage embryo transfer: a retrospective analysis of 67 147 IVF/ICSI cycles

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In addition, even PTB was observed to be higher in blastocyst transfer as compared with cleavage transfer in most previous studies ( 16 – 18 ), while other studies still showed conflicting results ( 19 ). We believe that several reasons may explain the controversy between previous studies: First, most studies, including ours, did not cover all possible PTB related confounders in analysis.…”

Section: Discussionmentioning

confidence: 83%

Preterm Birth in Assisted Reproductive Technology: An Analysis of More Than 20,000 Singleton Newborns

Zhang

et al. 2020

Front. Endocrinol.

View full text Add to dashboard Cite

Background: Several studies have shown that newborns conceived through the ART procedures were associated with an increased incidence of preterm delivery compared to those conceived spontaneously regardless of the type of ART procedure. The aim of the study was to explore risk factors for preterm birth (PTB) in assisted reproductive technology. Method: In this single center retrospective cohort study, a total of 23,111 singleton newborns from January 2010 to December 2018 were included. The primary outcome in this study was preterm birth, defined as live birth before 37 weeks' gestation. Result: In the 23,111 pregnancies, the incidence of PTB was 7.13%. In multivariate logistic regression analysis model, BMI was an independent predictor for PTB (OR = 1.05, 95% CI: 1.03-1.07; P = 0.00 in IVF/ICSI cycles; OR = 1.08, 95% CI: 1.03-1.12; P = 0.00 in IUI cycles). Also, another independent predictor in ART was male newborns (OR = 1.27, 95% CI: 1.14-1.41; P = 0.00 in IVF/ICSI cycles; OR = 1.60, 95% CI: 1.17-2.18; P = 0.00 in IUI cycles). In IVF/ICSI cycles, PTB was significantly higher in patients with advanced age (9.56% in ≥ 38 years old), and in patients with a history of cesarean section (10.39%). In addition, Blastocyst transfer, and frozen thawed transfer were also risk factor for PTB as compared with cleavage transfer, and fresh transfer, respectively. Moreover, in frozen thawed transfer cycles, stimulated protocol (estrogen-progesterone) increased PTB as compared with natural protocol (OR = 1.33, 95% CI: 1.12-1.59; P = 0.00). This situation was similar in IUI cycles as stimulated protocol also increased PTB when compared with natural protocol (OR = 1.72, 95% CI: 1.19-2.48; P = 0.00). Conclusion: Body mass index (BMI), delivery with male newborn, as well as stimulated protocols, were independent risk factors for PTB in both IVF/ICSI and IUI treatment cycles. In IVF/ICSI cycles, independent risk factors also included maternal, history of cesarean section, frozen thawed transfer, and blastocyst transfer.

show abstract

“…Based on the literature (24,25), we collected all potential correlated factors of perinatal outcomes from the records. These include the year of embryo transfer (2006-2009, 2010-2012, or 2013-2015), maternal age, gravidity (0, 1-2, or, ≥3), parity (0 or ≥1), main etiology of infertility (tubal factor, ovarian factor, male factor, or other reasons), sperm donation (yes or no), fertilization method (ICSI, IVF, or IVF + ICSI), fresh/frozen embryo transfer, blastocyst/cleavage-stage transfer, assisted hatching (yes or no), antral follicle count, basal serum follicle-stimulating hormone (FSH) level, endometrial thickness, maternal smoking history (yes or no), and gestational weight gain.…”

Section: Confounding Variablesmentioning

confidence: 99%

Effect of the Interaction Between Pre-pregnancy Body Mass Index and Fresh/Frozen Embryo Transfer on Perinatal Outcomes of Assisted Reproductive Technology-Conceived Singletons: A Retrospective Cohort Study

Zhao

et al. 2020

Front. Endocrinol.

Self Cite

View full text Add to dashboard Cite

show abstract

Comparison of perinatal outcomes following blastocyst and cleavage-stage embryo transfer: analysis of 10 years’ data from a single centre

Cited by 28 publications

References 32 publications

Perinatal outcomes in singleton live births after fresh blastocyst-stage embryo transfer: a retrospective analysis of 67 147 IVF/ICSI cycles

Perinatal outcomes in singleton live births after fresh blastocyst-stage embryo transfer: a retrospective analysis of 67 147 IVF/ICSI cycles

Preterm Birth in Assisted Reproductive Technology: An Analysis of More Than 20,000 Singleton Newborns

Effect of the Interaction Between Pre-pregnancy Body Mass Index and Fresh/Frozen Embryo Transfer on Perinatal Outcomes of Assisted Reproductive Technology-Conceived Singletons: A Retrospective Cohort Study

Contact Info

Product

Resources

About