Cumulative live birth rate of a blastocyst versus cleavage stage embryo transfer policy during in vitro fertilisation in women with a good prognosis: multicentre randomised controlled trial

被引：8

作者：

Cornelisse, Simone ^{[1
]}

Fleischer, Kathrin ^{[2
]}

van der Westerlaken, Lucette ^{[3
]}

de Bruin, Jan-Peter ^{[4
]}

Vergouw, Carlijn ^{[5
]}

Koks, Carolien ^{[6
]}

Derhaag, Josien ^{[7
]}

Visser, Jantien ^{[8
]}

van Echten-Arends, Jannie ^{[9
]}

Slappende, Els ^{[2
]}

Arends, Brigitte ^{[10
]}

van der Zanden, Moniek ^{[11
]}

van Dongen, Angelique ^{[12
]}

Brink-van der Vlugt, Janneke ^{[13
]}

de Hundt, Marcella ^{[14
]}

Curfs, Max ^{[15
]}

Verhoeve, Harold ^{[16
]}

Traas-Hofmans, Maaike ^{[17
,18
]}

Wurth, Yvonne ^{[19
]}

Manger, Petra ^{[20
]}

Pieterse, Quirine ^{[21
]}

Braat, Didi ^{[1
]}

van Wely, Madelon ^{[22
,23
]}

Ramos, Liliana ^{[1
]}

Mastenbroek, Sebastiaan ^{[22
,23
]}

机构：

[1] Radboud Univ Nijmegen, Dept Obstet & Gynaecol, Med Ctr, Nijmegen, Netherlands

[2] Nij Geertgen, Ctr Fertil, Elsendorp, Netherlands

[3] Leiden Univ, Reprod Ctr, Med Ctr, Leiden, Netherlands

[4] Jeroen Bosch Ziekenhuis, Dept Obstet & Gynaecol, Shertogenbosch, Netherlands

[5] Vrije Univ Amsterdam, Ctr Reprod Med, Amsterdam UMC Locat, Amsterdam, Netherlands

[6] Maxima Med Ctr, Dept Obstet & Gynaecol, Veldhoven, Netherlands

[7] MUMC, Ctr Reprod Med, Maastricht, Netherlands

[8] Amphia Ziekenhuis, Dept Obstet & Gynaecol, Breda, Netherlands

[9] Univ Med Ctr Groningen, Ctr Reprod Med, Groningen, Netherlands

[10] Univ Med Ctr Utrecht, Dept Reprod Med, Utrecht, Netherlands

[11] Haaglanden Med Ctr, Dept Obstet & Gynaecol, The Hague, Netherlands

[12] Hosp Gelderse Vallei, Dept Obstet & Gynaecol, Ede, Netherlands

[13] Nij Barrahus, Ctr Fertil, Wolvega, Netherlands

[14] NoordWest Ziekenhuisgrp, Dept Obstet & Gynaecol, Alkmaar, Netherlands

[15] Isala Clin, Isala Fertil Ctr, Zwolle, Netherlands

[16] OLVG Oost, Dept Obstet & Gynaecol, Amsterdam, Netherlands

[17] Gelre Ziekenhuizen, Dept Obstet & Gynaecol, Apeldoorn, Netherlands

[18] Gelre Ziekenhuizen, Dept Obstet & Gynaecol, Zutphen, Netherlands

[19] Elisabeth TweeSteden Ziekenhuis, IVF Ctr, Tilburg, Netherlands

[20] Diakonessen Hosp, Dept Obstet & Gynaecol, Utrecht, Netherlands

[21] Haga Ziekenhuis, Dept Obstet & Gynaecol, The Hague, Netherlands

[22] Locat Univ Amsterdam, Ctr Reprod Med, Amsterdam UMC, Amsterdam, Netherlands

[23] Amsterdam Reprod & Dev Res Inst, Amsterdam, Netherlands

来源：

BMJ-BRITISH MEDICAL JOURNAL | 2024年 / 386卷

关键词：

CRYOPRESERVATION; SINGLETONS; SET; AGE;

D O I：

10.1136/bmj-2024-080133

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVES To evaluate whether embryo transfers at blastocyst stage improve the cumulative live birth rate after oocyte retrieval, including both fresh and frozenthawed transfers, and whether the risk of obstetric and perinatal complications is increased compared with cleavage stage embryo transfers during in vitro fertilisation (IVF) treatment. DESIGN Multicentre randomised controlled trial. SETTING 21 hospitals and clinics in the Netherlands, 18 August 2018 to 17 December 2021. PARTICIPANTS 1202 women with at least four embryos available on day 2 after oocyte retrieval were randomly assigned to either blastocyst stage embryo transfer (n=603) or cleavage stage embryo transfer (n=599). INTERVENTIONS In the blastocyst group and cleavage group, embryo transfers were performed on day 5 and day 3, respectively, after oocyte retrieval, followed by cryopreservation of surplus embryos. Analysis was on an intention-to-treat basis, with secondary analyses as per protocol. MAIN OUTCOME MEASURES The primary outcome was the cumulative live birth rate per oocyte retrieval, including results of all frozen-thawed embryo transfers within a year after randomisation. Secondary outcomes included cumulative rates of pregnancy, pregnancy loss, and live birth after fresh embryo transfer, number of embryo transfers needed, number of frozen embryos, and obstetric and perinatal outcomes. RESULTS The cumulative live birth rate did not differ between the blastocyst group and cleavage group (58.9% (355 of 603) v 58.4% (350 of 599; risk ratio 1.01, 95% confidence interval (CI) 0.84 to 1.22). The blastocyst group showed a higher live birth rate after fresh embryo transfer (1.26, 1.00 to 1.58), lower cumulative pregnancy loss rate (0.68, 0.51 to 0.89), and lower mean number of embryo transfers needed to result in a live birth (1.55 v 1.82; P<0.001). The incidence of moderate preterm birth (32 to <37 weeks) in singletons was higher in the blastocyst group (1.87, 1.05 to 3.34). CONCLUSION Blastocyst stage embryo transfers resulted in a similar cumulative live birth rate to cleavage stage embryo transfers in women with at least four embryos available during IVF treatment. TRIAL REGISTRATION International Clinical Trial Registry Platform NTR7034.

引用

页数：10

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