Pregnancy and twinning rates using a tailored embryo transfer policy

A tailored embryo transfer policy based on the prognostic profile of the couple was prospectively evaluated. Single-embryo transfer (SET) was performed, followed by double-embryo transfer (DET) in frozen-thawed embryo transfer cycles in women with a good prognosis (<35 years, first cycle, >= 1 top-quality embryo). DET was performed in both fresh and frozen cycles in women with an intermediate prognosis (<35 years, first cycle and no top-quality embryo available, or <35 years and >= 1 failed cycles, or 35-38 years). Triple-embryo transfer (TET) in both fresh and frozen cycles was performed in women with a poor prognosis (>= 39 years). The cumulative ongoing pregnancy rate in the cycles of women with a good prognosis was 43% with a multiple pregnancy rate of 2%, in the cycles of women with an intermediate prognosis 27% and 23% and in the cycles of women with a poor prognosis 18% and 13%, respectively. These findings can be used to guide current practice: i.e. performing SET in women with a good prognosis and TET in women with a poor prognosis. The embryo transfer strategy in women with an intermediate prognosis requires further improvement, possibly by refining the prognosis according to the ovarian response after ovarian stimulation. (C) 2013, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.