Experience with a patient-friendly, mandatory, single-blastocyst transfer policy: the power of one

Abstract

Objective: To determine whether a mandatory single-blastocyst transfer (mSBT) algorithm reduced multiple gestation rates without sacrificing clinical pregnancy rates.

Design: Retrospective review.

Setting: U.S. university-based assisted reproductive technology (ART) program.

Patient(s): All women younger than 38 years undergoing their first ART cycle from 2009 to 2010 with ≥4 high-grade embryos on day 3 after oocyte retrieval (patients from 2009 were the "before" group, and patients completing ART under the mSBT policy in 2010 were the "after" group).

Intervention(s): mSBT algorithm.

Main outcome measure(s): Multiple gestation and clinical pregnancy rates.

Result(s): Of the qualified patients, 136 women met inclusion criteria (62 from 2009, 74 from 2010). The baseline demographics were similar between the groups. Statistically significantly fewer blastocysts were transferred per patient in 2010 compared with 2009 (1.5 vs. 1.9). The clinical pregnancy rates before (67.7%) or after (63.5%) the mSBT policy were not statistically significantly different. Multiple gestation rates were statistically significantly reduced, from 43.8% (2009) to 14.6% (2010) after the mSBT policy was instituted. More patients from 2010 had ≥1 blastocyst cryopreserved compared with 2009 (52.9% vs. 30.6%).

Conclusion(s): A novel single-blastocyst transfer algorithm reduced multiple gestation rates and improved cryopreservation rates without compromising clinical pregnancy rates in good-prognosis patients.

FIGURE 1

Summary of the mandatory single-blastocyst transfer (mSBT) algorithm from study inclusion to embryo transfer. Patients <38 years old and undergoing their first assisted reproductive technology (ART) cycle were included in the analysis (Box 1). On day 3 after oocyte retrieval (Box 2), patients with at least four high-grade embryos were encouraged to proceed to a day-5 blastocyst transfer. If the patient agreed to the mSBT policy, the embryos were placed in extended culture. If the patient declined the mSBT policy, two cleavage-stage embryos were transferred on day 3. On day 5 after oocyte retrieval (Box 3), patients who agreed to the mSBT had a transfer of a single high-grade blastocyst. If the blastocyst was less than “BB” grade, the patient was given the option to transfer one or two blastocysts. Csokmay. Single-blastocyst transfer algorithm. Fertil Steril 2011.

FIGURE 2

(A) Summary of the percentage of blastocysts transferred per patient (y axis) over time per quarter year (Q1–4) from 2009 to 2010 (x axis). Transfers of a single blastocyst (red line) increased after the institution of the mandatory single-blastocyst transfer (mSBT) policy as marked with an arrow in January 2010. Conversely, the percentage of two blastocyst transfers (blue line) decreased after the mSBT policy. No patient had more than two blastocysts transferred, so the total percentage of embryos transferred each quarter equals 100%. (B) Percentage of patients accepting or declining a single-blastocyst transfer (x axis) in 2010 (quarters 1–4, y axis) as designated by their agreement or declination of the mandatory single-blastocyst (mSBT) policy. More patients agreed (red bars) to the mSBT as 2010 progressed and fewer patients declined (blue bars). Csokmay. Single-blastocyst transfer algorithm. Fertil Steril 2011.