Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2021 Aug 13;21(1):554.
doi: 10.1186/s12884-021-04013-y.

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

Han-Chih Hsieh #  1 , Chun-I Lee #  2   3   4 , En-Yu Lai  1 , Jia-Ying Su  1 , Yi-Ting Huang  1   5 , Wei-Lin Zheng  6 , Chien-Hong Chen  4 , Chun-Chia Huang  4 , Pin-Yao Lin  4 , Maw-Sheng Lee  2   3   4 , Mark Liu  6 , Yen-Tsung Huang  7
Affiliations
Comparative Study

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

Han-Chih Hsieh et al. BMC Pregnancy Childbirth. .

Abstract

Background: For women undergoing in vitro fertilization (IVF), the clinical benefit of embryo transfer at the blastocyst stage (Day 5) versus cleavage stage (Day 3) remains controversial. The purpose of this study is to compare the implantation rate, clinical pregnancy rate and odds of live birth of Day 3 and Day 5 embryo transfer, and more importantly, to address the issue that patients were chosen to receive either transfer protocol due to their underlying clinical characteristics, i.e., confounding by indication.

Methods: We conducted a retrospective cohort study of 9,090 IVF cycles collected by Lee Women's Hospital in Taichung, Taiwan from 1998 to 2014. We utilized the method of propensity score matching to mimic a randomized controlled trial (RCT) where each patient with Day 5 transfer was matched by another patient with Day 3 transfer with respect to other clinical characteristics. Implantation rate, clinical pregnancy rate, and odds of live birth were compared for women underwent Day 5 transfer and Day 3 transfer to estimate the causal effects. We further investigated the causal effects in subgroups by stratifying age and anti-Mullerian hormone (AMH).

Results: Our analyses uncovered an evidence of a significant difference in implantation rate (p=0.04) favoring Day 5 transfer, and showed that Day 3 and Day 5 transfers made no difference in both odds of live birth (p=0.27) and clinical pregnancy rate (p=0.11). With the increase of gestational age, the trend toward non-significance of embryo transfer day in our result appeared to be consistent for subgroups stratified by age and AMH, while all analyses stratified by age and AMH were not statistically significant.

Conclusions: We conclude that for women without strong indications for Day 3 or Day 5 transfer, there is a small significant difference in implantation rate in favor of Day 5 transfer. However, the two protocols have indistinguishable outcomes on odds of live birth and clinical pregnancy rate.

Keywords: Blastocyst; Cleavage-stage transfer; Embryo transfer; In vitro fertilization; Indication bias.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CONSORT diagram for data processing
Fig. 2
Fig. 2
Propensity score distribution: a. Day 3 before matching; b. Day 5 before matching; c. Day 3 after matching; d. Day 5 after matching
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Jones G, Trounson A. Blastocyst stage transfer: pitfalls and benefits: The benefits of extended. Hum Reprod (Oxford. Print) 1999;14(6):1405–8. doi: 10.1093/humrep/14.6.1405. - DOI - PubMed
    1. Guerif F, Lemseffer M, Bidault R, Gasnier O, Saussereau M, Cadoret V, Jamet C, Royère D. Single day 2 embryo versus blastocyst-stage transfer: a prospective study integrating fresh and frozen embryo transfers. Hum Reprod. 2009;24(5):1051–8. doi: 10.1093/humrep/dep018. - DOI - PubMed
    1. Schoolcraft W, Gardner D. Blastocyst versus day 2 or 3 transfer. In: Seminars in Reproductive Medicine: 2001. p. 259–68. CopyrightⒸ 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New …. - PubMed
    1. Gardner D, Vella P, Lane M, Wagley L, Schlenker T, Schoolcraft W. Culture and transfer of human blastocysts increases implantation rates and reduces the need for multiple embryo transfers. Fertil Steril. 1998;69(1):84–8. doi: 10.1016/S0015-0282(97)00438-X. - DOI - PubMed
    1. Papanikolaou E, Kolibianakis E, Tournaye H, Venetis C, Fatemi H, Tarlatzis B, Devroey P. Live birth rates after transfer of equal number of blastocysts or cleavage-stage embryos in ivf. a systematic review and meta-analysis. Hum Reprod. 2008;23(1):91–9. doi: 10.1093/humrep/dem339. - DOI - PubMed

Publication types

LinkOut - more resources