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Meta-Analysis
. 2025 Jul;42(7):2119-2140.
doi: 10.1007/s10815-025-03487-5. Epub 2025 May 21.

Sequential embryo transfer efficacy in enhancing pregnancy outcomes: a systematic review and meta-analysis

Noran Magdy Shalma  1 , Ahmed M Talaia  2 , Mohamed R Abdelraouf  3 , Mostafa Abdullah Alsharabasy  4 , Ayah Abdulgadir  5 , Nada K Abdelsattar  6 , Mohamed Abd-ElGawad  6
Affiliations
Meta-Analysis

Sequential embryo transfer efficacy in enhancing pregnancy outcomes: a systematic review and meta-analysis

Noran Magdy Shalma et al. J Assist Reprod Genet. 2025 Jul.

Abstract

Background: Sequential embryo transfer (SEQET) can increase the availability of embryos at various stages within the implantation window, thus improving the outcomes of assisted conception. This research seeks to analyze and synthesize clinical information on the influence of SEQET on in vitro fertilization (IVF) embryo transfer outcomes.

Methods: The literature search was done through four databases, which are Pubmed, Web of Science, Scopus, and Cochrane. The inclusion criteria are clinical trials or observational studies comparing sequential embryo transfer (cleavage and blastocyst) to single-day embryo transfer (cleavage or blastocyst) in women undergoing IVF. Data was collected from the included studies and analyzed by RevMan software.

Results: Twenty-three studies fulfilled the criteria for inclusion in this study. We found that SEQET showed significant improvement in clinical and chemical pregnancy rates (P < 0.00001) in comparison to the cleavage embryo transfer (CET) group. Moreover, implantation rates (P = 0.002) and live births (P = 0.006) were significantly greater. In comparing SEQET to blastocyst transfer, SEQET was associated with a significant increase in the clinical pregnancy rate (P = 0.003).

Conclusion: This research discovered that sequential embryo transfer significantly enhanced live birth, clinical pregnancy, chemical pregnancy, and implantation rates compared to cleavage transfer. SEQET also improved clinical pregnancy rates compared to blastocyst transfer. However, there was no significant difference between the two groups in terms of live birth, implantation rates, or miscarriages.

Keywords: Cleavage transfer; IVF; Sequential embryo transfer.

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Conflict of interest statement

Declarations. Ethics approval: N/A. Consent to participate: N/A. Consent for publication: N/A. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram
Fig. 2
Fig. 2
A Risk of bias summary. B Risk of bias graph
Fig. 3
Fig. 3
A forest plot comparing clinical pregnancy rates. B Funnel plot of clinical pregnancy rates
Fig. 4
Fig. 4
Forest plot comparing clinical pregnancy in patients with RIF
Fig. 5
Fig. 5
Forest plot comparing clinical pregnancy in sequential ET vs blastocyst
Fig. 6
Fig. 6
Forest plot comparing clinical pregnancy rate between sequential ET and blastocyst transfer in patients with RIF
See this image and copyright information in PMC

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