Journal of Assisted Reproduction and Genetics

, Volume 33, Issue 9, pp 1195–1202 | Cite as

The effect on pregnancy and multiples of transferring 1–3 embryos in women at least 40 years old

  • Nouf M. Alasmari
  • Weon-Young Son
  • Michael H. DahanEmail author
Assisted Reproduction Technologies


Purpose "Capsule" is mandatory. Please provide.Single emrbyo transfer (SET) in women ≥40 years old appears to lower the chance of a pregnancy. However, it minimizes the risk of multiple pregnancies even in women of advanced maternal age. Therefore, women 40 years of age or older should be offered (SET).

This study was performed to investigate the multiple pregnancies and live birth rates when 1–3 embryos are transferred at this age in women at least 40 years of age.


A retrospective analysis of data which included 631 women aged 40 to 46 years, who underwent 901 cycles of IVF, from August 2010 to June 2012 was undertaken. These women underwent embryo transfer of 1–3 non-donor fresh embryo(s).


Results suggested that the average pregnancy rate when up to three embryos were transferred was 25 % for women 40 years old, 20 % for women 41 years old, 16 % for women 42 years old, 17 % for women 43 years old, 8 % for women 44 years old, 6 % for women 45 years old, and 0 % for women 46 years old. No live births occurred in women treated after their 44th birthday, and only patients younger than 42 years of age receiving double embryo transfer had a live birth of twins. Live birth rates increased as more embryos were transferred for 40- and 42-year-old subjects (p = 0.01 and 0.05, respectively).


From these results, it was concluded that SET in women ≥40 years old appears to lower the chance of a pregnancy. However, it minimizes the risk of multiple pregnancies even in women of advanced maternal age. Women 40 years of age or older should be offered single-embryo transfer. Further studies are needed to determine risk of multiple pregnancies in women 42 years of age or older when few embryos are transferred. Decisions on the number of embryos to transfer should be on a case by case basis, in discussion with the patient.


Assisted reproductive technology Elective single-embryo transfer Multiple pregnancy rates Advanced maternal age 





  1. 1.
  2. 2.
    Society for assisted reproductive technology. 2014 SART data. Available at:
  3. 3.
    Scotland GS, McLernon D, Kurinczuk JJ, McNamee P, Harrild K, Lyall H, et al. Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon. BJOG. 2011;118:1073–83.CrossRefPubMedGoogle Scholar
  4. 4.
    Luke B, Keith LG. The contribution of singletons, twins and triplets to low birth weight, infant mortality and handicap in the United States. J Reprod Med. 1992;37:661–6.PubMedGoogle Scholar
  5. 5.
    Powers WF, Kiely JL. The risks confronting twins: a national perspective. Am J Obstet Gynecol. 1994;170:456–61.CrossRefPubMedGoogle Scholar
  6. 6.
    MacKay AP, Berg CJ, King JC, Duran C, Chang J. Pregnancy-related mortality among women with multifetal pregnancies. Obstet Gynecol. 2006;107:563–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Xiong X, Saunders LD, Wang FL, Demianczuk NN. Gestational diabetes mellitus: prevalence, risk factors, maternal and infant outcomes. Int J Gynaecol Obstet. 2001;75:221–8.CrossRefPubMedGoogle Scholar
  8. 8.
    Saftlas AF, Olson DR, Franks AL, Atrash HK, Pokras R. Epidemiology of preeclampsia and eclampsia in the United States, 1979–1986. Am J Obstet Gynecol. 1990;163:460–5.CrossRefPubMedGoogle Scholar
  9. 9.
    Mackay AP, Berg CJ, Atrash HK. Pregnancy-related mortality from preeclampsia and eclampsia. Obstet Gynecol. 2001;97:533–8.PubMedGoogle Scholar
  10. 10.
    Thurin A, Hausken J, Hillensjö T, et al. Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med. 2004;351:2392–402.CrossRefPubMedGoogle Scholar
  11. 11.
    Martikainen H, Tiitinen A, Tomás C, et al. One versus two embryo transfer after IVF and ICSI: a randomized study. Hum Reprod. 2001;16:1900–3.CrossRefPubMedGoogle Scholar
  12. 12.
    Veleva Z, Vilska S, Hydén-Granskog C, Tiitinen A, Tapanainen JS, Martikainen H. Elective single embryo transfer in women aged 36–39 years. Hum Reprod. 2006;21:2098–102.CrossRefPubMedGoogle Scholar
  13. 13.
    van Montfoort APA, Dumoulin JCM, Land JA, Coonen E, Derhaag JG, Evers JLH. Elective single embryo transfer [eSET] policy in the first three IVF/ICSI treatment cycles. Hum Reprod. 2005;20:433–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Niinimäki M, Suikkari AM, Mäkinen S, Söderström-Anttila V, Martikainen H. Elective single-embryo transfer in women aged 40-44 years. Hum Reprod. 2013;28:331–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Baker VL, Jones CE, Cometti B, Hoehler F, Salle B, Urbancsek J, et al. Factors affecting success rates in two concurrent clinical IVF trials: an examination of potential explanations for the difference in pregnancy rates between the United States and Europe. Fertil Steril. 2010;94:1287–91.CrossRefPubMedGoogle Scholar
  16. 16.
    Frattarelli JL, Leondires MP, McKeeby JL, Miller BT, Segars JH. Blastocyst transfer decreases multiple pregnancy rates in in vitro fertilization cycles: a randomized controlled trial. Fertil Steril. 2003;79:228–30.CrossRefPubMedGoogle Scholar
  17. 17.
    Karaki RZ, Samarraie SS, Younis NA, Lahloub TM, Ibrahim MH. Blastocyst culture and transfer: a step toward improved in vitro fertilization outcome. Fertil Steril. 2002;77:114–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Gardner DK, Schoolcraft WB, Wagley L, Schlenker T, Stevens J, Hesla J. A prospective randomized trial of blastocyst culture and transfer in in-vitro fertilization. Hum Reprod. 1998;13:3434–40.CrossRefPubMedGoogle Scholar
  19. 19.
    Yang Z, Salem SA, Liu X, Kuang Y, Salem RD, Liu J. Selection of euploid blastocysts for cryopreservation with array comparative genomic hybridization [aCGH] results in increased implantation rates in subsequent frozen and thawed embryo transfer cycles. Mol Cytogenet. 2013:9;6:32.Google Scholar
  20. 20.
    Criteria for number of embryos to transfer: a committee opinion. The Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Fertil Steril. 2013:99:44–6.Google Scholar
  21. 21.
    Schieve LA, Peterson HB, Meikle SF, Jeng G, Danel I, Burnett NM, et al. Live-birth rates and multiple-birth risk using in vitro fertilization. JAMA. 1999;282:1832–38.CrossRefPubMedGoogle Scholar
  22. 22.
    Obasaju M, Kadam A, Biancardi T, Sulta K, Fateh M, Munne S. Pregnancies from single normal embryo transfer in women older than 4 years. Reprod Biomed Online. 2001;2:98–101.CrossRefPubMedGoogle Scholar
  23. 23.
    Kelly SM, Pirwany IR, Phillips SJ, Tan SL. Microdose gonadotrophin releasing hormone agonist [GnRH-a] flare protocol compared with standard long protocol GnRH-a for ovarian stimulation in patients undergoing in vitro fertilization. Fertil Steril. 2002;78:S234.CrossRefGoogle Scholar
  24. 24.
    Seyhan A, Ata B, Polat M, Son WY, Yarali H, Dahan MH. Severe early ovarian hyperstimulation syndrome following GnRH agonist trigger with the addition of 1500 IU hCG. Hum Reprod. 2013;28:2522–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Tan SL, Maconochie N, Doyle P, Campbell S, Balen A, Bekir J, et al. Cumulative conception and live-birth rates after in vitro fertilization with and without the use of long, short, and ultrashort regimens of the gonadotropin releasing hormone agonist buserelin. Am J Obstet Gynecol. 1994;171:513–20.CrossRefPubMedGoogle Scholar
  26. 26.
    Te Velde E, Habbema D, Leridon H, Eijkemans M. The effect of postponement of first motherhood on permanent involuntary childlessness and total fertility rate in six European countries since the 1970s. Hum Reprod. 2012;27:1179–83.CrossRefGoogle Scholar
  27. 27.
    Tsafrir A, Simon A, Revel A, Reubinoff B, Lewin A, Laufer N. Retrospective analysis of 1217 IVF cycles in women aged 40 years and older. Biomed Online. 2007;14:348–55.CrossRefGoogle Scholar
  28. 28.
    Seng SW, Yeong CT, Loh SF, Sadhana N, Loh SK. In-vitro fertilisation in women aged 40 years and above. Singapore Med J. 2005;46:132–6.PubMedGoogle Scholar
  29. 29.
    Hourvitz A, Machtinger R, Maman E, Baum M, Dor J, Levron J. Assisted reproduction in women over 40 years of age: how old is too old? Reprod Biomed Online. 2009;19:599–603.CrossRefPubMedGoogle Scholar
  30. 30.
    O'Connor KA, Holman DJ, Wood JW. Declining fecundity and ovarian ageing in natural fertility populations. Maturitas. 1998;30:127–36.CrossRefPubMedGoogle Scholar
  31. 31.
    Orvieto R, Bar-Hava I, Yoeli R. Results of in vitro fertilization cycles in women aged 43–45 years. Gynecol Endocrinol. 2004;18:75–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Steer CV, Mills CL, Tan SL. The cumulative embryoscore a predictive embryo scoring technique to select the optimal number of embryos to transfer in an in-vitro fertilization and embryo transfer program. Hum Reprod. 1992;7:117–9.PubMedGoogle Scholar
  33. 33.
    Márquez C, Sandalinas M, Bahce M. Chromosome abnormalities in 1255 cleavage-stage human embryos. Reprod Biomed Online. 2000;1:17–26.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Nouf M. Alasmari
    • 1
  • Weon-Young Son
    • 1
  • Michael H. Dahan
    • 1
    Email author
  1. 1.McGill Reproductive centerRoyal Victoria HospitalMontréalCanada

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