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Factors predicting double embryo implantation following double embryo transfer in assisted reproductive technology: implications for elective single embryo transfer

  • Assisted Reproduction Technologies
  • Published:
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Abstract

Purpose

The aim of this study was to identify factors associated with double embryo implantation following double embryo transfer (DET) during assisted reproductive technology (ART) procedures and to evaluate the implications of findings in selecting candidates for elective single embryo transfer (eSET).

Methods

Factors predicting double embryo implantation, defined as embryo transfers with two or more heartbeats on 6-week ultrasound following DET, were assessed using the US National ART Surveillance System data from 2000 to 2012 (n = 1,793,067 fresh, autologous transfers). Adjusted risk ratios (aRRs) were estimated after stratifying by prognosis. Favorable prognosis was defined as first-time ART with supernumerary embryo(s) cryopreserved. Average prognosis was defined as first-time ART without supernumerary embryo(s) cryopreserved, prior unsuccessful ART with supernumerary embryo(s) cryopreserved, or prior ART with previous birth(s) conceived with ART or naturally. Rates and factors associated with double embryo implantation were compared with single embryo implantation following DET among both prognosis groups.

Results

Double embryo implantation was positively associated with blastocyst (versus cleavage) transfer in favorable (aRR = 1.58 (1.51–1.65)) and average (aRR = 1.67 (1.60–1.75)) prognosis groups and negatively associated with age >35 years in both prognosis groups. For average prognosis patients, double embryo implantation was associated with retrieving >10 oocytes (aRR = 1.22 (1.18–1.24)).

Conclusions

Regardless of prognosis, patients aged <35 years with blastocyst-stage embryos and average prognosis patients from whom >10 oocytes were retrieved may be good candidates for eSET. Physicians may consider using these data to counsel patients on eSET, which would reduce multiple gestations and associated complications.

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Abbreviations

SET:

Single embryo transfer

DET:

Double embryo transfer

TET:

Triple embryo transfer

QET+:

Quadruple or higher embryo transfer

ET:

Embryo transfer

eSET:

Elective single embryo transfer

ART:

Assisted reproductive technology

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Acknowledgments

Caitlin Martin received support from the Marianne Ruby Award in Obstetrics and Gynecology from the Department of Gynecology and Obstetrics of Emory University. We acknowledge Dr. Luca Gianaroli for his help with the initial concept of the study and Dr. Jennifer Kawwass for her critical evaluation of the manuscript.

Author information

Authors and Affiliations

  1. Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop F-74, Atlanta, GA, 30341, USA

    Caitlin Martin, Jeani Chang, Sheree Boulet, Denise J. Jamieson & Dmitry Kissin

  2. Department of Gynecology and Obstetrics, Emory University, Glenn Building, 4th Floor, 69 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA

    Caitlin Martin

Authors
  1. Caitlin Martin
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Corresponding author

Correspondence to Caitlin Martin.

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Ethical approval

The study was approved by CDC’s institutional review board.

Authors’ role

All authors helped design the study and critically edit the manuscript. C.M. wrote the manuscript. J.C. performed the statistical analysis. C.M., J.C., S.B., and D.K. worked on the data analysis. All authors approved the final version of the manuscript.

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Additional information

Capsule

Predictors of double embryo implantation following double embryo transfer are age <35 years and blastocyst transfer in patients with favorable or average prognosis and retrieval of >10 oocytes in patients with average prognosis. Physicians will find this information useful when counseling patients with these characteristics, and these patients may be good candidates for eSET, which would reduce multiple gestations and associated complications.

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Martin, C., Chang, J., Boulet, S. et al. Factors predicting double embryo implantation following double embryo transfer in assisted reproductive technology: implications for elective single embryo transfer. J Assist Reprod Genet 33, 1343–1353 (2016). https://doi.org/10.1007/s10815-016-0770-9

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  • DOI: https://doi.org/10.1007/s10815-016-0770-9

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