Pregnancy Rate after Embryo Transfer on Day 5 and Day 6 in IVF. A Systematic Review and Meta-Analysis

Study Question: The question: is there any difference in pregnancy rate between embryo transfer day 5 and day 6 in IVF? What Is Known Already? Blastocyst transfer is increasingly popular in assisted reproductive technology (ART) centers today. Very few articles concentrate on comparing Day 5 and Day 6 embryo transfer with conflict results. Objective, Study Design: Systematic review and meta-analysis of published controlled studies. Searches conducted from 2001-2020 on PubMed. Medline, EMBASE, and ISI Web of Science Electronic database is used to collect data, using the following search terms: blastocyst, Day 5, Day 6, embryo transfer (E.T.) and pregnancy rate. Materials, Setting, Methods: A total of 6 full-text articles preselected from 211 references, based on title and abstract. Two independent reviewers performed data selection and extraction according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA). This systematic review was conducted according to (PICO) standard. Random-effect meta-analysis performed on all data (overall analysis). Results and the Role of Chance: Data from 6 relevant articles were extracted and integrated into the meta-analysis that reported clinical pregnancy rate (CPR) as an outcome in 5640 cycles, 2274 cycle had embryo transfer at day 6 and the control was 3366 cycle had embryo transfer day 5 showed a significantly higher clinical pregnancy rate following Day 5 embryo transfer compared with Day 6 embryo transfer with odd ratio and 95% confidence limit 0.73 (0.66 - 0.82) p value < 0.000. Sensitivity analysis led to similar results and conclusions. Limitations, Reasons for Caution: The validity of meta-analysis results depends mainly on the quality and the number of published studies available. Indeed, this meta-analysis included no randomized controlled trial (RCT). Wider Implications of the Findings: In regards to the results of this original meta-analysis, ART practitioners should preferably transfer D5 rather than D6 blastocysts. Further RCTs are needed to address the question of whether D6 embryos should be transported.

Pregnancy Outcomes for Day 5 Versus Day 6 Single Frozen-thawed Blastocyst Transfer with Different Qualities of Embryos: A Large Matched-cohort Study

Objective This study aimed to determine whether the day of blastocyst expansion affects pregnancy outcomes in frozen-thawed blastocyst transfer(FBT)cycles.Methods A retrospective match-cohort study was conducted.Patients who underwent blastocyst transfer in frozen-thawed cycles at day 5 or 6 were matched for potential confounding factors.A total of 2207 matched pairs of FBT cycles were included from January 2016 to December 2019 in our Reproductive Medicine Center.Results The clinical pregnancy rate(CPR)and live birth rate(LBR)were significantly increased in day 5 blastocyst transfers when compared to day 6 blastocyst transfers,in terms of the same embryo quality.For FBT cycles with good-quality embryo,the CPR at day 5 and 6 was 61.30%and 57.56%,respectively(P=0.045),and the LBR was 44.79%and 36.16%,respectively(P<0.001).For FBT cycles with poor-quality embryo,the CPR at day 5 and 6 was 48.61%and 40.89%,respectively(P=0.006),and the LBR was 31.71%and 25.74%,respectively(P=0.019).The CPR for FBT cycles with good-quality embryo was statistically higher at day 6 than that at day 5 with poor-quality embryo transferred(57.56%vs.48.61%,P=0.001).Maternal age,anti-Müllerian hormone(AMH),endometrial thickness,embryo quality,and the day of blastocyst expansion were independently correlated with the CPR and LBR.The FBT cycles at day 5 had significantly higher CPR(adjusted odds ratio[OR]=1.246,95%confidence intervals[CI]:1.097–1.415,P=0.001)and LBR(adjusted OR=1.435,95%CI:1.258–1.637,P<0.001)than those at day 6.Conclusion The embryo quality is the primary indicator for FBT cycles.Day 5 blastocysts should be preferred when the quality of embryo at day 5 is the same as that at day 6.

Pregnancy outcomes of four different cycle protocols for frozen embryo transfer: a large retrospective cohort study

Objective:To evaluate the pregnancy outcomes of the four endometrial preparation protocols for people undergoing frozen-thawed embryo transfer(FET),including natural cycle(NC),hormone replacement therapy cycle(HRT),gonadotropin-releasing hormone agonist artificial cycle(GAC),and ovarian stimulation cycle(OC).Methods:This retrospective cohort study enrolled 10,333 cycles of frozen embryo transfer performed at Xinan Gynecological Hospital in Sichuan,China,from January 2018 to December 2018.The patient's baseline characteristics and pregnancy outcomes were extracted from the medical record system.Pregnancy outcomes were compared among the four groups and multiple logistic regression models were used to adjust for the confounding factors.Results:After adjusting for covariates,multiple logistic regression analysis showed no statistical significance in pregnancy outcomes in the HRT group,GAC group,and OC group compared to the NC group in the entire population.The adjusted odds ratio of live birth was 0.976(95%)confidence interval[Cl](0.837-1.138)for the HRT group,0.959(95%confidence interval 0.797-1.152)for the GAC group,and 0.909(95%confidence interval 0.763-1.083)for the OC group.Conclusions:The natural protocol had comparable pregnancy outcomes compared to the other three endometrial preparation protocols in the overall FET population.More high-quality prospective randomized controlled trials are required to assess the efficacy of the four protocols and explore the optimal one.

Intrauterine Insemination Treatment Strategy for Women over 35 Years Old： Based on a Large Sample Multi-center Retrospective Analysis

As we all known, maternal age and ovarian reserve are two of the most important prognosis i-hctors for fertility, in 1980, the study of Menken et al. showed the female fertility declined after 32 years old, especially after 37 years old.

Effect of Acupuncture on Outcomes of in vitro Fertilisation:A Scoping Review

Objectives:To identify,examine and summarize the available evidence on the effectiveness and safety of acupuncture for in vitro fertilisation(IVF)outcomes.Methods:Eight electronic databases,including Pub Med,EMBASE,Cochrane Database of Systematic Review,Cochrane Central Register of Controlled Trials,China National Knowledge Infrastructure,Wanfang Database,Chinese Biomedical Database and VIP Database,were searched,supplemented by manual searches.Two researchers independently conducted the literature screening,data extraction,and methodological quality assessments.A narrative description was provided to show the general information and specific characteristics of the included studies.A bubble plot was used to visually display the overall effects of acupuncture on IVF outcomes.Results:Eighty-two studies were identified,including 64 primary studies and 18 systematic reviews.Transcutaneous electrical acupoint stimulation,electric acupuncture and manual acupuncture were applied in most studies and compared with no acupuncture,sham acupuncture and placebo acupuncture control groups.Sixty-three(98.4%)primary studies reported clinical pregnancy rate,and positive effects of acupuncture were found in 34 studies(54.0%).Live birth rate was reported in only 18(28.1%)primary studies,of which 10(55.6%)showed positive results.In addition,only 8 and 2 systematic reviews showed that acupuncture could increase clinical pregnancy events and live birth events,respectively.However,none of these reviews was of high methodological quality.Conclusions:Available evidence suggests that acupuncture therapy could improve clinical pregnancy rates.However,whether acupuncture could increase live birth events was difficult to determine based on the few studies that have reported this outcome indicator.Furthermore,the methodological quality of most systematic reviews was assessed as critically low or low.Studies with a rigorous design and standardized implementation should be performed to refine the available evidence.

Clinical Analysis on IVF-ET Treatment of 9 Cases of Post-cesarean Section Uterine Diverticulum

Objective To evaluate the influence of uterine diverticulum patients who have a history of cesarean section on IVF-ET process and pregnancy outcome. Methods Nine patients with uterine diverticulum after cesarean were retrospectively analyzed, who have received IVF-ET treatment. Clinical pregnancy rate and embryo implantation rate were measured. Results There were 9 infertility patients in all, 7 cases with tubal factor, 2 with unexplained factor; 3 cases were associated with prolonged menstruation period, including 1 patient was misdiagnosed as dysfunctioned uterine bleeding. There were a total of 16 transplantation cycles, including14 fresh cycles and 2 thawing cycles. Each cycle had at least one high-quality embryo available for transfer. Five cases were difficult to transfer. Two were clinical pregnancie, the implantation rate was 5.13% （2/39）. Conclusion In this study, 14 fresh cycles all had high-quality embryo transfer, uterine diverticulum had no effect on the development of ovums and the formation of high- quality embryos. But forming uterine diverticulum after cesarean section may lead to secondary infertility or patients with prolonged menstruation period, it also may lead it difficult to transfer during the treatment of IVF-ET and affect embryo implantation. So the patients with a history of cesarean section shall receive ultrasonic examination or hysteroscopy routinely before IVF treatment. If necessary surgical treatment is required.

Influence of Gynaecologic Adnexal Surgeries on Subsequent Ovarian Function and In Vitro Fertilization Treatment Outcome

Objective To investigate the correlation between gynaecologic adnexal surgery history and pregnancy outcome of in vitro fertilization （IVF） treatment. Methods A total of 810 women who were proceeded 810 IVF; treatment cycles from October 2009 to March 2011 were recruited to this retrospective study, based on whether they had history of gynaecologic adnexal surgeries or not. Among 810 women, 587 women had no gynaecologic adnexal surgeries （group A）, 223 women had gynaecologic adnexal surgeries （group B）. Additionally, the group B was further divided into 4 subgroups based on their different gynaecologic adnexal surgery histories, such as tubal conservative surgery （group Bal）, unilateral salpingectomy （group Ba2）, ovarian cyst ablation （group Bbl） and unilateral adnexal resection （group Bb2）. The basal levels of FSH, antral follicle count （AFC）, clinical pregnancy rate （CPR）, embryos implantation rates （IR） and live birth rates （LBR） were compared.Results The levels of FSH and AFC were significantly different between groups A and B, respectively. Therefore, CPR, IR and LBR were significantly lower （P 〈0.05） in group B （30.9%, 17.8% and 25.1%） compared with group A （39.9%, 22.8% and 32.4%）. Meanwhile, there was no significant difference between the patients who had tubal conservation surgery （group Bal） and who had unilateral salpingectomy （group Ba2）. However, in contrast to unilateral adnexectomy, ovarian cystectomy surgery influenced FSH and AFC significant, even for the number of oocyte retrieved, but did not affect the IVF treatment outcome. Conclusion The previous history of gynaecologic adnexal surgeries may affect the subsequent ovarian function and also IVF outcomes. As for different operation methods, between tubal conservation surgery and unilateral salpingectomy, the IVF outcomes were not significantly different. The same result we found in different ovarian operation groups.