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Optimizing the number of embryos to transfer on day 5: two should be the limit

2017; Brazilian Society of Assisted Reproduction; Volume: 21; Issue: 1 Linguagem: Inglês

10.5935/1518-0557.20170003

1518-0557

Claudio Ruhlmann, Lucas G Molina, Graciano Tessari, Felicitas Ruhlmann, Lautaro Tessari, Diego Gnocchi, Antonino Cattaneo, Marcela Irigoyen, A. Gustavo Martínez,

Reproductive Biology and Fertility

Objective: To define the appropriate number of embryos to be transferred at day 5.Methods: Retrospective analysis of 784 consecutive fresh day-5 embryo transfers performed between 2007 and 2015, divided in three groups: Group A (N = 219): received the only 2 embryos that reached a transferable stage; Group B (N = 357): received 2 selected embryos among several that reached a transferable stage; Group C (N = 208): received the only 3 developing embryos.Clinical pregnancy, implantation, multiple pregnancy and delivery rates were registered.Kruskal-Wallis and Fisher Exact tests were applied as appropriate.Results: Age and previous attempts were comparable in the 3 groups.Compared with Group A, Groups B and C had a higher oocyte recovery (10.7 ± 5.6 vs. 14.7 ± 8.0 vs. 13.8 ± 6.6), fertilization rate (75.97% vs. 81.60% vs. 83.29%)and percentage of embryos reaching a transferable stage on day 5 (39.98% vs. 63.99% vs. 60.97%), as well as a significantly higher clinical pregnancy (42.92% vs. 61.06% vs. 58.17%)and implantation rates (21.09% vs. 40.98%vs. 36.97%).The multiple pregnancy rate was higher in Groups B and C than in Group A (11.70% vs. 31.19%vs. 37.19%).The high order multiple pregnancy rate (> 2) was significantly increased in group C (1.06% vs. 0.92% vs. 14.05%).Conclusions: In patients with 3 or more day 5 developing embryos, delivery rates are similar if 2 or 3 embryos are transferred.The transfer of 3 embryos carries an unacceptable increase in the risk of high order multiple pregnancy, with its known consequences.According to our data, we should not exceed the number of 2 day-5 fresh embryos transferred.