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Blastocyst transfer increases cumulative-live-birth-rates and reduces time and cost to livebirth compared with cleavage stage in recipients of donated oocytes. A randomized controlled trial

  • E. Clua
    Correspondence
    Corresponding author: Clua E., Department of Obstetrics Gynecology and Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71, 08028 Barcelona, Spain, Telephone number: 0034932274700.
    Affiliations
    Department of Obstetrics Gynecology and Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71, 08028 Barcelona, Spain
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  • I. Rodríguez
    Affiliations
    Department of Obstetrics Gynecology and Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71, 08028 Barcelona, Spain
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  • G. Arroyo
    Affiliations
    Department of Obstetrics Gynecology and Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71, 08028 Barcelona, Spain
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  • A. Racca
    Affiliations
    Department of Obstetrics Gynecology and Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71, 08028 Barcelona, Spain
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  • F. Martínez
    Affiliations
    Department of Obstetrics Gynecology and Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71, 08028 Barcelona, Spain
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  • N.P. Polyzos
    Affiliations
    Department of Obstetrics Gynecology and Reproductive Medicine, Dexeus University Hospital, Gran Via de Carles III, 71, 08028 Barcelona, Spain
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Published:January 08, 2022DOI:https://doi.org/10.1016/j.rbmo.2022.01.001

      ABSTRACT

      Research Question

      : Does embryo transfer day (D5 vs D3) affect cumulative live-birth-rates (CLBR), time to live-birth (TTL) and cost-per-live-birth (CPL) in recipients of donated oocytes?

      Study Design

      : This is a single center RCT conducted between April 2017-August 2018. The recipients of donated oocytes were randomized to cleavage stage (D3 Group) or to blastocyst stage (D5 Group) embryo transfer.
      Eligible women were recipients between 18-50 years, in their 1st/2nd synchronous cycle (excluding: PGT-A, recurrent implantation failure and biopsy obtained sperm). Primary outcome was CLBR, within 12 months from 1st embryo transfer, considering fresh and subsequent frozen transfers. Additionally, we analyzed TTL (time from 1st embryo transfer until 1st livebirth) and CPL (cost per-live-birth).

      Results

      : A total of 134 recipients were randomized to D3 Group (n=69) or to D5 Group (n=65). D5 transfer results in 15.9% relative increase in CLBR and a significant shorter TTL as compared with D3 transfer. To reach a 50% CLBR, D3 Group required 6 months more than D5 Group (15.3 vs. 8.9 months, respectively). Moreover, the average CPL in D3 strategy supposed an increase of 24% with respect to the D5 strategy (14817.1 euros vs 10959.2 euros). Furthermore, clinical pregnancy rate (CPR) was approximately 25% inferior in D3 Group. The trial was prematurely stopped after unplanned interim analysis due to the initial poor results in D3 arm.

      Conclusions

      : The present study provides evidence that the transfer of blastocyst stage embryos in recipients of donated oocytes should be preferred since it leads to higher clinical pregnancy rate, live birth rate, shorter time to pregnancy and lower costs to achieve the pregnancy, as compared to cleavage stage embryo transfer.

      Key words

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      Biography

      Elisabet Clua obtained her degree in Biology in 1991 from the University of Barcelona and her PhD in Cellular Biology in 2016 from the Autonomous University of Barcelona. She has been working at the Reproductive Medicine Service at Dexeus University Hospital since 1995. She is currently in charge of the oocyte and embryo donation program.
      KEY MESSAGE
      Transfer of blastocyst stage embryos in recipients of donated oocytes should be preferred to cleavage stage since it leads to higher clinical pregnancy rate, live birth rate, shorter time, and lower costs to achieve the live birth, as compared to cleavage stage embryo transfer.