Document Detail

Trends and factors associated with the Day 5 embryo transfer, assisted reproductive technology surveillance, USA, 2001-2009.
MedLine Citation:
PMID:  22627658     Owner:  NLM     Status:  MEDLINE    
STUDY QUESTION: What characteristics are associated with a Day 5 embryo transfer?
SUMMARY ANSWER: The use of the Day 5 embryo transfer has increased over time, with clinicians allowing women with typically 'poorer' prognostic characteristics to undergo a Day 5 embryo transfer. The mean number of embryos per Day 5 transfer decreased from 2001 to 2009, although the prevalence of the Day 5 single embryo transfer remains low and the rate of multiple births remains substantial.
WHAT IS KNOWN AND WHAT THIS PAPER ADDS: Day 5 embryo transfer may reduce the rate of multiple gestation pregnancy. US trends over time in the prevalence of the Day 5 transfer, changes in characteristics of patients receiving Day 5 transfer, and number of embryos transferred are unknown.
DESIGN: We used 2001-2009 US National assisted reproductive technology (ART) Surveillance System (NASS) data on 620,295 fresh IVF cycles derived from autologous oocytes with a Day 3 or 5 embryo transfer. Trends in the mean number of embryos transferred from 2001 to 2009 were assessed by the day of transfer. For 349,947 cycles from clinics performing both Days 3 and 5 embryo transfers, multivariable logistic regression was used to determine the characteristics associated with the Day 5 embryo transfer. We also compared the characteristics of the Day 5 embryo cycles in 2001 and 2009.
MAIN RESULTS AND THE ROLE OF CHANCE: Overall, the proportion of ART cycles using the Day 5 embryo transfer increased from 12% in 2001 to 36% in 2009 (P<0.0001), while the mean number of embryos transferred decreased from 2.4 to 2.1 (P<0.0001). Among Day 5 transfers, the rate of the single embryo transfer tripled from 4.5% in 2001 to 14.8% in 2009 (P<0.0001); and the rate of multiple births decreased from 44.8 to 41.1% (P<0.0001). In cycles initiated after 2001, maternal age<35 years, no prior ART cycles, ≥1 prior pregnancies, baseline follicle stimulating hormone<10 international units and ≥10 oocytes retrieved were associated with the Day 5 embryo transfer. Compared with 2001, in 2009, a broader range of candidates received the Day 5 transfer. BIAS Women undergoing multiple ART cycles over time are not linked.
CONFOUNDING FACTORS AND OTHER REASONS FOR CAUTION: We ran multivariable logistic regression to lessen the effects of the confounding factors. Cycle cancelation rates by the day of embryo transfer are unknown.
GENERALIZABILITY TO OTHER POPULATIONS: Generalizable to ART clinics included in NASS.
STUDY FUNDING/COMPETING INTERESTS: This study was funded by the Centres for Disease Control. The authors have no competing interests to declare.
Courtney A Marsh; Sherry L Farr; Jeani Chang; Dmitry M Kissin; David A Grainger; Samuel F Posner; Maurizio Macaluso; Denise J Jamieson
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.     Date:  2012-05-24
Journal Detail:
Title:  Human reproduction (Oxford, England)     Volume:  27     ISSN:  1460-2350     ISO Abbreviation:  Hum. Reprod.     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-18     Completed Date:  2012-12-06     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  8701199     Medline TA:  Hum Reprod     Country:  England    
Other Details:
Languages:  eng     Pagination:  2325-31     Citation Subset:  IM    
Department of Obstetrics and Gynecology, University of Michigan Health System, 1500 E. Medical Center Drive, L4510 Women's Hospital, Ann Arbor, MI 48109, USA.
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MeSH Terms
Birth Rate
Blastocyst / cytology
Embryo Transfer / methods,  trends*
Fertilization in Vitro / methods,  trends
Infertility / therapy
Reproductive Techniques, Assisted / trends*
Time Factors
Treatment Outcome
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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