Embryo Transfer Strategies for Women with Recurrent Implantation Failure During the Frozen-thawed Embryo Transfer Cycles: Sequential Embryo Transfer or Double-blastocyst Transfer?

Qiao-hang Zhao1(), Yu-wei Song1(), Jian Chen1, Xiang Zhou1, Ji-lai Xie1, Qiu-ping Yao1,2, Qi-yin Dong3, Chun Feng1, Li-ming Zhou4, Wei-ping Fu2(), Min Jin1()

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Current Medical Science ›› 2024, Vol. 44 ›› Issue (1) : 212-222. DOI: 10.1007/s11596-024-2827-9

Embryo Transfer Strategies for Women with Recurrent Implantation Failure During the Frozen-thawed Embryo Transfer Cycles: Sequential Embryo Transfer or Double-blastocyst Transfer?

  • Qiao-hang Zhao1(), Yu-wei Song1(), Jian Chen1, Xiang Zhou1, Ji-lai Xie1, Qiu-ping Yao1,2, Qi-yin Dong3, Chun Feng1, Li-ming Zhou4, Wei-ping Fu2(), Min Jin1()
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Abstract

Abstract
Objective

Both sequential embryo transfer (SeET) and double-blastocyst transfer (DBT) can serve as embryo transfer strategies for women with recurrent implantation failure (RIF). This study aims to compare the effects of SeET and DBT on pregnancy outcomes.

Methods

Totally, 261 frozen-thawed embryo transfer cycles of 243 RIF women were included in this multicenter retrospective analysis. According to different embryo quality and transfer strategies, they were divided into four groups: group A, good-quality SeET (GQ-SeET, n=38 cycles); group B, poor-quality or mixed-quality SeET (PQ/MQ-SeET, n=31 cycles); group C, good-quality DBT (GQ-DBT, n=121 cycles); and group D, poor-quality or mixed-quality DBT (PQ/MQ-DBT, n=71 cycles). The main outcome, clinical pregnancy rate, was compared, and the generalized estimating equation (GEE) model was used to correct potential confounders that might impact pregnancy outcomes.

Results

GQ-DBT achieved a significantly higher clinical pregnancy rate (aOR 2.588, 95% CI 1.267–5.284, P=0.009) and live birth rate (aOR 3.082, 95% CI 1.482–6.412, P=0.003) than PQ/MQ-DBT. Similarly, the clinical pregnancy rate was significantly higher in GQ-SeET than in PQ/MQ-SeET (aOR 4.047, 95% CI 1.218–13.450, P=0.023). The pregnancy outcomes of GQ-SeET were not significantly different from those of GQ-DBT, and the same results were found between PQ/MQ-SeET and PQ/MQ-DBT.

Conclusion

SeET relative to DBT did not seem to improve pregnancy outcomes for RIF patients if the embryo quality was comparable between the two groups. Better clinical pregnancy outcomes could be obtained by transferring good-quality embryos, no matter whether in SeET or DBT. Embryo quality plays a more important role in pregnancy outcomes for RIF patients.

Keywords

recurrent implantation failure / sequential embryo transfer / frozen-thawed embryo transfer / embryo transfer strategies

Cite this article

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Qiao-hang Zhao, Yu-wei Song, Jian Chen, Xiang Zhou, Ji-lai Xie, Qiu-ping Yao, Qi-yin Dong, Chun Feng, Li-ming Zhou, Wei-ping Fu, Min Jin. Embryo Transfer Strategies for Women with Recurrent Implantation Failure During the Frozen-thawed Embryo Transfer Cycles: Sequential Embryo Transfer or Double-blastocyst Transfer?. Current Medical Science, 2024, 44(1): 212‒222 https://doi.org/10.1007/s11596-024-2827-9

References

[1]
Simon A, Laufer N. Assessment and treatment of repeated implantation failure (RIF). J Assist Reprod Genet, 2012,29(11):1227–1239
[2]
Coughlan C, Ledger W, Wang Q, et al. Recurrent implantation failure: definition and management. Reprod Biomed Online, 2014,28(1):14–38
[3]
Cimadomo D, Craciunas L, Vermeulen N, et al. Definition, diagnostic and therapeutic options in recurrent implantation failure: an international survey of clinicians and embryologists. Hum Reprod, 2021,36(2):305–317
[4]
Polanski LT, Baumgarten MN, Quenby S, et al. What exactly do we mean by recurrent implantation failure? A systematic review and opinion. Reprod Biomed Online, 2014,28(4):409–423
[5]
Almog B, Levin I, Wagman I, et al. Interval double transfer improves treatment success in patients with repeated IVF/ET failures. J Assist Reprod Genet, 2008,25(8):353–357
[6]
Ni Y, Tong C, Huang L, et al. The analysis of fertility quality of life and the influencing factors of patients with repeated implantation failure. Health Qual Life Outcomes, 2021,19(1):32
[7]
Machtinger R, Dor J, Margolin M, et al. Sequential transfer of day 3 embryos and blastocysts after previous IVF failures despite adequate ovarian response. Reprod Biomed Online, 2006,13(3):376–379
[8]
Fang C, Huang R, Li TT, et al. Day-2 and day-3 sequential transfer improves pregnancy rate in patients with repeated IVF-embryo transfer failure: a retrospective case-control study. Reprod Biomed Online, 2013,26(1):30–35
[9]
Ismail Madkour WA, Noah B, Zaheer H, et al. Does sequential embryo transfer improve pregnancy rate in patients with repeated implantation failure? A randomized control study. Middle East Fertil Soc J, 2015,20(4):255–261
[10]
Ye YP, Li P. Application of non-elective sequential embryo transfer in thaw embryo transfer cycle of women with repeated implantation failure. Chin J Fam Plan (Chinese), 2021,29(8):1673–1676
[11]
Zheng H, Cai GF, Xu WB, et al. Effect of sequential transfer of day 3 and day 5~6 in the frozen-thawed cycles of patients with previous IVF-embryo transfer failure. Mod Med J China (Chinese), 2021,23(3):23–27
[12]
Zhang YF, Luo HN, Shi R, et al. Clinical research of sequential embryo transfer in frozen thawed cycles of patients with recurrent implantation failure. Chin J Reprod Contracept, 2020,40(11):893–898
[13]
Zhang J, Wang C, Zhang H, et al. Sequential cleavage and blastocyst embryo transfer and IVF outcomes: a systematic review. Reprod Biol Endocrinol, 2021, 19(1):142
[14]
Kyono K, Fukunaga N, Chiba S, et al. Two-step consecutive transfer of early embryos and blastocysts. Reprod Med Biol, 2003,2(3):133–137
[15]
Tehraninejad ES, Raisi E, Ghaleh FB, et al. The sequential embryo transfer compared to blastocyst embryo transfer in in vitro fertilization (IVF) cycle in patients with the three repeated consecutive IVF. A randomized controlled trial. Gynecol Endocrinol, 2019,35(11):955–959
[16]
Arefi S, Ataei M, Maleki N, et al. Sequential (two-step) day 3/day 5 frozen-thawed embryo transfer: does it improve the pregnancy rate of patients suffering recurrent implantation failure? J Med Life, 2022,15(11):1365–1370
[17]
Wang JC, Ma JF, Geng Y, et al. Thawing cycle sequential embryo transfer in patients with repeated implantation failure. Tianjin Med J (Chinese), 2017,45(05):514–517
[18]
Ji M, Zhang L, Fu X, et al. The outcomes of sequential embryo transfer in patients undergoing in vitro fertilization with frozen-thawed embryos: A retrospective study. J Obstet Gynaecol Res, 2022,48(10):2563–2570
[19]
ALPHA Scientists In Reproductive Medicine; ESHRE Special Interest Group Embryology. Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Reprod Biomed Online, 2011,22(6):632–646
[20]
Gardner DK, Lane M, Stevens J, et al. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril, 2000,73(6):1155–1158
[21]
Ferreux L, Bourdon M, Sallem A, et al. Live birth rate following frozen-thawed blastocyst transfer is higher with blastocysts expanded on Day 5 than on Day 6. Hum Reprod, 2018,33(3):390–398
[22]
Zohni KM, Gat I, Librach C. Recurrent implantation failure: a comprehensive review. Minerva Ginecol, 2016,68(6):653–667
[23]
Stamenov GS, Parvanov DA, Chaushev TA. Mixed double-embryo transfer: A promising approach for patients with repeated implantation failure. Clin Exp Reprod Med, 2017,44(2):105–110
[24]
Ruiz-Alonso M, Blesa D, Díaz-Gimeno P, et al. The endometrial receptivity array for diagnosis and personalized embryo transfer as a treatment for patients with repeated implantation failure. Fertil Steril, 2013,100(3):818–824
[25]
Ruiz-Alonso M, Galindo N, Pellicer A, et al. What a difference two days make: “personalized” embryo transfer (pET) paradigm: a case report and pilot study. Hum Reprod, 2014,29(6):1244–1247
[26]
Abramovici H, Dirnfeld M, Weisman Z, et al. Pregnancies following the interval double-transfer technique in an in vitro fertilization-embryo transfer program. J In Vitro Fert Embryo Transf, 1988,5(3):175–176
[27]
Shiotani M, Noda Y, Mori T. Embryo-dependent induction of uterine receptivity assessed by an in vitro model of implantation in mice. Biol Reprod, 1993,49(4):794–801
[28]
Wakuda K, Takakura K, Nakanishi K, et al. Embryo-dependent induction of embryo receptivity in the mouse endometrium. J Reprod Fertil, 1999,115(2):315–324
[29]
Koot YE, van Hooff SR, Boomsma CM, et al. An endometrial gene expression signature accurately predicts recurrent implantation failure after IVF. Sci Rep, 2016,6:19411
[30]
Macklon N. Recurrent implantation failure is a pathology with a specific transcriptomic signature. Fertil Steril, 2017,108(1):9–14
[31]
Sebastian-Leon P, Garrido N, Remohí J, et al. Asynchronous and pathological windows of implantation: two causes of recurrent implantation failure. Hum Reprod, 2018,33(4):626–635
[32]
Tang Z, Hong M, He F, et al. Effect of endometrial injury during menstruation on clinical outcomes in frozen-thawed embryo transfer cycles: A randomized control trial. J Obstet Gynaecol Res, 2020,46(3):451–458
[33]
Huang W, Liu B, He Y, et al. Variation of diagnostic criteria in women with chronic endometritis and its effect on reproductive outcomes: A systematic review and meta-analysis. J Reprod Immunol, 2020,140:103146
[34]
Gao M, Jiang X, Li B, et al. Intrauterine injection of human chorionic gonadotropin before embryo transfer can improve in vitro fertilization-embryo transfer outcomes: a meta-analysis of randomized controlled trials. Fertil Steril, 2019,112(1):89–97
[35]
Pourmoghadam Z, Abdolmohammadi-Vahid S, Pashazadeh F, et al. Efficacy of intrauterine administration of autologous peripheral blood mononuclear cells on the pregnancy outcomes in patients with recurrent implantation failure: A systematic review and meta-analysis. J Reprod Immunol, 2020,137:103077
[36]
Maleki-Hajiagha A, Razavi M, Rouholamin S, et al. Intrauterine infusion of autologous platelet-rich plasma in women undergoing assisted reproduction: A systematic review and meta-analysis. J Reprod Immunol, 2020,137:103078
[37]
Jiang Y, Zhao Q, Zhang Y, et al. Treatment of G-CSF in unexplained, repeated implantation failure: A systematic review and meta-analysis. J Gynecol Obstet Hum Reprod, 2020,49:101866
[38]
Altm?e S, Mendoza-Tesarik R, Mendoza C, et al. Effect of Growth Hormone on Uterine Receptivity in Women With Repeated Implantation Failure in an Oocyte Donation Program: A Randomized Controlled Trial. J Endocr Soc, 2018,2(1):96–105
[39]
Makrigiannakis A, Makrygiannakis F, Vrekoussis T. Approaches to Improve Endometrial Receptivity in Case of Repeated Implantation Failures. Front Cell Dev Biol, 2021,9:613277
[40]
He A, Zou Y, Wan C, et al. The role of transcriptomic biomarkers of endometrial receptivity in personalized embryo transfer for patients with repeated implantation failure. J Transl Med, 2021,19(1):176
[41]
Ben Rafael Z. Endometrial Receptivity Analysis (ERA) test: an unproven technology. Hum Reprod Open, 2021,2021(2):hoab010
[42]
Fragouli E, Wells D, Thornhill A, et al. Comparative genomic hybridization analysis of human oocytes and polar bodies. Hum Reprod, 2006,21(9):2319–2328
[43]
Holte J, Berglund L, Milton K, et al. Construction of an evidence-based integrated morphology cleavage embryo score for implantation potential of embryos scored and transferred on day 2 after oocyte retrieval. Hum Reprod, 2007,22(2):548–557
[44]
Kroener LL, Ambartsumyan G, Pisarska MD, et al. Increased blastomere number in cleavage-stage embryos is associated with higher aneuploidy. Fertil Steril, 2015,103(3):694–698
[45]
Desai N, Ploskonka S, Goodman L, et al. Delayed blastulation, multinucleation, and expansion grade are independently associated with live-birth rates in frozen blastocyst transfer cycles. Fertil Steril, 2016,106(6):1370–1378
[46]
Haas J, Meriano J, Laskin C, et al. Clinical pregnancy rate following frozen embryo transfer is higher with blastocysts vitrified on day 5 than on day 6. J Assist Reprod Genet, 2016,33(12):1553–1557
[47]
Wang W, Cai J, Liu L, et al. Does the transfer of a poor quality embryo with a good quality embryo benefit poor prognosis patients? Reprod Biol Endocrinol, 2020,18(1):97
[48]
Hill MJ, Eubanks AE, Csokmay JM, et al. Is transferring a lower-quality embryo with a good-quality blastocyst detrimental to the likelihood of live birth? Fertil Steril, 2020,114(2):338–345
[49]
Wintner EM, Hershko-Klement A, Tzadikevitch K, et al. Does the transfer of a poor quality embryo together with a good quality embryo affect the In Vitro Fertilization (IVF) outcome? J Ovarian Res, 2017,10(1):2
[50]
El-Danasouri I, Sterzik K, Rinaldi L, et al. Effect of transferring a morphologically impaired embryo with a good quality embryo on the pregnancy and implantation rates. Eur Rev Med Pharmacol Sci, 2016,20(3):394–398
[51]
Aldemir O, Ozelci R, Baser E, et al. Impact of Transferring a Poor Quality Embryo Along with a Good Quality Embryo on Pregnancy Outcomes in IVF/ICSI Cycles: a Retrospective Study. Geburtshilfe Frauenheilkd, 2020,80(8):844–850
[52]
Adamson GD, Norman RJ. Why are multiple pregnancy rates and single embryo transfer rates so different globally, and what do we do about it? Fertil Steril, 2020,114(4):680–689
[53]
Díaz-Gimeno P, Ruiz-Alonso M, Blesa D, et al. The accuracy and reproducibility of the endometrial receptivity array is superior to histology as a diagnostic method for endometrial receptivity. Fertil Steril, 2013,99(2):508–517
[54]
Díaz-Gimeno P, Horcajadas JA, Martínez-Conejero JA, et al. A genomic diagnostic tool for human endometrial receptivity based on the transcriptomic signature. Fertil Steril, 2011,95(1):50–60
[55]
Liu Z, Liu X, Wang M, et al. The Clinical Efficacy of Personalized Embryo Transfer Guided by the Endometrial Receptivity Array/Analysis on IVF/ICSI Outcomes: A Systematic Review and Meta-Analysis. Front Physiol, 2022,13:841437
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