Adherence to embryo transfer guidelines in favorable-prognosis patients aged less than 35 years using autologous oocytes and in recipients using donor oocytes: a Society for Assisted Reproductive Technology Clinic Outcome Reporting System study

Julian A. Gingold, Melissa Fazzari, Rachel Gerber, Michelle Kappy, Michelle Goodman, Harry Lieman, Staci Pollack, Manvinder Singh, Sangita Jindal

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: To measure the consequences of nonadherence with the 2013 American Society for Reproductive Medicine elective single embryo transfer (eSET) guidelines for favorable-prognosis patients. Design: Retrospective cohort. Setting: In vitro fertilization clinics. Patient(s): A total of 28,311 fresh autologous, 2,500 frozen-thawed autologous, and 3,534 fresh oocyte-donor in vitro fertilization cycles in 2014–2016 at Society for Assisted Reproductive Technology-reporting centers. Intervention(s): Patients aged <35 years or using donors aged <35 years underwent first blastocyst transfer. Main Outcome Measure(s): Singleton birth rate, gestational age at delivery, and birth weight were compared between the eSET and non-eSET groups using the chi-square or Fisher's exact test or t-tests. Result(s): Among fresh transfers, 15,643 (55%) underwent eSET. Live births after non-eSETs were less likely singletons (38.0% vs. 96.5%; adjusted relative risk [aRR], 0.56) and more likely complicated by preterm delivery (55.0% vs. 20.1%; aRR, 2.39) and low birth weight (<2,500 g) (40.1% vs. 10.6%; aRR, 3.4) compared with those after eSET. Among frozen-thawed transfers, 1,439 (58%) underwent eSET. Live births after non-eSETs were less likely singletons (41.9% vs. 95.2%; aRR, 0.69; 95% confidence interval, 0.66–0.73) and more likely complicated by preterm delivery (56.4% vs. 19.5%; aRR, 2.6; 95% confidence interval, 2.2–3.1) and low birth weight (38.0% vs. 8.9%; aRR, 3.9) compared with those after eSET. Among fresh donor oocyte transfers, 1,946 (55%) underwent eSET. Live births after non-eSETs were less likely singletons (31.3% vs. 97.3%; aRR, 0.48) and more likely complicated by preterm delivery (61.1% vs. 25.7%; aRR, 2.09) and low birth weight (44.3% vs. 11.7%; aRR, 3.39) compared with those after eSET. Conclusion(s): Nonadherence with transfer guidelines was associated with dramatically increased multiple pregnancies, preterm births, and low birth weights.

Original languageEnglish (US)
Pages (from-to)548-559
Number of pages12
JournalFertility and sterility
Volume117
Issue number3
DOIs
StatePublished - Mar 2022

Keywords

  • Embryo transfer
  • blastocyst
  • elective single embryo transfer
  • guidelines
  • multiple pregnancy

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynecology

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