PGDIS 2017 · Poster presentation

Single embryo transfer as an imperative choice for patients ≥ 38 years old in autologous IVF PGS cycles

O. O. Barash, S. P. Willman, K. A. Ivani, D. S. Wachs, E. M. Rosenbluth, F. Rabara, N. Huen, L. N. Weckstein

Reproductive Science Center of the San Francisco Bay Area, USA

PGDIS 2017 International Conference

751

Autologous IVF PGS cycles

627 patients · 36.06 ± 3.98 y.o.

307 / 35

SET / DET in ≥ 38 y.o.

Multi-gestation SET 0.33 % vs DET 45.7 %

83.6 %

Cumulative LBR · 2 SETs

Kaplan–Meier · 89.5 % after 3 SETs

Age-independent

Ongoing PR after SET

≤34 / 35–37 / 38–40 / ≥41 y.o.: 58–63 %

Background

Why this study

Comprehensive chromosomal screening has been proven as the best option to increase clinical outcomes in autologous IVF cycles for advanced-maternal-age patients. The high efficiency of PGS allows clinics to maintain high pregnancy rates while transferring fewer embryos in the younger patient population. Despite this, double embryo transfer is still being performed due to concerns about lower implantation rates associated with aging, even when they are not related to chromosomal status.

Objective. Evaluate clinical pregnancy rates after single and double embryo transfer in patients 38 – 41 y.o. and over 41 y.o. in autologous IVF PGS cycles.

Materials & Methods

Cohort and endpoints

Design. Retrospective comparative study, January 2013 – January 2017.
Cohort. 751 cycles — 409 autologous under 38 y.o., 342 autologous ≥ 38 y.o. (307 SET, 35 DET). Vitrify after biopsy; frozen HRT transfer.
Embryos. 3,920 analyzed. Average blastocysts available for biopsy 5.23 ± 1.69 per cycle. Euploid embryos per cycle dropped from 6.22 ± 1.43 in ≤ 25 y.o. to 0.32 ± 0.18 in ≥ 45 y.o.
Analysis. Clinical PR by fetal heartbeat at 6–7 weeks. Cumulative live birth estimated by non-parametric Kaplan–Meier product-limit estimator.

Results · SET by age

Ongoing PR after single euploid ET is age-independent

No statistically significant difference in ongoing PR after single euploid ET across age groups (≤ 34, 35–37, 38–40, ≥ 41 y.o.) — 58.47 %, 63.16 %, 62.38 %, and 59.22 % respectively (χ² = 0.815, p = 0.3667); linear regression y = −0.1522x + 61.433.

Clinical PR was also comparable between elective and non-elective SET in the ≥ 41 y.o. group — 61.70 % (29/47) vs 57.14 % (32/56), χ² = 0.22, p = 0.639.

Results · SET vs DET in ≥ 38 y.o.

DET raises PR modestly at the cost of a large multiple-gestation burden

Clinical PR was significantly higher after DET vs SET in patients ≥ 38 y.o. — 80.00 % (28/35) vs 61.24 % (188/307) (χ² = 4.753, p < 0.05).

In the same age group the multiple-gestation rate after DET was dramatically higher — 0.33 % (1/307) vs 45.71 % (16/35) (χ² = 16.715, p < 0.05).

Fig. 5 — Ongoing PR and multiple-gestation rate, SET vs DET (patients ≥ 38 y.o.).

Results · Kaplan–Meier

Cumulative live birth after consecutive SETs

The cumulative probability of a live birth after two consecutive single euploid embryo transfers was 83.6 % and after three consecutive SETs — 89.5 % (Fig. 6).

Table I · Morphology in ≥ 38 y.o.

Ongoing PR and live-birth rate by transferred blastocyst morphology

Morphology	SETs	+ hCG	− hCG	Biochem.	Miscarr.	Ongoing PR, %	Births 2013–15	Live births	LBR, %
AA	74	61	13	7	6	64.86	43	26	60.47
AB	95	78	17	5	6	70.53	59	37	62.71
BA	12	9	3	0	1	66.67	6	3	50.00
BB	89	69	20	13	4	58.43	60	33	55.00
B−/−B	37	22	15	5	4	35.14	28	10	35.71

Good-quality vs fair vs borderline-fair: ongoing PR 64.86 % (48/74) vs 58.4 % (52/89) vs 35.14 % (13/37), χ² = 5.68, p < 0.05.

Conclusion

Summary of findings

Clinical PR after single embryo transfer is age-independent in IVF PGS cycles. With single euploid ET, high clinical PRs and low multiple-gestation rates can be achieved even in the older patient population. Therefore, in IVF PGS cycles, single embryo transfer should be imperative for advanced-maternal-age patients.

References

Cited works

1.Gerris J, De Sutter P, De Neubourg D, et al. A real-life prospective health economic study of elective single embryo transfer versus two-embryo transfer in first IVF/ICSI cycles. Hum Reprod. 2004;19(4):917–923. PubMed
2.Gleicher N, Barad DH. A review of, and commentary on, the ongoing second clinical introduction of preimplantation genetic screening (PGS) to routine IVF practice. J Assist Reprod Genet. 2012;29(11):1159–1166. PubMed
3.Handyside AH. 24-chromosome copy number analysis: a comparison of available technologies. Fertil Steril. 2013;100(3):595–602. PubMed

Reprint requests

Oleksii Barash, Ph.D. · ivfbigdata@gmail.com