Feasibility of Elective Single Cleavage-Stage Embryo Transfer: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Zhihui ,  LA Xiaolin , ZHAO Jing , GONG Xiaoyun , HU Bo , WANG Peng

Center for Clinical Reproductive Medicine, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding author：

LA Xiaolin, Email: xiaolinla@hotmail.com

Keywords：

Elective single embryo transfer; In vitro fertilization-embryo transfer (IVF-ET); Cleavage stage; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20130214

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To analyze published literature about the clinical studies on elective single versus double embryo transfer using meta-analysis, so as to provide more convincing evidence for the clinical application of elective single embryo transfer.
Methods 　We electronically searched foreign and domestic biomedical databases including PubMed, Ovid, EMbase, MEDLINE and CENTRAL, to collect randomized controlled trials (RCTs) on elective single versus double embryo transfer. According to Cochrane systematic review method, two reviewers independently screened studies according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.1 software.
Results 　A total of 9 RCTs involving 2 784 cases were included, of which, 1 452 were in the trial group while the other 1 332 were in the control group. The results of meta-analysis indicated that, compared with elective double embryo transfer, during each transfer period elective single embryo transfer reduced the live birth rate (RR=0.66, 95%CI 0.59 to 0.73, P lt;0.000 01), multiple pregnancy rate (RR=0.05 95%CI 0.02 to 0.11, P lt;0.000 01), preterm birth rate (RR=0.39, 95%CI 0.26 to 0.60, P lt;0.000 1), and low birth weight rate (RR=0.25, 95%CI 0.15 to 0.44, P lt;0.000 01). However, it had no effect on the ectopic pregnancy rate (RR=0.55, 95%CI 0.11 to 2.77, P=0.47), miscarriage rate (RR=1.33, 95%CI 0.92 to 1.91, P=0.13), and neonatal mortality rate (RR=0.31, 95%CI 0.03 to 2.76, P=0.29).
Conclusion 　Compared with elective double embryo transfer, during each transfer period elective single embryo transfer reduces the live birth rate, multiple pregnancy rate, preterm birth rate, and low birth weight rate. No significant difference was found between the two groups in the other indicators.

Citation： WANG Zhihui,LA Xiaolin,ZHAO Jing,GONG Xiaoyun,HU Bo,WANG Peng. Feasibility of Elective Single Cleavage-Stage Embryo Transfer: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2013, 13(10): 1251-1257. doi: 10.7507/1672-2531.20130214 Copy

1.	Milingos DS, Bhattacharya S. Single embryo transfer. Obstet Gynaecol Med, 2009, 19(8): 229-231.
2.	HFEA. HFEA register data 2003/2004. [2007-06-01] http://www.hfea.gov.uk.
3.	Ombelet W, de Sutter P, van der Elst J, et al. Multiple gestation and infertility treatment: registration, reflection and reaction-the Belgian project. Hum Reprod Update, 2005, 11(1): 3-14.
4.	Higgins J, Green S. Cochrance Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available from www. cochranehand-book. org.
5.	Gerris J, de ND, Mange lschots K, et al. Prevention of twin pregnancy after in-vitro fertilization or intracytoplasmic sperm injection based on strict embryo criteria : a prospective randomized clinical trial. Hum Reprod, 1999, 14(10): 2581-2587.
6.	Heijnen EM, Eijk emans MJ, de KC, et al. A mild treatment strategy for in-vitro fertilisation: a randomized non-inferiority trial. Lancet, 2007, 369(9563): 743-749.
7.	Kjellberg AT, Carlsson P, Bergh C. Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis. Hum Reprod, 2006, 21(1): 210-216.
8.	Lukassen HG, Braat DD, Wetzels AM, et al. Two cycles with single embryo transfer versus one cycle with double embryo transfer: a randomized controlled trial. Hum Reprod, 2005, 20(3): 702-708.
9.	Martikainen H, Tiitinen A, Tomas C, et al. One versus two embryo transfer after IVF and ICSI: a randomized study. Hum Reprod, 2001, 16(9): 1900-1903.
10.	Moustafa MK, Sheded SA, El Aziz Mousta MA. Elective single embryo transfer versus double embryo transfer in assisted reproduction. Reprod Biomed Online, 2008, 17(1): 82-87.
11.	Thurin A, Hausken J, Hillensjo T, et al. Elective single -embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med, 2004, 351(23): 2392-2402.
12.	Thurin A, Olivius C, Bergh C, et al. Cumulative live-birth rates in a trial of single-embryo or double-embryo transfer. N Engl J Med, 2009, 361(18): 1812-1813.
13.	van Montfoort AP, Fiddelers AA, Janssen JM, et al. In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial. Hum Reprod, 2006, 21(2): 338-343.
14.	Adashi EY, Barri PN, Berkowitz R, et al. Infertility therapy-associated multiple pregnancies (births): an ongoing epidemic. Reprod Biomed Online, 2003, 7(5): 515-542.
15.	Rosheen Grady, Nika Alavi, Rachel Vale, et al. Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis. Fertility and Sterility, 2012, 97(2): 324-331.
16.	Strandell A, Bergh C, Lundin K. Selection of patients suitable for one-embryo transfer may reduce the rate of multiple births by half without impairment of overall birth rates. Hum Reprod, 2000, 15(2): 2520-2525.
17.	Milingos DS, Bhattacharya S. Single embryo transfer. Obstetrics, Gynaecology and Reproductive Medicine, 2009, 19(8): 229-231.
18.	de Sutter P, Bontinck J, Schutysers V, et al. First-trimester bleeding and pregnancy outcome in singletons after assisted reproduction. Hum Reprod, 2006, 21(7): 1907-1911.
19.	De Sutter P, Delbaere I, Gerris J, et al. Birthweight of singletons after assisted reproduction is higher after single- than after double-embryo transfer. Hum Reprod, 2006, 21(10): 2633-2637.
20.	Sullivan EA, Wang YP, Hayward I, et al. Single embryo transfer reduces the risk of perinatal mortality, a population study. Hum Reprod, 2012, 36(18): 1732-1740.

1. Milingos DS, Bhattacharya S. Single embryo transfer. Obstet Gynaecol Med, 2009, 19(8): 229-231.
2. HFEA. HFEA register data 2003/2004. [2007-06-01] http://www.hfea.gov.uk.
3. Ombelet W, de Sutter P, van der Elst J, et al. Multiple gestation and infertility treatment: registration, reflection and reaction-the Belgian project. Hum Reprod Update, 2005, 11(1): 3-14.
4. Higgins J, Green S. Cochrance Handbook for Systematic Reviews of Interventions Version 5.1.0[updated March 2011]. The Cochrane Collaboration, 2011. Available from www. cochranehand-book. org.
5. Gerris J, de ND, Mange lschots K, et al. Prevention of twin pregnancy after in-vitro fertilization or intracytoplasmic sperm injection based on strict embryo criteria : a prospective randomized clinical trial. Hum Reprod, 1999, 14(10): 2581-2587.
6. Heijnen EM, Eijk emans MJ, de KC, et al. A mild treatment strategy for in-vitro fertilisation: a randomized non-inferiority trial. Lancet, 2007, 369(9563): 743-749.
7. Kjellberg AT, Carlsson P, Bergh C. Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis. Hum Reprod, 2006, 21(1): 210-216.
8. Lukassen HG, Braat DD, Wetzels AM, et al. Two cycles with single embryo transfer versus one cycle with double embryo transfer: a randomized controlled trial. Hum Reprod, 2005, 20(3): 702-708.
9. Martikainen H, Tiitinen A, Tomas C, et al. One versus two embryo transfer after IVF and ICSI: a randomized study. Hum Reprod, 2001, 16(9): 1900-1903.
10. Moustafa MK, Sheded SA, El Aziz Mousta MA. Elective single embryo transfer versus double embryo transfer in assisted reproduction. Reprod Biomed Online, 2008, 17(1): 82-87.
11. Thurin A, Hausken J, Hillensjo T, et al. Elective single -embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med, 2004, 351(23): 2392-2402.
12. Thurin A, Olivius C, Bergh C, et al. Cumulative live-birth rates in a trial of single-embryo or double-embryo transfer. N Engl J Med, 2009, 361(18): 1812-1813.
13. van Montfoort AP, Fiddelers AA, Janssen JM, et al. In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial. Hum Reprod, 2006, 21(2): 338-343.
14. Adashi EY, Barri PN, Berkowitz R, et al. Infertility therapy-associated multiple pregnancies (births): an ongoing epidemic. Reprod Biomed Online, 2003, 7(5): 515-542.
15. Rosheen Grady, Nika Alavi, Rachel Vale, et al. Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis. Fertility and Sterility, 2012, 97(2): 324-331.
16. Strandell A, Bergh C, Lundin K. Selection of patients suitable for one-embryo transfer may reduce the rate of multiple births by half without impairment of overall birth rates. Hum Reprod, 2000, 15(2): 2520-2525.
17. Milingos DS, Bhattacharya S. Single embryo transfer. Obstetrics, Gynaecology and Reproductive Medicine, 2009, 19(8): 229-231.
18. de Sutter P, Bontinck J, Schutysers V, et al. First-trimester bleeding and pregnancy outcome in singletons after assisted reproduction. Hum Reprod, 2006, 21(7): 1907-1911.
19. De Sutter P, Delbaere I, Gerris J, et al. Birthweight of singletons after assisted reproduction is higher after single- than after double-embryo transfer. Hum Reprod, 2006, 21(10): 2633-2637.
20. Sullivan EA, Wang YP, Hayward I, et al. Single embryo transfer reduces the risk of perinatal mortality, a population study. Hum Reprod, 2012, 36(18): 1732-1740.

Chinese Journal of Evidence-Based Medicine

Feasibility of Elective Single Cleavage-Stage Embryo Transfer: A Meta-Analysis

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