How compliant are in vitro fertilization member clinics in after embryo transfer guidelines An analysis of 59689 fresh first in vitro fertilization autologous cycles from 2011 to 2012

Authors:
Sanaz Keyhan, M.D., Kelly S. Acharya, M.D., Chaitanya R. Acharya, M.S., Jason S. Yeh, M.D., Meredith P. Provost, M.D., Ph.D., James M. Goldfarb, M.D., Suheil J. Muasher, M.D.

Abstract:

Objective:
To determine whether IVF clinics are compliant with American Society for Reproductive Medicine (ASRM) and Society for Assisted Reproductive Technology (SART) (ASRM/SART) guidelines and assess the multiple pregnancy outcomes according to the number of embryos transferred.

Design:
Retrospective cohort study.

Setting:
Not applicable.

Patient(s):
Data from 59,689 fresh first autologous IVF cycles from the 2011–2012 SART registry.

Intervention(s):
None.

Main Outcome Measure(s):
Percentage of compliant cycles, multiple pregnancy rate (PR).

Result(s):
Between 2011 and 2012, a total of 59,689 fresh first autologous cycles were analyzed. Among cleavage-stage ET cycles, the noncompliance rate ranged from 10%–27.4% depending on the age group. The multiple PR was significantly increased in noncompliant cycles involving patients <35 years (38.1% vs. 28.7%) and 35–37 years (35.4% vs. 24.5%) compared with compliant cycles. Among blastocyst-stage ET cycles, the highest rate of noncompliance was seen in patients <35 years old (71%), which resulted in a statistically higher multiple PR (48.3% vs. 2.8%) compared with compliant cycles. Far fewer cycles were noncompliant in patients 35–40 years of age. In a subanalysis of compliant cycles, transferring two blastocyst embryos in patients 35–37 years and 38–40 years resulted in a higher live birth rate compared with the transfer of one embryo (50.4% vs. 40.9% and 42.1% vs. 30.0%, respectively) but the multiple PR was also significantly higher (40.5% vs. 1.7% and 34.0% vs. 2.0%, respectively). Conclusion(s):
Most first fresh autologous IVF cycles performed from 2011–2012 were compliant with ASRM/SART guidelines, except those that involved a blastocyst ET in patients <35 years. Despite compliance, cycles that involved the transfer of >1 embryo resulted in a high multiple PR, whereas noncompliant cycles resulted in an even more remarkable multiple PR for both cleavage and blastocyst-stage embryos. Clinics need to be more compliant with ET limits and ASRM/SART need to consider revising their guidelines to limit the number of blastocyst transfer to one in patients ≤40 years of age undergoing their first IVF cycle. Furthermore, decreasing the number of cleavage-stage embryos transferred in patients ≤40 years of age should also be considered.

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