Most Donor-Oocyte IVF Cycles Exceed Recommended Embryo Transfer Limits

More than 70% of donor-oocyte in vitro fertilization (IVF) cycles involved the transfer of 2 or more blastocysts in 2013, according to a new analysis of 2013 IVF registry data. Noncompliance with recommended embryo transfer limits contributes to multiple pregnancy rates that exceed 50% in this patient population.

Kelly S. Acharya, MD, a fellow of the Division of Reproductive Endocrinology and Infertility at Duke University Medical Center, presented findings from the study at the Scientific Congress & Expo of the American Society for Reproductive Medicine (ASRM) held October 15 to 19, 2016, in Salt Lake City, UT.

Multifetal gestation is associated with increased complication rates and worse neonatal outcomes relative to singleton gestations. In an effort to minimize multiple pregnancy rates, the ASRM and Society for Assisted Reproductive Technology (SART) developed a series of guidelines in 2009 and 2013 regarding the optimal number of embryos to transfer in IVF based on a spectrum of prognostic factors. Based on the favorable prognosis of donor-oocyte IVF, the ASRM and SART recommended single embryo blastocyst transfer for donor-oocyte IVF cycles involving donors aged younger than 35 years.

The current study was designed to gain a better understanding of trends in compliance with national embryo transfer guidelines over time. Researchers examined data from the SART registry during 2 time periods: 2011-2012 and 2013.

The analysis included 12,998 donor-oocyte IVF cycles with fresh blastocyst transfer among women aged 35 years or younger. Cycles were considered noncompliant if 2 or more blastocyst-stage embryos (day 5 or 6) were transferred.

The primary end points were the noncompliance rate and the multiple pregnancy rate observed in 2011-2012 compared with 2013. Multiple pregnancy was defined as 2 or more fetal heartbeats on ultrasonography.

Results showed that noncompliance rates remained consistently high during the 2 time periods, with no significant difference between 2011-2012 (72.4%) and 2013 (71.2%; Table).

Table. Donor Oocyte IVF Cycle Outcomes by Cohort

Variable 2011-2012
(n = 10,238)
2013 (n = 2,760) P Value
Noncompliant, % 72.4 71.2 .23
Mean oocytes retrieved, n 22 22 .10
Embryos transferred, mean (range) 2.1 (2-6) 2 (2-11) .09
Mean embryos cryopreserved, n 4.2 4.4 .14
Clinical pregnancy rate, % 72.0 70.6 .21
Live birth rate, % 63.0 60.7 .23
Singletons, % 47.2 48.0 .67
Multiple pregnancy rate, % 52.8 52.0 .67
Multiple live birth rate, % 46.2 48.0 .29

IVF = in vitro fertilization.

All other outcomes, including clinical pregnancy rates, live birth rates, and multiple pregnancy rates, were not significantly changed over time.

“The multiple pregnancy rate remains unacceptably high at more than 50%,” commented Acharya.

In another study presented at the ASRM Scientific Congress & Expo this week, Acharya and colleagues showed high rates of noncompliance with blastocyst transfer recommendations among women undergoing autologous IVF cycles.

The next step for the research team will be to examine more recent trends in compliance with embryo transfer recommendations once the 2014 data become available from the SART registry, said Acharya.

Source: Acharya KS, Keyhan S, Acharya CR, Li SJ, Muasher SJ. Noncompliance with ASRM/SART guidelines continues to be high in 2013 compared to 2011-2012 in donor oocyte cycles with blastocyst transfer. Presented at: American Society for Reproductive Medicine 2016 Scientific Congress & Expo; October 15-19, 2016; Salt Lake City, UT. Abstract P-574.