How to balance the live birth rate and the multiple pregnancy rate by selecting the cleavage-stage embryo number and quality for POSEIDON Group 1 and Group 2? A retrospective study.

PURPOSE: For unexpected low-prognosis patients (Group 1 and Group 2) defined by POSEIDON criteria, how to maximize the live birth rate while controlling the multiple birth rate by tailoring the embryo transfer number and quality?

METHODS

This was a retrospective study, including patients from Poseidon Group 1 (N = 672) and Group 2 (N = 503) who underwent cleavage-stage embryo transfer. Logistic regression was used for the comparative analysis of clinical outcomes among subgroups divided by the number and quality of embryos.

RESULTS

For Group 1, compared to transferring a single good-quality embryo (GQE), a good-quality embryo with a poor-quality embryo (GQE + PQE) did not significantly improve the live birth rate, although increasing in value (40.5% vs 31.9%, P = 0.272), meanwhile obviously raised the multiple birth rate to 28.1% (P = 0.042). For Group 2, double embryo transfer (DET) was associated with a higher live birth rate than single embryo transfer (SET) (22.4% vs 6.3%, P = 0.001) and further analysis indicated that the similar trend observed in the GQE + PQE group compared to the GQE group (26.1% vs 8.5%, P = 0.017) with statistical significance, but without a significant increase in the multiple birth rate (8.3%, P = 1.000).

CONCLUSIONS

The study indicated that  a single good-quality cleavage-stage embryo was an option for patients in Poseidon Group 1 to avoid the risk of multiple pregnancies. DET with mixed quality cleavage-stage embryo might be an alternative for Poseidon Group 2, given that it improved the pregnancy outcomes while controlling the multiple birth rates.