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Elective Single Blastocyst Embryo Transfer in Women over 40

A recently published study evaluated blastocyst transfer outcomes for women age 40 to 44, according to the number and quality of embryos transferred in their IVF cycle. “The question we wanted to ask from a research standpoint is, ‘Where do you draw the line between maximizing the chance of a healthy pregnancy and increasing the risk of a multiple pregnancy as women age?’” says Dr. Eric Widra, Medical Director of Shady Grove Fertility. “Do the same rules apply as women get older?”

The retrospective review looked at 1,145 IVF cycles by 932 patients aged 40 to 44 from 2008 to 2013. Embryos were categorized A, B, C or D based on their morphology. (None of these cycles used preimplantation genetic screening, PGS, but since then there’s been a rapid increase in the utilization of PGS for patients of all ages, Widra says.)

The research revealed:

  • 21% of A blastocysts resulted in a live birth
  • 10.5% of B blastocysts resulted in a live birth
  • 5.6% of C blastocysts resulted in a live birth
  • D embryos did not contribute significantly to a live birth

Additionally, when transferring at least one A blastocyst, “Only additional A blastocysts significantly increased the chances of live birth per embryo transfer. But, transferring additional A, B and C blastocysts all significantly increased risks of multiple pregnancy.”

The study also revealed multiple pregnancy rates, per clinical pregnancy, as follows:

  • 45% for transfers including two A blastocysts
  • 60% for transfers including three A blastocysts.
  • Triplets in 10% of all pregnancies in transfers of three or more blastocysts of any quality

“The takeaway is that we still need to be cautious in transferring large numbers of embryos in women over 40 when those embryos are of good quality or when they are tested by PGS and deemed to be normal. Because if you have good quality embryos even after age 40, there still is a significant risk of multiples if you’re transferring three or more,” Widra says. Multiple pregnancy is not a desired outcome because it comes with significant health risks for mother and children.


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