Does sequential embryo transfer improve pregnancy rate in patients with repeated implantation failure? A randomized control study

Background: Repeated failure of in vitro fertilization treatment is frustrating to the patients and their clinicians. Various treatment plans and a change of protocol have been suggested for "low responders"; however, patients who fail treatment repeatedly inspite of good quality embryos pose a special therapeutic challenge. Additional challenge would be imposed on that particular group when the local IVF regulating low does not permit surplus embryo freezing. Objective: To examine whether sequential transfer of embryos on day 3 and on day 5 after ovum pick-up improves IVF/ET success rates in patients with repeated consecutive IVF failures ( ?, 3 trials) compared to day 3 alone, with the background that local regulation prohibits embryo freezing. Study design: Randomized controlled study. Women scheduled for IVF/ET with repeated consecutive IVF failures ( ?, 3 trials) were randomized to either sequential transfer of embryos on day 3 and on day 5 after ovum pick-up (Group I = 74) or conventional day 3 transfer (Group II = 73) as a control. The primary outcome measures were clinical pregnancy rate and implantation rate. The secondary outcome measures were ongoing pregnancy rate and early pregnancy loss. Results: Baseline and cycle characteristics were comparable in both groups. Clinical pregnancy rate (per embryo transfer) was significantly higher in sequential ET group (37. 8 A) compared to that in day 3 group (21.9 A) (P value <0.05). Also, implantation rate per embryos transferred) was significantly higher in sequential ET group (17.1%) compared to that in control group (10.5%) (P value <0.01). Similarly, ongoing pregnancy (per embryo transfer) was significantly higher in sequential ET group (33. 8%) compared to that in day 3 group (19.2%) (P value <0.05). Conclusions: Patients with repeated implantation failures, treatment with the sequential embryo transfer approach had significantly improved pregnancy outcomes compared to regular day 3 transfers. This approach would be particularly useful when neither oocyte freezing is a clinical option due to insufficient number of collected oocytes nor surplus embryo freezing is an option as the current local regulatory law prohibits it. (C) 2015 The Authors. Production and hosting by Elsevier B.V. on behalf of Middle East Fertility Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).