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. 2000 Jul;17(6):335–343. doi: 10.1023/A:1009457112230

The Influence of Supernumerary Embryos on the Clinical Outcome of IVF Cycles

Osama Salha 1, Tunde Dada 1, Steve Levett 1, Vicki Allgar 1, Vinay Sharma 1
PMCID: PMC3455402  PMID: 11042831

Abstract

Purpose: To assess the influence of the presence of qualitysupernumerary embryos on the clinical outcome and risk ofmultiple conception in patients having their first in vitrofertilization (IVF) cycle.

Methods: Retrospective cohort study of 1448 women havingtheir first IVF treatment cycle who received 4004 embryoswhere at least six embryos were available for transfer treatedin an Assisted Conception Unit based in a large teachinghospital.

Results: The replacement of three rather than two embryos towomen under 35 years who had good-quality supernumeraryembryos resulted in a higher twin (12.5 vs. 11.9%) and tripletbirth rates (2.1 vs. 0%), without significantly improving theclinical pregnancy (50.5 vs. 45.2%) or total live birth rates(38.9 vs. 35.7%). In the absence of quality spare embryos,these women who had three rather than two embryosreplaced had a significantly higher clinical pregnancy rate(39.3 vs. 28.8%; P = 0.04), total live birth (32.7 vs. 19.4%;P = 0.02) and singleton birth rate per cycle (20.8 vs. 14.4%;P = 0.04), without significantly influencing the multiplebirth rate. In women over 35 years, the replacement of threeinstead of two embryos in the presence or absence of qualitysupernumerary embryos led to a significant improvement inclinical outcome, without being associated with a concurrentincrease in the multiple birth rate. Women in both age groupswho had either two or three embryos replaced in the presenceof quality supernumerary embryos had a notably better clinicaloutcome compared with their counterparts who had thesame number of embryos replaced, but with no qualityembryos to spare.

Conclusions: The presence of good-quality supernumeraryembryos can be used as a reference to determine the optimalnumber of embryos to transfer and as an indicator of theprobability of success of an individual couple in a givencycle. Optimal pregnancy rates and simultaneous reductionof multiple gestation can be achieved with a flexible embryoreplacement policy that is based on embryo quality, maternalage, and the presence or absence of surplus quality embryos.

Keywords: IVF, supernumerary embryos, embryo quality, multiple pregnancy, maternal age

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