Skip to main content
NCBI home page
Journal of Assisted Reproduction and Genetics logoLink to Journal of Assisted Reproduction and Genetics
. 1999 Jan;16(1):1–5. doi: 10.1023/A:1022581225987

The Transfer of Two Embryos Instead of Three to Reduce the Risk of Multiple Pregnancy: A Retrospective Analysis

Phillip L Matson 1,✉, Jennifer Browne 1, Richard Deakin 1, Bruce Bellinge 1
PMCID: PMC3468211  PMID: 9987685

Abstract

Purpose:Our purpose was to investigate whether a reduction in the number of embryos transferred from three to two would help reduce the incidence of multiple pregnancies and yet leave the pregnancy rate unaffected.

Methods:Women were treated in a routine clinical in vitro fertilization program and the results analyzed retrospectively.

Results:There was no reduction in the pregnancy rate when two embryos were transferred compared with three. Indeed, there was actually an increase in pregnancy rate after the transfer of two embryos in those cases with one or more embryos remaining after the transfer.

Conclusions:The transfer of only two embryos compared to three in women younger than 40 years of age does not compromise the chance of pregnancy. Triplets were not seen in the limited series of patients when only two embryos were transferred, but the incidence of twins remained the same. Further consideration should be given to strategies that enable the transfer of single embryos without compromising the pregnancy rate.

Keywords: embryo, multiple, number, pregnancy, transfer

Full Text

The Full Text of this article is available as a PDF (376.5 KB).

REFERENCES

  • 1.Staessen C, Janssenwillen C, Van den Abeel E, Devroey P, Van Steirteghem AC. Avoidance of triplet pregnancies by elective transfer of two good quality embryos. Hum Reprod. 1993;8:1650–1653. doi: 10.1093/oxfordjournals.humrep.a137907. [DOI] [PubMed] [Google Scholar]
  • 2.Walters D. Can pregnancy rates be maintained when two embryos are replaced in in-vitro fertilization? Hum Reprod. 1994;9:184. doi: 10.1093/oxfordjournals.humrep.a138474. [DOI] [PubMed] [Google Scholar]
  • 3.Alikani M, et al. Embryo transfer should not be strictly regulated. Fertil Steril. 1997;68:782–783. doi: 10.1016/s0015-0282(97)00354-3. [DOI] [PubMed] [Google Scholar]
  • 4.De Jonge CJ, et al. Embryo number for transfer should be regulated. Fertil Steril. 1997;68:784–786. doi: 10.1016/s0015-0282(97)00355-5. [DOI] [PubMed] [Google Scholar]
  • 5.Goldbeck-Wood S. Europe is divided on embryo regulations. BMJ. 1996;313:512. doi: 10.1136/bmj.313.7056.512. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Waterstone J, et al. Elective transfer of two embryos. Lancet. 1991;337:975–976. doi: 10.1016/0140-6736(91)91605-t. [DOI] [PubMed] [Google Scholar]
  • 7.Nijs M, Geerts L, van Roosendaal E, Segal-Bertin G, Vanderzwalmen P, Schoysman R. Prevention of multiple pregnancies in an in vitro fertilization program. Fertil Steril. 1993;59:1245–1250. doi: 10.1016/s0015-0282(16)55984-6. [DOI] [PubMed] [Google Scholar]
  • 8.Tasdemir M, et al. Two instead of three embryo transfer in in-vitro fertilization. Hum Reprod. 1995;10:2155–2158. doi: 10.1093/oxfordjournals.humrep.a136252. [DOI] [PubMed] [Google Scholar]
  • 9.Craft I, et al. Limiting the number of oocytes and embryos transferred in GIFT and IVF. BMJ. 1991;303:185. doi: 10.1136/bmj.303.6795.185. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Hull MGR, Fleming CF, Hughes AO, McDermott A. The age-related decline in female fecundity: A quantitative controlled study of implanting capacity and survival of individual embryos after in vitro fertilization. Fertil Steril. 1996;65:783–790. doi: 10.1016/s0015-0282(16)58214-4. [DOI] [PubMed] [Google Scholar]
  • 11.Hodgen G. GnRH agonists and antagonists in ovarian stimulation. Hum Reprod. 1996;11(1):123–132. doi: 10.1093/humrep/11.suppl_5.123. [DOI] [PubMed] [Google Scholar]
  • 12.Doyle P. The outcome of multiple pregnancy. Hum Reprod. 1996;11(4):110–117. doi: 10.1093/humrep/11.suppl_4.110. [DOI] [PubMed] [Google Scholar]
  • 13.Levine MI, Wild J, Steer P. Higher multiple births and the modern management of infertility in Britain. Br J Obstet Gynaecol. 1992;99:607–613. doi: 10.1111/j.1471-0528.1992.tb13831.x. [DOI] [PubMed] [Google Scholar]
  • 14.Callahan TL, Hall JE, Ettner SL, Christiansen CL, Greene MF, Crowley WF., Jr The economic impact of multiple-gestation pregnancies and the contribution of assisted-reproduction techniques to their incidence. N Engl J Med. 1994;331:244–249. doi: 10.1056/NEJM199407283310407. [DOI] [PubMed] [Google Scholar]
  • 15.Garel M, Stark C, Blondel B, Lefebvre G, Vauthier-Brozes D, Zorn JR. Psychological reactions after multifetal pregnancy reduction: a 2-year follow-up study. Hum Reprod. 1997;12:617–622. doi: 10.1093/humrep/12.3.617. [DOI] [PubMed] [Google Scholar]
  • 16.Roest J, van Heusden AM, Verhoeff A, Mous HVF, Zeilmaker GH. A triplet pregnancy after in vitro fertilization is a procedure-related complication that should be prevented by replacement of two embryos only. Fertil Steril. 1997;67:290–295. doi: 10.1016/S0015-0282(97)81913-9. [DOI] [PubMed] [Google Scholar]
  • 17.Craft I, Ah-Moye M, Al-Shawaf T, Fiamanya W, Robertson, Serhal P, Shrivastav P, Simons E, Brinsden P. Analysis of 1071 GIFT procedures—the case for a flexible approach to treatment. Lancet. 1988;1:1094–1098. doi: 10.1016/s0140-6736(88)91908-3. [DOI] [PubMed] [Google Scholar]
  • 18.Munne S, Alikani M, Tomkin G, Grifo J, Cohen J. Embryo morphology, developmental rates and maternal age are correlated with chromosome abnormalities. Fertil Steril. 1995;64:382–391. [PubMed] [Google Scholar]
  • 19.Widra EA, Gindoff PR, Smotrich DB, Stillman R. Achieving multiple-order embryo transfer identifies women over 40 years of age with improved in vitro fertilization outcome. Fertil Steril. 1996;65:103–108. doi: 10.1016/s0015-0282(16)58035-2. [DOI] [PubMed] [Google Scholar]
  • 20.Horne G, Critchlow JD, Newman MC, Edozien L, Matson PL, Lieberman BA. A prospective evaluation of cryopreservation strategies in a two-embryo transfer programme. Hum Reprod. 1997;12:542–547. doi: 10.1093/humrep/12.3.542. [DOI] [PubMed] [Google Scholar]
  • 21.Speirs AL, Lopata A, Gronow MJ, Kellow GN, Johnston WI. Analysis of the benefits and risks of multiple embryo transfer. Fertil Steril. 1983;39:468–471. doi: 10.1016/s0015-0282(16)46933-5. [DOI] [PubMed] [Google Scholar]
  • 22.Yaron Y, Amit A, Kogosowski A, Peyser MR, David MP, Lessing JB. The optimal number of embryos to be transferred in shared oocyte donation: walking the thin line between low pregnancy rates and multiple pregnancies. Fertil Steril. 1997;12:699–702. doi: 10.1093/humrep/12.4.699. [DOI] [PubMed] [Google Scholar]
  • 23.Gardner DK, Vella P, Lane M, Wagley L, Schlenker T, Schoolcraft WB. Culture and transfer of human blastocysts increases implantation rates and reduces the need for multiple embryo transfers. Fertil Steril. 1998;69:84–88. doi: 10.1016/s0015-0282(97)00438-x. [DOI] [PubMed] [Google Scholar]
  • 24.Menezo Y, Veiga A. Cryopreservation of blastocysts. In: Gomel V, Leung PCK, editors. In Vitro Fertilization and Assisted Reproduction. Bologna: Monduzzi Editore; 1997. pp. 49–53. [Google Scholar]
  • 25.Jones GM, Trounson AO, Gardner DK, Kausche A, Lolatgis N, Wood C. Evolution of a culture protocol for successful blastocyst development and pregnancy. Hum Reprod. 1998;13:169–177. doi: 10.1093/humrep/13.1.169. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Assisted Reproduction and Genetics are provided here courtesy of Springer Science+Business Media, LLC

RESOURCES