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Prados N.,Instituto Valenciano Of Infertilidad Seville | Prados N.,Pablo De Olavide University | Quiroga R.,Instituto Valenciano Of Infertilidad Seville | Caligara C.,Instituto Valenciano Of Infertilidad Seville | And 6 more authors.
Reproduction, Fertility and Development | Year: 2015

The purpose of this study was to determine which strategy of embryo transfer has a better trade-off in live birth delivery rate versus multiple pregnancy considering patient acceptance: elective single embryo transfer (eSET) or elective double embryo transfer (eDET). In all, 199 women <38 years of age undergoing their first IVF treatment in a private centre were included in a prospective open-label randomised controlled trial. Patients were randomised into four groups: (1) eSET on Day 3; (2) eSET on Day 5; (3) eDET on Day 3; and (4) eDET on Day 5. Per patient, main analysis included acceptance of assigned group, as well as multiple and live birth delivery rates of the fresh cycle. Secondary analysis included the rates of subsequent cryotransfers and the theoretical cumulative success rate. Of 98 patients selected for eSET, 40% refused and preferred eDET. The live birth delivery rate after eDET was significantly higher after eDET versus eSET (65% vs 42%, respectively; odds ratio≤1.6, 95% confidence interval 1.1-2.1). No multiple births were observed after eSET, compared with 35% after eDET. Although live birth delivery is higher with eDET, the increased risk of multiple births is avoided with eSET. Nearly half the patients refused eSET even after having been well informed about its benefits. © 2015 CSIRO. Source


Ruiz-Alonso M.,IVIOMICS | Blesa D.,University of Valencia | Diaz-Gimeno P.,University of Valencia | Diaz-Gimeno P.,Computational Medicine Institute | And 6 more authors.
Fertility and Sterility | Year: 2013

Objective: To demonstrate the clinical value of the endometrial receptivity array (ERA) in patients with repeated implantation failure (RIF), for guiding their personalized embryo transfer (pET) as a novel therapeutic strategy. Design: Prospective interventional multicenter clinical trial. Setting: University-affiliated infertility and private clinics. Patient(s): Eighty-five RIF patients and 25 comparison patients. Intervention(s): Endometrial sampling and pET guided by ERA. Main Outcome Measure(s): A receptive (R) or nonreceptive (NR) endometrial status according to ERA. Pregnancy (PR) and implantation (IR) rates after pET. Result(s): The ERA test gave an R result of 74.1% in RIF patients versus 88% in control subjects. Clinical follow-up was possible in 29 RIF patients, in whom pET was performed, resulting in 51.7% PR and 33.9% IR. The IRs and PRs in the 6 months after the biopsy showed that pregnancy was not related to the local injury. Twenty-two RIF patients (25.9%) were NR, and in 15 of them a second ERA validated a displacement of the window of implantation (WOI). In eight of them, pET was performed on the day designated by the ERA, resulting in 50.0% PR and 38.5% IR. These results should be considered as preliminary. Conclusion(s): There is an increased percentage of WOI displacement in RIF patients compared with comparison group patients, leading to the concept of pET as a therapeutic strategy. Rescue of NR patients by pET in a displaced WOI results in similar PR and IR. © 2013 by American Society for Reproductive Medicine. Source

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