IMR Press / CEOG / Volume 50 / Issue 11 / DOI: 10.31083/j.ceog5011231
Open Access Original Research
Retrospective Analysis of Fresh Single Blastocyst Transfer versus Two Cleavage-Stage Fresh Day-3 Embryo Transfer with High-Quality Embryos during Gonadotropin-Releasing Hormone Antagonist Cycles in High Responders
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1 Center for Reproductive Medicine, the Third Affiliated Hospital of Sun Yat-sen University, 510630 Guangzhou, Guangdong, China
2 Department of Obstetrics, the Third Affiliated Hospital, Sun Yat-sen University, 510630 Guangzhou, Guangdong, China
*Correspondence: (Yuan Zhang); (Tingting Xia)
These authors contributed equally.
Clin. Exp. Obstet. Gynecol. 2023, 50(11), 231;
Submitted: 5 May 2023 | Revised: 15 July 2023 | Accepted: 24 July 2023 | Published: 21 November 2023
(This article belongs to the Special Issue In-Vitro Fertilization (IVF))
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: High responders are characterized by a large number of retrieved oocytes and/or a high level of estradiol on the day of administration of human chorionic gonadotropin. There is controversy in the literature regarding live birth rates from fresh day-5 single blastocyst transfer (day-5 SBT) compared to cleavage-stage fresh day-3 embryo transfer (day-3 ET) in high responders. The aim of this study was therefore to compare reproductive outcomes between day-5 SBT and day-3 ET using high-quality embryos and gonadotropin-releasing hormone (GnRH) antagonist protocols in high responders undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Methods: This was a single-center retrospective study of 282 high responders who underwent fresh day-5 SBT (day-5 SBT group, n = 142) or two cleavage-stage fresh day-3 embryo transfer (day-3 ET group, n = 140) between 2015 and 2019. Results: No significant differences were observed between the day-5 SBT and day-3 ET groups in terms of clinical pregnancy rate (51.41% vs. 59.29%, p = 0.183) or live birth rate (41.55% vs. 52.86%, p = 0.057). The incidence of multiple pregnancy (1.37% vs. 36.14%) and of low birth weight (5.00% vs. 32.26%) were significantly less frequent in the day-5 SBT group than in the day-3 ET group (p < 0.001 and p < 0.001, respectively). Conclusions: SBT may be the preferred choice for high-quality embryos in high responders undergoing IVF/ICSI during GnRH antagonist cycles with fresh embryo transfers. This is due to the lower incidence of obstetric complications compared to day-3 ET, although the clinical outcomes for the two groups are comparable.

high responder
fresh cycle
blastocyst transfer
cleavage-stage embryo
gonadotropin-releasing hormone antagonist
A2020575/Medical Scientific Research Foundation of Guangdong Province of China
Fig. 1.
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