Objective: Embryo quality assessment with morphological evaluation remains the first-line method of assessment to select the best embryo for transfer. We aimed to determine if an effect of poor quality embryos on good quality ones exists, whether by a paracrine effect or an adverse endometrial influence, when they are transferred together.
Materials and methods: We included 412 couples, who underwent intracytoplasmic sperm injection (ICSI) cycles in a tertiary IVF center. Single embryo transfer with a good quality embryo and double embryo transfers with a good + poor quality embryo were evaluated. Overall pregnancy (PR) and live birth rates (LBR) were our main outcome measures.
Results: When PR and LBR are compared, there was no statistical significance between single embryo transfer (SET) and double embryo transfer (DET) groups (51.7 % vs 53.7 %, p = 0.620 and 47 % vs 43.1 %, p = 0.117). When the PR and LBRs were compared between SET from poor cohort and DET group, the outcomes were better in DET group (22.1 % vs 53.7 %, p < 0.001 and 22.1 % vs 43.1 %, p < 0.001). The PR and LBRs of SET from good cohort were significantly better than those of DET (64.4 % vs 53.7 %, p < 0.001 and 57.7 % vs 43.1, p < 0.001). When the PR and LBRs of SET from good cohort and SET from poor cohort were compared, better results were obtained in SET from good cohort.
Conclusion: The addition of poor quality embryo even is of benefit to the LBR, in the setting of when there is only one good quality blastocyst available for the transfer.
Keywords: Blastocyst; Double embryo transfer; Good quality embryo; Live birth rate; Poor quality embryo; Pregnancy rate; Single embryo transfer.
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