Effect of transfer of a poor quality embryo along with a top quality embryo on the outcome during fresh and frozen in vitro fertilization cycles

When only one top quality embryo is available, this study does not support double embryo transfer by adding a poor quality embryo along with a top quality embryo.

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Volume 110, Issue 4, Pages 655–660


Samuel James Alexander Dobson, B.M., B.S., Maria Teresita Lao, M.Sc., Essam Michael, M.D., Alex C. Varghese, Ph.D., Kannamannadiar Jayaprakasan, Ph.D.



To evaluate the impact of a poor quality embryo (PQE) during double ET (DET) with a top quality embryo (TQE) on IVF outcome.


A review of prospectively collected data.


Tertiary level fertility clinic.


All patients undergoing blastocyst transfers as part of fresh IVF (n = 939) and frozen ET (n = 1,009) cycles performed between 2010 and 2016.


Single ET (SET) with TQE (group 1) was set as control and compared with outcomes for SET with PQE (group 2), DET with 2 TQEs (group 3), PQE plus TQE (group 4), and 2 PQE (group 5).

Main Outcome Measure(s)

Live births and multiple births.


The live birth rates for group 4 were statistically similar to group 1 during fresh IVF (26.5% vs. 33.7%; odds ratio [OR], 0.95; 95% confidence interval [CI] 0.53–1.7) and frozen ET (24.2% vs. 32.7%; OR, 0.75; 95% CI 0.48–1.2), although there was a trend for lower success. Conversely, multiple births were higher in group 4 for fresh IVF (19% vs. 4.7%; OR, 2.9; 95% CI 1.3–6.6) and frozen ET (10.3% vs. 2.6%; OR, 2.4; 95% CI 1.2–4.9). The live birth rates for group 2 (12.2% for fresh IVF and 14.6% for frozen ET) and group 5 (21.2% for fresh IVF and 14% for frozen ET) were lower and for group 3 were higher (40.8% for fresh IVF and 40.3% for frozen ET) when compared with group 1. Multiple births were significantly higher with DET.


This study does not support DET with one PQE along with a TQE, when there is only one TQE and one or more PQEs available for fresh IVF or frozen ET.

Read the full text here.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. 


Go to the profile of Micah J Hill
over 3 years ago

Thank you for your paper.  I found it of great interest as we had similar findings we presented at ASRM last year.  While we approached it from the opposite hypothesis (embryo-endometrial cross-talk may actually reduce birth when a good quality embryo is transferred with a poor quality one) we had the same findings: the second poor quality embryo only increases twin rate with little effect on overall live birth outcome.


1. you labelled this a prospective cohort study.  Can you please clarify how this was a prospective cohort versus a retrospective cohort of existing data?  This minor point of how people label their cohort study is always very interesting to me!

2. you excluded cleavage embryo transfer, but did any top quality blasts also get transferred with a morula or compacting embryo and was this assessed?

3. are the fresh and frozen transfer rates the same and if not, did you consider adjusting for this in your analysis?  For example, since you included only the 1st transfer cycle, one would think that frozen would be better prognosis (ie. freeze only for OHSS risk would be young, high responders and be over represented in the frozen transfer group).

Thanks for your paper on a very interesting topic and I appreciate your considerations on the questions!