Is transferring a lower-quality embryo with a good-quality blastocyst detrimental to the likelihood of live birth?

The addition of a lower-quality second embryo does not have a detrimental effect on a good-quality blastocyst and increases multiple gestation more than improving live birth.

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VOLUME 114, ISSUE 2, P338-345


Micah J. Hill, D.O., Allison E. Eubanks, M.D., John M. Csokmay, M.D., Alicia Y. Christy, M.D., Samad Jahandideh, Ph.D., Alan H. DeCherney, M.D., Kate Devine, M.D., Eric D. Levens, M.D., Matthew T. Connell, D.O.



To determine if transferring a lower-quality embryo with a good-quality blastocyst is detrimental, given that evidence suggests that embryos can signal the endometrium and that embryo quality may affect negatively endometrial receptivity.


Retrospective cohort study.


In vitro fertilization center.


Single- versus double-embryo transfer.


Patients with a double-embryo transfer of a good-quality blastocyst plus a lower-quality blastocyst, early blastocyst, or morula were compared with patients receiving a single good-quality blastocyst.

Main Outcome Measure(s)

Live birth, multiple gestation.


In this study, 4,640 in vitro fertilization cycles were analyzed. In none of the analyses did transferring a second lower-quality embryo negatively affect birth rate. In the primary analysis, transferring a second lower-quality embryo increased live birth by 10% and the multiple birth rate by 15%. The addition of a fair- or poor-quality blastocyst or early blastocyst markedly increased the twin birth rate by 22%–27% with an 8%–12% increase in live birth. The addition of a morula did not increase live birth but resulted in 12% more multiples. In women younger than 38 years, adding a lower-quality embryo increased the birth rate by 7% but resulted in 18% increase in multiples. In women 38 years or older, adding a lower-quality embryo increased the live birth rate by 9% with a 15% increase in multiples.


Addition of a lower-quality embryo does not have a detrimental effect on a good-quality blastocyst and results in a small increase in live births. However, this is at the expense of a marked increase in the likelihood of multiple gestations.

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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. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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