October 17-21 2015 Baltimore Maryland

OBJECTIVE: ASRM and SART regularly update guidelines on the
maximum number of embryos to transfer per cycle. Providers/patients, however,
often elect to transfer more than the recommended number of embryos
which can lead to an unnecessary increase in the number of multiple pregnancies.
The objective of this study was to determine the prevalence of cleavage
transfer cycles that do not conform to current recommended embryo transfer
(ET) limits and assess the impact of noncompliance on multiple pregnancy
rate (MPR) in first IVF cycles with a favorable prognosis.
DESIGN: Retrospective cohort study.
MATERIALS AND METHODS: 30,567 first fresh autologous IVF cycles
in women under 43 undergoing cleavage stage embryo transfer (ET) from the
2011-2012 SART registry were stratified into cohorts based on ASRM
defined age bins. Cycles were classified as compliant (C) versus noncompliant
(NC) based on their adherence to the published 2009/2013 guidelines for
first IVF cycles with a favorable prognosis. Main outcomes measured were
percentage of C and NC cycles in each age group as well as the MPR (R2
fetal heart beats on ultrasound) in each of these groups. Secondary outcomes
included clinical pregnancy rate (CPR), live birth rate (LBR), and singletons
(1 fetal heart beat on ultrasound). Data were analyzed using two-sided
Welch’s t-test for each age category and the Benjamini-Hochberg procedure
was used to control the false discovery rate.
RESULTS: The percentage of NC cycles ranged from 2 to 27.4% in
different age groups. Compared to C cycles, noncompliance resulted in
higher MPR in every age group, but statistical significance was reached
only in the two youngest age bins (p