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Purpose <p>Among IVF/ICSI patients with only 2–4 Day 3 embryos, which embryo culture strategy is associated with the highest cumulative live birth rate (CLBR): cleavage-stage transfer, blastocyst-stage transfer, or a mixed strategy?</p> Methods <p>This retrospective cohort study included 5758 first IVF/ICSI cycles performed between January 2016 and May 2022. Patients were divided into 3 groups according to embryo culture strategy: cleavage group (all embryos transferred/frozen at Day 3, <i>n</i> = 1859), blastocyst group (all embryos cultured to Day 5, <i>n</i> = 529), and mixed group (1–2 best cleavage embryos transferred or cryopreserved, with the remainder cultured, <i>n</i> = 3370). The primary outcome was CLBR per oocyte retrieval cycle. Confounders were adjusted using multivariable logistic regression. In addition, a doubly robust approach combining inverse probability weighting (IPW) with regression adjustment was performed as a sensitivity analysis.</p> Results <p>Compared with the cleavage-stage group, the blastocyst-stage group had a significantly lower CLBR after one oocyte retrieval cycle (adjusted odds ratio (aOR) 0.243, 95% CI 0.185–0.319 in logistic regression; aOR 0.345, 95% CI 0.271–0.437 in IPW). In contrast, the mixed group showed no significant difference in CLBR after adjustment (aOR 0.924, 95% CI 0.795–1.075 in logistic regression; aOR 0.978, 95% CI 0.867–1.103 in IPW).</p> Conclusions <p>For IVF patients with limited Day 3 embryos, a full blastocyst-stage strategy was associated with a substantially lower cumulative chance of live birth, whereas a mixed strategy did not improve CLBR compared with the cleavage-stage strategy after adjustment. These findings suggest that preserving transfer opportunities may be more important than further in vitro selection in this population.</p>

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Extended embryo culture and cumulative live birth in patients with limited embryos

  • 期刊论文

  • 发表日期：

    2026年7月25日

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  • Huizi Jin,
  • Wenju Peng,
  • Jiejun Luo,
  • Lei Jin,
  • Jian-Qiao Liu

摘要

Purpose

Among IVF/ICSI patients with only 2–4 Day 3 embryos, which embryo culture strategy is associated with the highest cumulative live birth rate (CLBR): cleavage-stage transfer, blastocyst-stage transfer, or a mixed strategy?

Methods

This retrospective cohort study included 5758 first IVF/ICSI cycles performed between January 2016 and May 2022. Patients were divided into 3 groups according to embryo culture strategy: cleavage group (all embryos transferred/frozen at Day 3, n = 1859), blastocyst group (all embryos cultured to Day 5, n = 529), and mixed group (1–2 best cleavage embryos transferred or cryopreserved, with the remainder cultured, n = 3370). The primary outcome was CLBR per oocyte retrieval cycle. Confounders were adjusted using multivariable logistic regression. In addition, a doubly robust approach combining inverse probability weighting (IPW) with regression adjustment was performed as a sensitivity analysis.

Results

Compared with the cleavage-stage group, the blastocyst-stage group had a significantly lower CLBR after one oocyte retrieval cycle (adjusted odds ratio (aOR) 0.243, 95% CI 0.185–0.319 in logistic regression; aOR 0.345, 95% CI 0.271–0.437 in IPW). In contrast, the mixed group showed no significant difference in CLBR after adjustment (aOR 0.924, 95% CI 0.795–1.075 in logistic regression; aOR 0.978, 95% CI 0.867–1.103 in IPW).

Conclusions

For IVF patients with limited Day 3 embryos, a full blastocyst-stage strategy was associated with a substantially lower cumulative chance of live birth, whereas a mixed strategy did not improve CLBR compared with the cleavage-stage strategy after adjustment. These findings suggest that preserving transfer opportunities may be more important than further in vitro selection in this population.