Obstetrical and neonatal outcomes from the BEST Trial: single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates

Eric J Forman; Kathleen H Hong; Jason M Franasiak; Richard T Scott Jr

doi:10.1016/j.ajog.2013.10.016

Obstetrical and neonatal outcomes from the BEST Trial: single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates

Am J Obstet Gynecol. 2014 Feb;210(2):157.e1-6. doi: 10.1016/j.ajog.2013.10.016. Epub 2013 Oct 18.

Authors

Eric J Forman¹, Kathleen H Hong², Jason M Franasiak², Richard T Scott Jr²

Affiliations

¹ Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ; Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ. Electronic address: eforman@rmanj.com.
² Reproductive Medicine Associates of New Jersey, Basking Ridge, NJ; Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ.

PMID: 24145186
DOI: 10.1016/j.ajog.2013.10.016

Abstract

Objective: We sought to determine whether performing elective single embryo transfer (eSET) after trophectoderm biopsy and rapid aneuploidy screening results in improved obstetrical and neonatal outcomes compared with transferring 2 untested embryos.

Study design: The Blastocyst Euploid Selective Transfer (BEST) Trial enrolled infertile couples with a female partner up to age 42 years who were undergoing in vitro fertilization. They were randomized to receive transfer of a single euploid embryo (eSET) or to the standard of care with transfer of 2 embryos that were not biopsied for aneuploidy screening (untested 2-embryo transfer). Gestational age at delivery, birthweight, and neonatal intensive care unit (NICU) lengths of stay were compared with Mann-Whitney U. The risk of preterm delivery, low birthweight, and NICU admission were compared with χ(2).

Results: Among the 175 randomized patients, the delivery rates were similar (69% after euploid eSET vs 72% after untested 2-embryo transfer; P = .6) through the fresh cycle and up to 1 frozen transfer, with a dramatic difference in multiple births (1.6% vs 47%; P < .0001). The risk of preterm delivery (P = .03), low birthweight (P = .002), and NICU admission (P = .04) were significantly higher after untested 2-embryo transfer. Babies born after untested 2-embryo transfer spent >5 times as many days in the NICU (479 vs 93 days; P = .03).

Conclusion: By enhancing embryo selection with a validated method of aneuploidy screening, a single euploid embryo with high reproductive potential can be selected for transfer. Using this approach, eSET can be performed without compromising delivery rates and improving the chance of having a healthy, term singleton delivery after in vitro fertilization.

Keywords: aneuploidy screening; in vitro fertilization; preimplantation genetic screening; single embryo transfer.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aneuploidy*
Birth Weight
Chromosome Disorders / diagnosis*
Female
Fertilization in Vitro
Genetic Testing* / methods
Humans
Infant, Newborn
Pregnancy
Pregnancy Outcome*
Preimplantation Diagnosis* / methods
Single Embryo Transfer*