Optimizing Embryo Selection: Developmental Competence and Reproductive Outcomes Following Single versus Combined Transfer of Top- and Poor-Quality Embryos
DOI:
https://doi.org/10.22034/JATE.2026.233Keywords:
Assisted Reproductive Technology; Embryo Transfer; Embryo Viability; Intracytoplasmic Sperm Injection; Live Birth; Pregnancy OutcomeAbstract
Embryo selection based on developmental competence is a key determinant of successful assisted reproductive technology outcomes. This study aimed to evaluate whether transferring poor-quality embryos (PQEs) alongside a top-quality embryo (TQE) influences pregnancy and live birth outcomes in fresh intracytoplasmic sperm injection (ICSI) cycles. In this retrospective cohort study, data from 400 women who underwent fresh ICSI cycles at Mehr Outpatient Surgical and Infertility Center, Rasht, Iran, between May 2022 and December 2023 were analyzed. Participants were classified into nine groups according to the number of embryos transferred (single, double, or triple embryo transfer) and embryo quality (different combinations of TQEs and PQEs). Biochemical pregnancy, clinical pregnancy, ongoing pregnancy, and live birth rates were compared among the groups using multivariate logistic regression adjusted for maternal age, endometrial thickness, and day of embryo transfer. Significant differences were observed in biochemical pregnancy (P = 0.001), clinical pregnancy (P = 0.004), ongoing pregnancy (P = 0.006), and live birth rates (P = 0.003) among the study groups. However, after adjustment for potential confounders, embryo transfer group was not independently associated with reproductive outcomes. Increasing maternal age was negatively associated with live birth, whereas greater endometrial thickness was positively associated with treatment success. The addition of one or more PQEs to a TQE did not improve live birth outcomes or increase multiple pregnancy rates in fresh ICSI cycles. These findings support elective single top-quality embryo transfer as an effective embryo selection strategy for optimizing reproductive outcomes while minimizing the risk of multiple gestations.
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