Effectiveness of sequential embryo transfer in IVF/ICSI: A systematic review and meta-analysis

Abstract Purpose The window of implantation extends 3–6 days within the secretory phase in most normal women. The efficacy of such technique (sequential transfer) is still debatable in IVF/intracytoplasmic sperm injection (ICSI). The purpose of this systematic review was to investigate whether sequential transfer is more beneficial to pregnancy outcomes in IVF/ICSI. Method Search terms included “double embryo transfer”, “sequential transfer”, “consecutive transfer”, “IVF”, “ICSI”. The selection criteria were nonrandomized studies and randomized controlled studies. For data collection and analysis, the Review Manager software, Newcastle–Ottowa Quality Assessment Scale and GRADE approach were used. Results The clinical pregnancy rate and live birth rate showed that compared to the control protocol, the treatment group (sequential embryo transfer) were higher (RR 1.31, 95% CI (1.15 to 1.48), I2 = 49%, P < 0.0001), (RR 1.65, 95% CI (1.18 to 2.31), I2 = 0%, P = 0.003). The results were statistically significant. The multiple pregnancies rate and miscarriage rate were no statistical significance. Conclusion The sequential embryo transfer provided higher clinical pregnancy rate and live birth rate than the control protocol, with the same rate of multiple pregnancies and miscarriage. The sequential embryo transfer could be a safe option as a personalized protocol for infertile patients.