Double embryo transfer gives good pregnancy and live birth rates in poor responders with a modest increase in multiple birth rates: results from an observational study

OBJECTIVE: The aim of this study was to compare pregnancy and live birth rates in poor responders when transferring one or two embryos. Poor responders were defined as having four or fewer oocytes retrieved in combination with a high dose of gonadotrophins. DESIGN: Retrospective, observational study. SETTING: Reproductive Medicine, University Hospital. Methods and Sample. All fresh cycles, in total 5 351, performed during the years 2003-2008 were included, where 367 cycles were poor responders. MAIN OUTCOME MEASURES: Pregnancy and live birth rates. RESULTS: In the poor responders, the live birth rate per oocyte pick-up and per embryo transfer was 10.9 and 16.3%, respectively, compared with 23.9 and 27.7%, respectively, in the normal responders (p=0.0001 and p=0.01, respectively). In the poor responders, the live birth rate per single embryo transfer was 10.8%, compared with 27.8% per double embryo transfer (DET; p=0.0014) and in normal responders 28.1 vs. 26.6%, respectively (p=0.34). Multiple birth rates after DET were 9.1% in the poor responders and 25.6% in the normal responders. CONCLUSIONS: This study confirms that poor responders have overall lower live birth rates after in vitro fertilization treatment compared with normal responders. The live birth rate after DET in poor responders was clinically and statistically significantly higher than after single embryo transfer, with a modest increase in multiple birth rates. Thus, in poor responders, DET might be considered more often than in normal responders. Single embryo transfer should, however, be the first option among women stimulated with a low/normal dose of gonadotrophins irrespective of the number of retrieved oocytes.