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Clinical and Experimental Obstetrics & Gynecology  2020, Vol. 47 Issue (2): 215-219    DOI: 10.31083/j.ceog.2020.02.5128
Original Research Previous articles | Next articles
Separate transfer of two frozen-thawed embryos reduces multiple gestations in assisted reproductive technology
T. Hasegawa1, *(), K. Nakagawa2, R. Sugiyama2, N. Kuji1, H. Nishi1
1Department of Obstetrics and Gynecology, Tokyo Medical University, Shinjyuku, Tokyo, Japan
2Division of Reproductive Medicine, Sugiyama Clinic, Setagaya, Tokyo, Japan
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Abstract  Aim: In assisted reproductive technology (ART), there are different opinions regarding how an embryo should be transferred to the uterus. For double embryo transfer (DET) cycles in particular, there is no consensus regarding the appropriate embryo transfer (ET) method. Therefore, the present authors developed a novel ET method called separated (s-DET); with this method, two embryos are transferred to separate settings. The authors evaluated and compared pregnancy outcomes of s-DET and conventional DET (c-DET). Materials and Methods: In this prospective cohort study, 129 patients underwent separated ET. One hundred fifty-two patients underwent c-DET, which involves transferring two embryos together. All patients underwent ET of two frozen-thawed embryos. Results: The clinical pregnancy and implantation rates of the s-DET group were 20.9 % and 10.4 %, respectively; these rates were similar to those of the conventional DET group (26.3 % and 16.1 %, respectively). However, the multiple gestation rate of the D-DET group (0.0 %) was significantly lower than that of the conventional double ET group (22.5 %; p = 0.006). Conclusions: s-DET might make ART safer and decrease multiple gestations resulting from DET cycles.
Key words:  Embryo transfer      In vitro fertilization      Obstetrics      Pregnancy      Assisted reproductive techniques     
Published:  15 April 2020     
*Corresponding Author(s):  T. Hasegawa     E-mail:

Cite this article: 

T. Hasegawa, K. Nakagawa, R. Sugiyama, N. Kuji, H. Nishi. Separate transfer of two frozen-thawed embryos reduces multiple gestations in assisted reproductive technology. Clinical and Experimental Obstetrics & Gynecology, 2020, 47(2): 215-219.

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Figure 1.  — Ultrasound image of the s-DET procedure. After the first embryo is transferred to the fundus of the uterus, the second embryo is transferred to a position with a 1 cm space by inserting another transfer tube. The arrows indicate air bubbles following the transfer of embryos.

Table 1  — Background characteristics of the s-DET and c- DET groups.
s-DET c-DET P value
Cycles, n 129 152
Age, years# 38.8 ± 3.5 38.7 ± 3.8 NS
Previous ET attempts, n# 3.3 ± 3.3 3.9 ± 3.0 NS
Gravidity n# 0.9 ± 1.2 0.6 ± 0.9 NS
Parity, n# 0.3 ± 0.5 0.2 ± 0.4 NS
Cause of infertility
Male factor, n (%) 66 (51.2) 78 (51.3) NS
Tubal factor, n (%) 6 (4.7) 8 (5.2) NS
Endometriosis, n (%) 4 (3.1) 9 (6.0) NS
Unexplained, n (%) 53 (41.0) 57 (37.5) NS
Table 2  — Embryo quality between the s-DET and c-DET groups.
s-DET c-DET P value
No. of double good embryos, n (%) 35(27.1) 42(27.6) NS
No. of good & poor embryos, n (%) 62(48.1) 60(39.5) NS
No. of double poor embryos, n (%) 32(24.8) 50(32.9) NS
Best no. of blastomeres, n# 8.2 ± 1.7 7.9 ± 1.4 NS
Total no. of blastomeres, n# 15.3 ± 2.8 14.6 ± 2.3 NS
Table 3  — Reproductive outcomes in the s-DET and c-DET groups.
(n = 129)
(n = 152)
p value
Transferred embryos, n 258 304
Positive hCG, n (%) 37 (28.7) 45 (29.6) NS
Clinical pregnancy, n (%) 27 (20.9) 40 (26.3) NS
GS, n 27 49
Implantation rate, % 10.4 16.1 NS
Multiple pregnancies, n (%) 0 (0.0) 9 (22.5) 0.006
Miscarriage, n (%) 4 (14.8) 9 (22.5) NS
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