Does transferring a good-quality embryo with a lower-quality embryo reduce the probability of success?

This is a question I am often asked by patients.

In the August 2020 edition of Fertility and Sterility, Is transferring a lower-quality embryo with a good-quality blastocyst detrimental to the likelihood of live birth?” was published.  This is a good study that indicates when transferring a lower quality blastocyst with a high-quality blastocyst, at the same time, it does not result in a decreased probability of success.  In fact, there is a small increase in the number of live births.  In women 38 years or older, the rate increased about 9% with regards to live birth and there was about a 15% increase in multiple pregnancy.  For patients under 38 years old, the increase in the live birth rate was about 7% but there was an 18% increase in the multiple pregnancy rate. 

With that said, the embryos were not tested with PGT-A in this study.  At MCRM Fertility, we have increased the recommendation for the use of PGT-A and as a result, utilize single embryo transfer almost universally.  So, the multiple pregnancy rate, thankfully, has tremendously decreased over time.  The overall live birth rate and success rate has increased significantly, as well.

Dr. Ahlering