{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T15:05:53Z","timestamp":1785251153411,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,2,7]],"date-time":"2021-02-07T00:00:00Z","timestamp":1612656000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The effect of embryo quality on clinical outcomes of assisted reproductive technology following a double transfer is not well defined, with some studies suggesting that a low\u2010quality embryo transferred with a high\u2010quality embryo decreases the live birth rate (LBR), compared with transferring a single high\u2010quality embryo. Our study examined whether the quality of a second blastocyst transferred affects the outcome, controlling for the number of the available high\u2010quality blastocysts (HQB).<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A historical cohort study of 2346 fresh blastocyst transfers in a single fertility clinic between 2013 and 2019. The main outcomes were pregnancy, miscarriage, live birth, and multiple gestation rates. Outcomes were compared between single embryo transfers with a high\u2010quality blastocyst (SET\u2010H), double embryo transfers with two HQBs (DET\u2010HH), and transfers with one high\u2010quality and one low\u2010quality blastocyst (DET\u2010HL). Outcomes were also assessed between SET and DET when only low\u2010quality blastocysts were available.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>With one HQB available, DET\u2010HL increased LBR (adjusted odds ratio [OR] 1.65, 95% CI 1.09\u20102.49) compared with SET\u2010H, but increased multiple gestation rate (aOR 23.1, 95% CI 3.0\u2010177.6). With two HQBs available, DET\u2010HH was associated with a higher LBR (aOR 1.62, 95% CI 1.28\u20102.04) and lower miscarriage rate (aOR 0.56, 95% CI 0.40\u20100.80), but very high twin rate (aOR 49.8, 95% CI 24.3\u2010102.1) compared with SET\u2010H. A SET\u2010H with at least one or more HQB available to freeze, compared with a SET\u2010H with no other HQB available, had a higher LBR (aOR 1.69, 95% CI 1.17\u20102.45). When there were no HQBs available, compared with SET\u2010L, a DET\u2010LL had a higher live birth (aOR 3.20, 95% CI 1.78\u20107.703) and twin rate (aOR 3.72\u00a0\u00d7\u00a010<jats:sup>10<\/jats:sup>) and a lower miscarriage rate (aOR 0.24, 95% CI 0.10\u20100.58).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>When there is one HQB available, transferring an additional low\u2010quality blastocyst would only slightly increase the LBR, but significantly increase the twin rate, therefore SET should be recommended. When two or more HQBs are available, SET\u2010H would have a reasonably good chance of success without the very high twin rate associated with DET\u2010HH. DET\u2010LL when compared with SET\u2010L, would increase the LBR, but increase the risk of multiple gestation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14088","type":"journal-article","created":{"date-parts":[[2021,2,8]],"date-time":"2021-02-08T20:04:44Z","timestamp":1612814684000},"page":"1124-1131","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Adding a low\u2010quality blastocyst to a high\u2010quality blastocyst for a double embryo transfer does not decrease pregnancy and live birth rate"],"prefix":"10.1111","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6151-7132","authenticated-orcid":false,"given":"Efstathios","family":"Theodorou","sequence":"first","affiliation":[{"name":"The Centre for Reproductive &amp; Genetic Health (CRGH) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0391-0443","authenticated-orcid":false,"given":"Benjamin P.","family":"Jones","sequence":"additional","affiliation":[{"name":"Hammersmith Hospital Imperial College NHS Trust London UK"},{"name":"Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne","family":"Cawood","sequence":"additional","affiliation":[{"name":"The Centre for Reproductive &amp; Genetic Health (CRGH) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carleen","family":"Heath","sequence":"additional","affiliation":[{"name":"The Centre for Reproductive &amp; Genetic Health (CRGH) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Serhal","sequence":"additional","affiliation":[{"name":"The Centre for Reproductive &amp; Genetic Health (CRGH) London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5652-7384","authenticated-orcid":false,"given":"Jara","family":"Ben\u2010Nagi","sequence":"additional","affiliation":[{"name":"The Centre for Reproductive &amp; Genetic Health (CRGH) London UK"},{"name":"Imperial College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,7]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Human Fertilisation and Embryology Authority.Fertility treatment in 2017: Trends and Figures.https:\/\/www.hfea.gov.uk\/about\u2010us\/publications\/research\u2010and\u2010data\/. 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