Elective single embryo transfer: A 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice

Stillman, Robert J.; Richter, Kevin S.; Banks, Nicole; Graham, James R.

doi:10.1016/j.fertnstert.2008.09.023

Cited by 102 publications

(82 citation statements)

References 95 publications

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“…Ovarian hyperstimulation occurred primarily with mixed FSH/LH protocol under pituitary suppression with either GnRH antagonist or GnRH agonist as previously described [16]. In general, oral contraception was started 3 weeks prior to ovarian stimulation.…”

Section: Stimulation Protocolmentioning

confidence: 99%

The simplified SART embryo scoring system is highly correlated to implantation and live birth in single blastocyst transfers

Heitmann

Hill

Richter

et al. 2013

J Assist Reprod Genet

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Objective Prior studies have validated the ability of the SART embryo scoring system to correlate with outcomes in cleavage stage embryo transfers. However, this scoring system has not been evaluated in blastocyst transfers. The objective of this study was to estimate the correlation between the simplified SART embryo scoring system and ART cycle outcomes in single blastocyst transfers. Materials and methods All fresh, autologous single blastocyst transfers cycles from a large ART center from 2010 were analyzed. Blastocysts were given a single grade of good, fair, or poor based upon SART criteria which combines the grading of the inner cell mass and trophectoderm. Multiple logistic regression assessed the predictive value of the SART grade on embryo implantation and live birth. Results Seven hundred seventeen fresh, autologous single blastocyst transfers cycles were included in the analysis. The live birth rate was 52 % and included both elective and nonelective SBT. Chi square analysis showed higher live birth in good grade embryos as compared to fair (p=0.03) and poor (p=0.02). Univariate binary logistic regression analysis demonstrated SART embryo grading to be significantly correlated with both implantation and live birth (p<0.01). This significance persisted when patient age, BMI, and the stage of the blastocyst were controlled for with multiple logistic regression. In five patients with a poor blastocyst score, there were no live births. Conclusion These data demonstrate that the SART embryo scoring system is highly correlated to implantation and live birth in single blastocyst transfers. Patients with a good grade embryo are excellent candidates for a single blastocyst transfer.

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Section: Stimulation Protocolmentioning

confidence: 99%

The simplified SART embryo scoring system is highly correlated to implantation and live birth in single blastocyst transfers

Heitmann

Hill

Richter

et al. 2013

J Assist Reprod Genet

Self Cite

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“…We have been performing eSET since 2004, but patient resistance remains our biggest barrier to increasing the number of eSET cycles, as many prior groups have experienced [5]. We believe that patient education, insurance mandates, improving ART success, and financial incentives will result in increasing use of eSET [7].…”

Section: Discussionmentioning

confidence: 99%

Decreased gonadotropin requirements in once daily compared to twice daily administration: a prospective, randomized study

Sharara

Collins

Abdo

2012

J Assist Reprod Genet

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Objective Despite the lack of any scientific data, many ART programs split the daily gonadotropin dose during ovarian stimulation, while others give the entire dose during a single administration, usually at night. Design Prospective randomized. Patient(s) 213 women undergoing IVF/ICSI cycles at a single private ART center. Intervention(s) Gonadotropin administration once daily compared to twice daily. Main outcome measure(s) Gonadotropin usage, clinical and ongoing PR Results There were 110 women in the once daily compared to 103 in the twice daily arm. All cycles were blastocyst transfers. There was a significantly lower FSH use in the once daily arm compared to the twice daily arm (1507.5±517.5 IU vs. 1702.5±622.5, P00.015), and a trend towards lower hMG use in the once daily arm (1342.5±562.5 IU vs. 1462.5± 645.0, P00.15), without compromising clinical pregnancy rate (PR) (71.8% vs. 70.9%, P 0 NS) or delivery/ongoing PR (58.2% vs. 62.1%, P 0 NS). There were no differences in age, body mass index (BMI), peak estradiol, peak progesterone, retrieved oocytes, fertilized oocytes, number of ET, or PR. Conclusions Once daily administration is associated with lower gonadotropin usage without compromising success rates.

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“…However, the typical estimated financial burden of pregnancy does not include potential expenses relating to complications incurred during pregnancy and/or birth, or even the birth of twins, all of which are more frequent with the use of DET instead of SET [33]. The results of one study showed a 2.5% incidence of twins stemming from viable SET pregnancies while there was a grossly statistically significant 54.2% multiple pregnancy occurrence rates with DET pregnancies [37]. While extreme, these numbers are comparable to the findings of many other studies, and only further support the idea that, complications aside, electing to undergo DET runs the risk of multiple pregnancy [21,24,25,35].…”

Section: Widespread Costs Of Ivf Proceduresmentioning

confidence: 99%

“…Unlike many Westernized countries, the United States (US) is only now implementing more of a nation-wide healthcare plan; it is still the case that several US insurance providers do not cover infertility treatments [11]. Dr. Stillman notes that "multiple factors, including the existence of national health care plans providing complete or partial coverage for assisted reproduction for most Europeans and legislation requiring single ET (SET) in Belgium and Sweden, have led to more rapid implementation of SET and lower multiple-pregnancy rates in Europe than in the United States" [37]. Without adequate ART insurance coverage and financial support available in most states, a large part of the United States has some of the most expensive ART procedures in the world [47].…”

Section: Widespread Costs Of Ivf Proceduresmentioning

confidence: 99%

“…Researchers limited the study population by including only patients without insurance or with the state-mandated insurance coverage. The uninsured patients were then offered the option of Shared Risk, which only incurred expenses upon a successful live birth and also minimized the cost differentials between DET and possible multiple cycles of eSET [37,51]. Once the financial disincentives of eSET were minimized, the choice of eSET over DET increased significantly from a rate of 16% for patients without either insurance or Shared Risk to 24% and 25% for those with Shared Risk and insurance coverage, respectively.…”

Section: Widespread Costs Of Ivf Proceduresmentioning

confidence: 99%

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Assessment of the Field of Assisted Reproductive Technology: Improvements and the Future of Human In Vitro Fertilization

Brown¹

2015

JFIV Reprod Med Genet

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In vitro fertilization (IVF), a form of assisted reproductive technology, has expanded since its introduction in the 1970's to enable patients with prolonged infertility and/or clinical complications to produce biological offspring. This review analyzes the topics of controversy surrounding IVF, weighing evidence concerning contemporary fertility techniques that aim to advance the field of IVF. A comparison of single embryo transfer to double embryo transfer, in the context of economic expenditure and the likelihood of multiple pregnancy, provides support for electing the former. An ethically controversial topic is preimplantation genetic screening, a technology with the potential to reduce the incidence of genetic abnormalities, thereby increasing rates of healthy pregnancies. Lastly, the integration of in vitro maturation (IVM) can allow for a more diverse patient population to benefit from IVF treatment, while simultaneously avoiding several of the associated disadvantages. The future of IVF rests on continued research, and the resulting widespread integration of increasingly effective methods.

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Elective single embryo transfer: A 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice

Cited by 102 publications

References 95 publications

The simplified SART embryo scoring system is highly correlated to implantation and live birth in single blastocyst transfers

The simplified SART embryo scoring system is highly correlated to implantation and live birth in single blastocyst transfers

Decreased gonadotropin requirements in once daily compared to twice daily administration: a prospective, randomized study

Assessment of the Field of Assisted Reproductive Technology: Improvements and the Future of Human In Vitro Fertilization

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