Elective Single Embryo Transfer: Guidelines for Practice British Fertility Society and Association of Clinical Embryologists

Abstract

Assisted conception treatment is the single most important cause in the increase in multiple pregnancy and births over the last 25 years. Multiple births are associated with significant peri natal morbidity and mortality. Europe has led the way in reducing multiple births by widespread adoption of an elective single embryo policy, which in Belgium is linked to an increase in state funding. Randomized controlled trials suggest that an eSET policy must include the ability to cryopreserve and transfer any remaining quality embryos to obtain parity with a double embryo transfer. This document provides a review of the available evidence with guidelines for practice, to help facilitate the introduction of an eSET policy in the UK.

Live birth rate, multiple pregnancy rate, and obstetric outcomes of elective single and double embryo transfers: Hong Kong experience

“…5 In 2008, the British Fertility Society, in conjunction with the Association of Clinical Embryologists, introduced guidelines for eSET in the UK that aimed to reduce IVF multiple pregnancy rates to less than 10%. 6 Meta-analyses have shown that in a selected population, compared with double embryo transfer (DET), eSET could reduce multiple pregnancy rates significantly, without compromising cumulative pregnancy rates. 7,8 Our centre offered eSET to eligible women in order to reduce the multiple pregnancy rate.…”

La criopreservación embrionaria en estadios más avanzados de desarrollo disminuye la frecuencia de pacientes con embriones criopreservados y el número de embriones criopreservados

“…Por lo tanto, uno de los grandes desafíos es reducir la frecuencia de multigestación 10 . Es por eso que las sociedades médicas de países desarrollados abogan por la transferencia de uno o dos embriones, de acuerdo a la edad de la paciente y los resultados anteriores [11][12][13][14][15][16] .…”

Towards single embryo transfer? Modelling clinical outcomes of potential treatment choices using multiple data sources: predictive models and patient perspectives

“…35,36 Selection of embryos by extended in vitro culture to the blastocyst stage has received much attention, [37][38][39] and a Cochrane review, 39 and was one approach suggested in the ACE/BFS guidelines. 11 Invasive pre-implantation genetic screening has been advocated as a potential approach and is available clinically. 40 However, there is little evidence for its effectiveness in increasing treatment outcomes and, in contrast, recent prospective RCTs have provided evidence that the invasive nature of the embryo biopsy procedure may be detrimental.…”

“…Grading systems differ between centres and there is a clear need for a unified, quality-assessed scoring system to allow intercentre collation of data. 11 In the present dataset, with nominally equivalent grading schemes across the centres (see Chapter 4, Data extraction and cleaning), it was necessary to normalise the grades between centres. This process is non-trivial and inexact, requiring rather strong assumptions.…”