Elective single versus double embryo transfer: live birth outcome and patient acceptance in a prospective randomised trial

Abstract

The purpose of this study was to determine which strategy of embryo transfer has a better trade-off in live birth delivery rate versus multiple pregnancy considering patient acceptance: elective single embryo transfer (eSET) or elective double embryo transfer (eDET). In all, 199 women <38 years of age undergoing their first IVF treatment in a private centre were included in a prospective open-label randomised controlled trial. Patients were randomised into four groups: (1) eSET on Day 3; (2) eSET on Day 5; (3) eDET on Day 3; and (4) eDET on Day 5. Per patient, main analysis included acceptance of assigned group, as well as multiple and live birth delivery rates of the fresh cycle. Secondary analysis included the rates of subsequent cryotransfers and the theoretical cumulative success rate. Of 98 patients selected for eSET, 40% refused and preferred eDET. The live birth delivery rate after eDET was significantly higher after eDET versus eSET (65% vs 42%, respectively; odds ratio=1.6, 95% confidence interval 1.1-2.1). No multiple births were observed after eSET, compared with 35% after eDET. Although live birth delivery is higher with eDET, the increased risk of multiple births is avoided with eSET. Nearly half the patients refused eSET even after having been well informed about its benefits.

The impact of age on blastocyst scoring after single and double embryo transfers

“…These numbers emphasize the need to avoid DETs in young patients and our data goes further to show that in patients aged 38-39 years, there is still a very high chance (40%) of twinning, after the transfer of two cryopreserved blastocysts. In agreement with our data, no multiple births were observed after elective SET, compared with 35% after elective DET in the study by Prados et al (2014). Thus, blastocyst DETs should be performed only in particular instances, as in cases of previous gestation failures following single good quality blastocyst transfer and for women aged above 40 years.…”

“…Thus, blastocyst DETs should be performed only in particular instances, as in cases of previous gestation failures following single good quality blastocyst transfer and for women aged above 40 years. One interesting aspect to point out from the last report (Prados et al, 2014) is the fact that despite the increased risks of gestational and neonatal problems associated with twin pregnancies, nearly half the patients refused elective SET even after having been well informed about its benefits.…”

Impact of Transferring a Poor Quality Embryo Along with a Good Quality Embryo on Pregnancy Outcomes in IVF/ICSI Cycles: a Retrospective Study

“…There is increasing preference for elective single-embryo transfers (SET) in in vitro fertilization (IVF) cycles because cumulative live birth rates are high after fresh cycles followed by frozen and thawed cycles with SET [4]. However, double-embryo transfers (DET) are still preferred in many IVF clinics because the clinical pregnancy and live birth rates are higher than with SET cycles [5,6]. Nevertheless, it is also known that multiple pregnancy rates are higher in DET, resulting in higher maternal and perinatal mortality and morbidity rates [5,6].…”

Comparison of Pregnancy Outcomes in Young Patients Following Fresh Versus Frozen Single Blastocyst Transfer: A Retrospective Study

“…How to reduce multiple pregnancy rate while achieving satisfactory pregnancy outcomes has become a research hotspot in recent years. Previous research has uncovered that single blastocyst transfer can achieve similar satisfactory pregnancy outcomes as double cleavagestage embryo transfer [4] . Therefore, single blastocyst transfer should be an ideal selection.…”