Factors affecting patients’ attitudes toward single- and multiple-embryo transfer

Newton, Christopher; McBride, Joanna; Feyles, Valter; Tekpetey, F.; Power, Stephanie

doi:10.1016/j.fertnstert.2006.06.043

Cited by 80 publications

(62 citation statements)

References 29 publications

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“…This is consistent with the findings of previous studies suggesting that many women have a clear preference for DET despite being aware of the risks associated with twin pregnancy. 9,10 …”

Section: Comparison With Other Studiesmentioning

confidence: 99%

“…8 Women in particular are deterred from taking up eSET, fearing that it will reduce their chances of live birth or result in a need for additional treatment cycles. 9,10 Healthcare commissioners lack information on how alternative embryo transfer strategies will affect health service costs, pregnancy rates and twin pregnancy rates over time in different subgroups of women. 7 To address these concerns, this study models the effectiveness and cost-effectiveness of using eSET versus DET in up to three full treatment cycles (i.e.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

Scotland

McLernon

Kurinczuk

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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Objectives To assess the cumulative costs and consequences of double embryo transfer (DET) or elective single embryo transfer (eSET) in women commencing in vitro fertilisation (IVF) treatment aged 32, 36 and 39 years. Design Microsimulation model.Setting Three assisted reproduction centres in Scotland.Sample A total of 6153 women undergoing treatment at one of three Scottish IVF clinics, between January 1997 and June 2007.Methods A microsimulation model, populated using data inputs derived from a large clinical data set and published literature, was developed to compare the costs and consequences of using eSET or DET over multiple treatment cycles.Main outcome measures Disability-free live births; twin pregnancy rate; women's quality-adjusted life-years (QALYs); health service costs.Results Not only did DET produce a higher cumulative live birth rate compared with eSET for women of all three ages, but also a higher twin pregnancy rate. Compared with eSET, DET ranged from costing an additional £27 356 per extra live birth in women commencing treatment aged 32 years, to costing £15 539 per extra live birth in 39-year-old women. DET cost £28 300 and £20 300 per additional QALY in women commencing treatment aged 32 and 39 years, respectively.Conclusions Considering the high twin pregnancy rate associated with DET, coupled with uncertainty surrounding QALY gains, eSET is likely to be the preferred option for most women aged £36 years. The cost-effectiveness of DET improves with age, and may be considered cost-effective in some groups of older women. The decision may best be considered on a case-by-case basis for women aged 37-39 years.Keywords Cost-effectiveness, in vitro fertilisation, single embryo transfer.Please cite this paper as: Scotland G, McLernon D, Kurinczuk J, McNamee P, Harrild K, Lyall H, Rajkhowa M, Hamilton M, Bhattacharya S. Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon.

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“…This is consistent with the findings of previous studies suggesting that many women have a clear preference for DET despite being aware of the risks associated with twin pregnancy. 9,10 …”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

Scotland

McLernon

Kurinczuk

et al. 2011

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

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“…But when these couples are properly informed of the risks associated with multiple pregnancy, the rate of those wishing single embryo transfer increases from 33% to 60% [5].…”

Section: Introductionmentioning

confidence: 99%

Contribution of cryopreservation in a mandatory SET policy: analysis of 5 years of application of law in an academic IVF center

Salame

Devreker

Imbert

et al. 2011

J Assist Reprod Genet

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Objective To analyse treatment outcomes after SET law enforcement and to evaluate the contribution of cryopreservation in a SET policy. Material Embryo transfer cycles performed after the law enforcement (SET period) was retrospectively compared to the cycles performed before the law enforcement (DET period).Results Pregnancy and delivery rates after fresh transfer of SET and DET periods were comparable (31.7% versus 33.3% and 24.5% versus 26.2%, respectively, NS). Overall twin delivery rate is significantly decreased after the law enforcement (11.3% versus 22.4%, p<0.001) but not in patients aged 36 to 39 years (20.3% versus 24%, NS). Frozen-thawed embryo cycles allowed similar cumulative pregnancy rate (30.6%, NS). Taking into account all frozen embryos still to be transferred, SET period offers a better overall pregnancy rate than the DET period (36.1% versus 32.3%, p<0.01). ConclusionsThe Belgian law allowed a dramatic reduction of twin deliveries especially for patients under 36 years. Cryopreservation maintains a similar cumulative pregnancy rate.

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“…Although a review of 13 studies found the majority of infertile couples favoured a multiple birth [17] studies had used non-standardised and often hypothetical questions. There is growing evidence that couples' preferences are dominated by their desire to achieve pregnancy [18] and a preference for multiple embryo transfer is largely driven by a perception that the chance of pregnancy is increased after double embryo transfer [19][20][21]. Studies have explored attitudes towards a multiple birth and single embryo transfer at different time points and this may also have had an impact on their findings.…”

Section: Introductionmentioning

confidence: 99%

“…Such findings have prompted researchers to try to influence attitudes towards multiple births and eSET using information and educational materials about the associated risks [21,32,33]. To date research in this area has used quite lengthy questionnaires developed for each individual project.…”

Section: Introductionmentioning

confidence: 99%

Comparing patients’ and clinicians’ perceptions of elective single embryo transfer using the attitudes to a twin IVF pregnancy scale (ATIPS)

Rai

Betsworth

Beer

et al. 2010

J Assist Reprod Genet

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Background This study evaluated a questionnaire originally developed for use with health professionals to explore and compare patients' and clinicians' perceptions of elective single embryo transfer and twin births. Methods IVF clinicians and patients attending an independent Fertility clinic were surveyed using the Attitudes to a twin birth scale (ATIPS) comprising two subscales: attitudes to twins (A-Twin) and attitudes to elective single embryo transfer (A-SET). After refinement total sample scores showed both subscales were reliable with Cronbach's alpha >0.8 and item-total correlations >0.35. Results Questionnaires were completed by 100 female IVF patients and 17 IVF clinicians. A-Twin subscale scores indicated neither the IVF clinicians nor female IVF patients demonstrated very positive attitudes to a twin birth although the IVF female patients were more in favour (t=5.29, n=117, p=<0.001). Responses suggest both groups would benefit from increased information about the risks of a twin birth for the baby. First cycle IVF female patients were significantly more positive about eSET (z=3.94, n=100, p=<0.001). Clinicians perceive both their colleagues' and female patients' negativity towards eSET; suggesting a role for education. Conclusions This study found the ATIPS to be a reliable measure which could be useful in evaluating interventions to promote single embryo transfer.

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Factors affecting patients’ attitudes toward single- and multiple-embryo transfer

Cited by 80 publications

References 29 publications

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

Minimising twins in in vitro fertilisation: a modelling study assessing the costs, consequences and cost-utility of elective single versus double embryo transfer over a 20-year time horizon

Contribution of cryopreservation in a mandatory SET policy: analysis of 5 years of application of law in an academic IVF center

Comparing patients’ and clinicians’ perceptions of elective single embryo transfer using the attitudes to a twin IVF pregnancy scale (ATIPS)

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