Five-years of a mandatory single-embryo transfer (mSET) policy dramatically reduces twinning rate without lowering pregnancy rates

Kresowik, Jessica D.; Stegmann, B.; Ryan, Ginny L.; Voorhis, Bradley J. Van

doi:10.1016/j.fertnstert.2011.09.007

Cited by 53 publications

(25 citation statements)

References 8 publications

(7 reference statements)

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“…Our inclusion criteria of singleton delivery has perhaps selected for a larger proportion of patients who underwent SET, however our institution has been reported in the literature to have an overall rate of SET of 28% for all patients undergoing embryo transfer from June 2004 to May 2009. 7 This is significantly greater than the national average reported in a survey of the SART database showing a rate of only 4-5% SET between the years 2004 and 2006. 8 The presence of a second gestational sac that spontaneously disappears after eight weeks gestation has been associated with poorer obstetrical outcomes in several previous studies, including preterm delivery, low birth weight, very low birth weight, and postnatal mortality in survivor singleton pregnancies .9,10 Further subgroup analysis within our cohort was considered, but was not performed because of the very small number of women with a vanishing twin.…”

Section: Infertility Diagnosis and Art Outcomementioning

confidence: 73%

Influence of infertility diagnosis on pregnancy outcome in ART

Eppsteiner

Stegmann

Santillan

2013

Proc Obstet Gynecol

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Section: Infertility Diagnosis and Art Outcomementioning

confidence: 73%

Influence of infertility diagnosis on pregnancy outcome in ART

Eppsteiner

Stegmann

Santillan

2013

Proc Obstet Gynecol

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“…It is well documented that multiple gestation pregnancies are a higher risk pregnancy when compared to singleton gestations. Recent publications have reported similar live birth rate with a significant reduction in multiple gestation with the use of selective single embryo transfer when compared to multiple embryo transfer [2,8,12].…”

Section: Introductionmentioning

confidence: 87%

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

Hill

Heitmann

Richter

et al. 2012

Fertility and Sterility

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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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“…Where ART is regulated and publicly financed, such as Quebec, Belgium, and Sweden, single-embryo transfer is mandated with the transfer of two or more embryos permitted in special circumstances only [38][39][40][41][42][43][44][45]. In the UK where fertility treatment can be covered under the National Health Service, the Human Fertilisation and Embryology Authority established a 15% multiple-birth target which appears to have been attained [46] notwithstanding a successful legal challenge mounted by IVF clinic directors objecting to embryo transfer restriction measures being attached to the clinic's operating license [47].…”

Section: Asrm-sart Embryo Transfer Guidelinesmentioning

confidence: 99%

“One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients

White

2017

J Assist Reprod Genet

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In January 2016, Melissa Cook, a California gestational surrogate experiencing a multiple-birth pregnancy following the in vitro fertilization (IVF) transfer of three embryos comprised of donor eggs and sperm provided by the intended father, went to the media when the intended father requested that she undergo a fetal reduction because twins were less expensive to raise than triplets. Much of the legal interest in this case to date has centered on the enforceability of surrogacy contracts. However, the Cook case also raises troubling issues about fertility treatment practices involving gestational surrogates, twin preference, and third-party reproduction medical decision-making. This paper focuses on multiple-embryo transfers in the context of US surrogacy arrangements.Offering an original analysis of data obtained from the US national-assisted reproduction registry, it examines singleand multiple-embryo transfer trends over a 12-year period (2003 to 2014). Findings reveal that recommended guidelines were followed in fewer than 42% of the cases in 2014. The paper argues that ensuring equitable medical treatment for all recipients of IVF requires the adoption of treatment guidelines tailored to, and offering protections for, specific patient groups, and that, once in place, guidelines must be robustly implemented.

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Five-years of a mandatory single-embryo transfer (mSET) policy dramatically reduces twinning rate without lowering pregnancy rates

Cited by 53 publications

References 8 publications

Influence of infertility diagnosis on pregnancy outcome in ART

Influence of infertility diagnosis on pregnancy outcome in ART

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

“One for Sorrow, Two for Joy?”: American embryo transfer guideline recommendations, practices, and outcomes for gestational surrogate patients

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