Promoting the use of elective single embryo transfer in clinical practice

Tobias, Tamara; Sharara, Fady I.; Franasiak, Jason M.; Heiser, Patrick W.; Pinckney-Clark, Emily

doi:10.1186/s40738-016-0024-7

Cited by 18 publications

(13 citation statements)

References 59 publications

(113 reference statements)

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“…Two or more embryos were transferred to increase the chance of pregnancy, as a result, leading to a high risk of multiple pregnancy, which is considered as the most common adverse event associated with IVF-ET technology [ 2 ]. Multiple pregnancies are associated with significant complications and health risks for both mothers and infants [ 3 ]. Therefore, clinicians are gradually shifting from the initial goal of obtaining pregnancy to attaining the birth of a single healthy baby.…”

Section: Introductionmentioning

confidence: 99%

Live birth rate and neonatal outcomes of different quantities and qualities of frozen transferred blastocyst in patients requiring whole embryo freezing stratified by age

Chen

Liu

et al. 2020

BMC Pregnancy Childbirth

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Background Multiple pregnancies are associated with significant complications and health risks for both mothers and infants. Single blastocyst transfer (SBT) is a logical and effective measure to reduce the incidence of multiple pregnancy with assisted reproductive technology (ART). Whether it is suitable for everyone undergoing SBT was inconclusive, in view of the consideration of embryo quality and patients’ age. Therefore, this study aimed to explore live birth rate (LBR) and neonatal outcomes of different quantities and qualities of blastocysts in patients stratified by age, using a cutoff of 35 years, who required whole embryo freezing and underwent a subsequent frozen thawed transfer (FET) cycle. Methods Atotal of 3,362 patients were divided into five groups: group A (n=1569) received a single good-quality blastocyst, group B (n=1113) received two good-quality blastocysts, group C (n=313) received one good-and one average-quality blastocyst, group D (n=222) received two average-quality blastocysts, and group E (n=145) received one average-quality blastocyst. Results For patients who received good-quality blastocysts, irrespective of age, the LBR of double blastocyst transfer (DBT) was about 50–65% and the multiple pregnancy rate (MPR) was 40–60%; however, the LBR of SBT was 40–55%, and the MPR was 3.5–6.3%. For patients who only had average-quality blastocysts, the MPR of double average-quality blastocyst transfer was as high as 30–50%. Moreover, about 70–90% of preterm births resulted from multiple pregnancies, and about 85–95% of low birth weight babies come from multiple pregnancies. The neonatal outcomes (gestational age, birth weight, and birth height) of DBT were significantly lower than those of SBT regardless of age, and this statistical difference disappeared if the patients were subgrouped by singleton or twin. There is no significant difference in neonatal outcomes between single good-quality blastocyst and single average-quality blastocyst transfer. Conclusions SBT is a preferable option for patients regardless of age when good-quality blastocysts are available. For patients who only had average-quality blastocysts, they should be informed that DBT was associated with higher multiple pregnancy and adverse neonatal outcomes when compared with SBT regardless of age, suggesting that the practice of SBT is also feasible for these patients.

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Section: Introductionmentioning

confidence: 99%

Live birth rate and neonatal outcomes of different quantities and qualities of frozen transferred blastocyst in patients requiring whole embryo freezing stratified by age

Chen

Liu

et al. 2020

BMC Pregnancy Childbirth

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“…Another major barrier to the clinic's acceptance of eSET is the patient's strong desire for the transfer of more than one embryo. This is influenced by many factors including the patient's length of infertility, financial situation, and lack of knowledge, or discounting the risks and complications, of multiple pregnancy and birth [18].…”

Section: Design and Outcomementioning

confidence: 99%

Guidance for elective single-embryo transfer should be applied to frozen embryo transfer cycles

Freeman

Hinds

Howard

et al. 2019

J Assist Reprod Genet

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Purpose To provide clinicians with data showing the benefits of transferring a single blastocyst in frozen embryo transfer (FET) cycles so that they may counsel their patients accordingly. Methods This is a closed cohort study of 678 FET cycles occurring between January 2011 and December 2017 in a private IVF laboratory and associated physicians' practice. Patients included in the analysis were less than 38 years of age at oocyte collection, had at least two vitrified blastocysts, and were undergoing their first autologous FET cycle. The patients were categorized into four groups after they had chosen either elective single-embryo transfer (eSET) or double-embryo transfer (eDET). Outcomes for eSET and eDET were compared within groups of patients having freeze-all IVF cycles (PGT-A patient vs. non-PGT-A patient) and fresh IVF transfer groups (negative outcome vs. pregnant/delivered in fresh cycle). Main outcome measures of the study were live birth, multiple pregnancy, and implantation rates. Results There were no statistically significant differences observed in live birth rates for eSET (54-62%) vs. eDET (54-66%) (P = 0.696-1.000) in the four patient groups evaluated. Multiple pregnancy rates were significantly decreased in all eSET groups (0-3%), compared with eDET groups (24-65%) (P = 0.0001-0.037). Conclusions This data shows that transfer of a single vitrified-warmed blastocyst maintains live birth rates, while decreasing multiple pregnancies, and may become more acceptable to physicians and patients.

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“…Education can alter patient desire for twins (29,30). Using written and verbal communication, couples were educated about the health risks of twins to pregnant women, their fetuses and offspring.…”

Section: Pro 3 Brad Van Voorhis MDmentioning

confidence: 99%

Prevention of in vitro fertilization twins should focus on maximizing single embryo transfer versus twins are an acceptable complication of in vitro fertilization

Meldrum

Adashi

Garzo

et al. 2018

Fertility and Sterility

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Promoting the use of elective single embryo transfer in clinical practice

Cited by 18 publications

References 59 publications

Live birth rate and neonatal outcomes of different quantities and qualities of frozen transferred blastocyst in patients requiring whole embryo freezing stratified by age

Live birth rate and neonatal outcomes of different quantities and qualities of frozen transferred blastocyst in patients requiring whole embryo freezing stratified by age

Guidance for elective single-embryo transfer should be applied to frozen embryo transfer cycles

Prevention of in vitro fertilization twins should focus on maximizing single embryo transfer versus twins are an acceptable complication of in vitro fertilization

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