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Studies reveal higher pregnancy and birth rate with single embryo transfer

30 March 2009
Appeared in BioNews 501

Two recent studies, published in the journal Human Reproduction last week, have revealed that implanting a single embryo during IVF procedures may result in improved pregnancy rates and could also be cheaper than when implanting two embryos.

Although implanting two or more embryos can improve chances of becoming pregnant during IVF, the practise has been linked to multiple births and associated medical problems such as premature birth, low birth weight and possible neurological problems, in addition a greater risk of other complications during pregnancy and birth. Further, multiple births are much more costly in terms of healthcare and other associated social costs than single births.

The first study utilised data from over 1,500 fertility patients under the age of 40, treated at Oulu University Hospital in Finland between 1995 and 2004. It found that when comparing the data from 1995 and 2000, when single embryo transfer (SET) was only used in 4.2 per cent of patients, with that from 2000-2004, when SET was used in 46.2 per cent of patients, the overall pregnancy rate and live birth rates were significantly higher and the multiple birth rate was lower.

Dr Hannu Martikainen, who led the first study, said 'This study shows that the implementation of an [elective] SET policy, together with an effective embryo freezing programme, results in a better outcome and lower treatment cost for women under the age of 40 having IVF, ICSI (intracytoplasmic sperm injection) or both. This refutes any concerns about the cost implications or efficacy of an eSET policy'. The study also found that a live birth from SET was on average nearly €20,000 less expensive than those born through double embryo transfer (DET).

In the second study, researchers used mathematical models to determine the cost-effectiveness of SET and double embryo transfer policies. 'A choice has to be made between three cycles of eSET, DET or standard treatment', said study leader Audrey Fiddelers, of the Academic Hospital Maastricht in the Netherlands. 'It is not cost effective to switch between these three treatment methods during the period of the three cycles of treatment', she said. The researchers said that the 'real-word' cost-effectiveness of each policy should be taken into account by policy makers in this area.

A single embryo transfer (SET) policy has been advocated by the Human Fertilisation and Embryology Authority in the UK, which regulates fertility clinics. Last year the British Fertility Society (BFS) and the Association of Clinical Embryologists (ACE) introduced new guidelines aimed at reducing the number of multiple births, recommending that a SET policy should be adopted for women under 37. SET remains elective, however, and it is up to patients and clinics to decide whether to transfer one or more embryos at a time.

In IVF, one embryo is better than two
Medpage Today |  25 March 2009
Single embryo best for IVF success, study finds |  25 March 2009
Single embryo implants work better: study
AFP |  25 March 2009
Single embryo transfer is the cheapest and most effective strategy for assisted reproduction
EurekaAlert |  24 March 2009
15 October 2012 - by Dr Rachael Panizzo 
A mathematical model has been developed that predicts the probability that a couple will become pregnant...
16 August 2010 - by Chris Chatterton 
One of the biggest problems facing patients and doctors during fertility treatment is when to decide to switch to an alternative method, after the failure of a particular approach....
28 September 2009 - by Nishat Hyder 
A report published on 24 September 2009 by the Australian Institute of Health and Welfare ('the Institute') has indicated that although an increasing number of women are turning to assisted reproductive technologies (ART) to assist with pregnancy, the number of multiple births is decreasing....
23 February 2009 - by Professor Joep Geraedts 
Whilst reading the Commentary by Norbert Gleicher recently published in BioNews (1), we were surprised and saddened that the same arguments given at the ESHRE annual meeting (2) last summer in Barcelona, were repeated without a clinical counterpart. ESHRE wishes to reaffirm its response to Gleicher last July; the complications...
26 January 2009 - by Shantal Rajah 
Elective single embryo transfer (eSET) policy implementation has raised many issues among patients, IVF experts and fund holders. The main concern in relation to this policy is that we do not know how much, and by what percentage, it will reduce the pregnancy rate in our patients. The policy says...
26 January 2009 - by Norbert Gleicher 
On the European side of the Atlantic single embryo transfer (SET) is increasingly becoming standard practice. As a consequence of legislation, as in Belgium, of professional dogma, as in most Scandinavian countries, or the product of the regulatory prowess of the Human Fertilisation and Embryology Authority (HFEA), as in the...
26 January 2009 - by Sandy Starr 
This month sees the coming into force of new regulations by the UK's Human Fertilisation and Embryology Authority (HFEA), which seek to ensure that elective single embryo transfer (eSET) for women under 40 becomes standard practice in IVF treatment in the UK. Under these regulations, public and private fertility clinics...
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