Single embryo transfer in clinical practice

The high incidence of multiple pregnancies is the main reason for adverse treatment outcome in assisted reproduction. A good strategy to avoid multiple pregnancies is elective single embryo transfer and cryopreservation of spare embryos. Important factors in an elective single embryo transfer programme are good counselling of the patients and the selection of embryos with high implantation potential. In the infertility clinic at Helsinki University Central Hospital the elective single embryo transfer programme was started in 1997 and in 2000 the transfer policy turned to single embryo transfer as primary option. In 2003 60% of fresh transfers were elective single embryo transfers and 66% of frozen transfers were single embryo transfers. It has been shown that an elective single embryo transfer programme can be adopted in daily practice and that it decreases the multiple pregnancy rate, in our programme to around 7% with acceptable overall pregnancy and delivery rates. In Finland the increased use of single embryo transfer has reduced the proportion of multiple births. Finally, a good cryopreservation programme is essential to achieve a good cumulative delivery rate without multiple pregnancies.