Elective single embryo transfer following in vitro fertilization

Area of Science:

• Reproductive Medicine
• In Vitro Fertilization (IVF)
• Maternal-Fetal Medicine

Background:

• Multiple pregnancies, often resulting from double embryo transfer (DET) in IVF, carry increased risks for both mother and child.
• Elective single embryo transfer (eSET) aims to reduce these risks by transferring only one embryo.

Purpose of the Study:

• To review the comparative effectiveness of eSET versus DET in IVF.
• To provide guidelines for optimizing live birth rates and minimizing twin pregnancies through eSET.

Main Methods:

• Systematic review of published literature including systematic reviews, RCTs, and observational studies up to November 2009.
• Searches of PubMed, Medline, and The Cochrane Library using relevant keywords.
• Evidence evaluated using established criteria for clinical practice guidelines.

Main Results:

• Selective eSET in good-prognosis patients can reduce multiple pregnancy rates without significantly compromising overall live birth rates.
• eSET may reduce live birth rates in women aged 38 and over.
• Cumulative live birth rates with eSET followed by frozen-thawed embryo transfer are similar to DET.
• eSET is more cost-effective than DET for good-prognosis patients.

Conclusions:

• eSET is recommended for good-prognosis patients, particularly younger women in their first or second IVF cycles with good quality embryos available.
• Effective cryopreservation programs are essential for maximizing cumulative live birth rates with eSET.
• Patient and physician education on the risks of twin pregnancy and the benefits of eSET is crucial for successful implementation.