Elective single-embryo transfer in women aged 40-44 years

Area of Science:

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

Background:

• Elective single-embryo transfer (eSET) is proven effective for women under 35, yielding high pregnancy rates and low multiple birth rates.
• Limited data exists on eSET feasibility and outcomes for women aged 40 and older.

Purpose of the Study:

• To evaluate the feasibility and outcomes of an elective single-embryo transfer (eSET) policy for women aged 40-44 undergoing IVF or ICSI.
• To compare clinical pregnancy rates, live birth rates, and multiple birth rates between eSET and double-embryo transfer (DET) in this age group.

Main Methods:

• Retrospective cohort study of 628 women aged 40-44 treated between 2000-2009 at a single fertility clinic.
• Analysis of fresh IVF/ICSI cycles comparing eSET (n=264) with DET (n=364).
• Evaluation of cumulative outcomes including frozen-thawed embryo transfer cycles.

Main Results:

• Fresh eSET cycles showed clinical pregnancy rates of 23.5% and live birth rates of 13.6%, compared to 19.5% and 11.0% for DET.
• No twin pregnancies occurred in fresh eSET cycles, versus 7.5% in DET cycles.
• Cumulative clinical pregnancy rates (37.1% vs 24.2%) and live birth rates (22.7% vs 13.2%) were significantly higher with eSET (P < 0.001 and P = 0.002, respectively).

Conclusions:

• An eSET policy is feasible for women aged 40-44 with good prognoses, demonstrating acceptable cumulative pregnancy and live birth rates.
• eSET effectively reduces the risk of twin pregnancies in this older age group.
• Findings are generalizable to IVF units with established eSET and cryopreservation expertise.