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In Vitro Fertilization01:24

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In vitro fertilization (IVF) is a form of assisted reproductive technology where an egg is fertilized with sperm in a controlled laboratory environment before transferring the resulting embryo into the uterus. This process is designed to help individuals and couples experiencing difficulties conceiving.
The IVF process begins with ovarian stimulation, during which reproductive endocrinologists prescribe hormonal medications to stimulate the ovaries to produce multiple eggs instead of the single...
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Is a Blanket Elective Single Embryo Transfer Policy Defensible?

Eli Y Adashi1, Norbert Gleicher2,3,4,5

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Elective single embryo transfer (eSET) in in vitro fertilization (IVF) is debated. While often preferable, selective double embryo transfer (DET) is crucial for patient autonomy and specific infertility cases.

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Area of Science:

  • Reproductive Medicine
  • In Vitro Fertilization (IVF)
  • Maternal-Neonatal Health

Background:

  • Elective single embryo transfer (eSET) was proposed in 1999 to reduce maternal and neonatal morbidity.
  • The debate centers on whether a universal eSET policy is justifiable in assisted reproductive technology.

Purpose of the Study:

  • To review the arguments for and against expanded eSET utilization in IVF.
  • To evaluate the defensibility of a blanket eSET policy.
  • To highlight the role of non-IVF fertility treatments in multiple births.

Main Methods:

  • Summary of a recent oral debate between proponents and opponents of expanded eSET.
  • Review of existing literature on eSET, double embryo transfer (DET), and multiple births.

Main Results:

  • eSET is preferable when feasible and agreed upon by patient and provider.
  • Selective DET should be considered for patients with prolonged infertility, advanced age, or personal preference.
  • IVF-generated twins constitute a minority (15.7%) of the US twin birth rate; non-IVF treatments are the primary cause.

Conclusions:

  • A blanket eSET policy is not universally defensible due to patient autonomy and individual circumstances.
  • Focusing solely on IVF for multiple birth reduction efforts is paradoxical, as non-IVF treatments contribute significantly.
  • This debate may prompt a reevaluation of regulatory and educational priorities in fertility treatments.