Deciding how many embryos to transfer: ongoing challenges and dilemmas

Area of Science:

• Reproductive Medicine
• In Vitro Fertilization (IVF)
• Healthcare Policy

Background:

• Multiple births from IVF increase risks, yet single-embryo transfer is not universally adopted.
• Professional guidelines for embryo transfer exist but have ambiguities and are often unenforced.

Purpose of the Study:

• To investigate why in vitro fertilization (IVF) providers frequently transfer multiple embryos.
• To explore the perspectives and decision-making processes of both IVF providers and patients regarding embryo transfer numbers.

Main Methods:

• Conducted in-depth interviews with 27 IVF providers (physicians and other healthcare professionals) and 10 patients.
• Qualitative analysis of interviews to understand decision-making factors and challenges.

Main Results:

• Embryo transfer decisions are dyadic and dynamic, influenced by institutional factors, provider experience, and patient perceptions.
• Many providers find evidence on twin birth risks unconvincing, and patients often downplay these risks.
• Significant tensions and uncertainties exist in how clinicians discuss and manage embryo transfer decisions with patients.

Conclusions:

• Ambiguities in guidelines and differing risk perceptions contribute to multiple embryo transfers.
• Addressing challenges in embryo transfer decision-making requires improved communication, education, and potentially clearer policies.
• Findings have implications for future IVF practice, research, policy, and patient education.