Is mandating elective single embryo transfer ethically justifiable in young women?

Area of Science:

• Reproductive Medicine
• Obstetrics
• Neonatal Outcomes

Background:

• In vitro fertilization (IVF) increases obstetric complications and neonatal risks compared to natural conception.
• Multiple embryo transfer, particularly in IVF, contributes significantly to these adverse outcomes, especially higher-order pregnancies.

Purpose of the Study:

• To evaluate the implications of legally mandated elective single-embryo transfer (eSET) for young women undergoing IVF.
• To discuss the balance between reducing risks associated with multiple pregnancies and respecting patient autonomy in fertility treatment decisions.

Main Methods:

• Comparative analysis of IVF outcomes with natural conception.
• Review of legal mandates for eSET in various jurisdictions.
• Ethical considerations regarding patient autonomy versus mandated interventions.
• Comparison of risks associated with eSET, double-embryo transfer (DET), and other fertility treatments like ovulation induction.

Main Results:

• While eSET reduces risks, mandated eSET may infringe upon patient autonomy and overlook potential financial/social benefits of DET for some women.
• Mandated eSET is inconsistent with other fertility practices that also carry risks of multiple pregnancies.
• DET should be prohibited only in very high-risk scenarios.

Conclusions:

• A blanket mandate for eSET in IVF is ethically questionable and may not be universally appropriate.
• Patient autonomy should be respected, with DET remaining an option for carefully selected women.
• Recommendations include preimplantation genetic screening and improved support for IVF patients to encourage informed eSET choices.