Should single-embryo transfer be mandatory in patients undergoing IVF?
PRO: Using SET in good-prognosis patients is safe and highly effective infertility care.
It is a physician’s professional responsibility to transfer a single embryo to patients with a good prognosis during in vitro fertilization (IVF). I make this statement based on several observations. First, the risks of multiple birth, including twins, after IVF are substantial for both the mother and children. Second, recent developments in IVF allow practitioners to perform single-embryo transfer (SET) with high efficacy, particularly when considering the cumulative pregnancy rate (outcomes with both fresh and frozen embryo transfer) from a given IVF stimulation cycle. Third, as professionals, we are expected to regulate our own behavior. If physicians do not take the lead in practicing and mandating safe and effective clinical care, then who will?
Finally, physicians should take the lead in health care expenditure reduction, which society is demanding. SET has consistently been shown to lower the rates of multiple birth and premature delivery, thereby leading to marked reductions in health care costs.
Couples presenting for IVF often desire twins, feeling that this will complete their family more quickly. Many are ignorant, however, of the health risks posed by twin gestations. It is a health care professional’s responsibility to provide the relevant education. IVF-conceived twin pregnancies are riskier than singleton pregnancies in terms of both maternal and newborn complications. The most obvious difference is in the preterm delivery rate, which is 6 to 7 times higher than that of singletons and leads to much more frequent neonatal intensive care unit admissions.1
Some have argued that if a family desires 2 children, the complications of twins should be compared with 2 consecutive IVF singleton pregnancies. This analysis was performed recently in Sweden and revealed significantly higher rates of maternal and neonatal complications, with a sevenfold increase in birth before 32 weeks among the twin gestations.2 This leads to much higher health care costs, estimated to exceed $1 billion annually for care of preterm births from IVF-conceived multiple gestations.3