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    Elective single-embryo transfer: No longer elective

     

    Several recent advances have facilitated and accelerated widespread adoption of SET. They include:

     

    • Improved embryo culture and selection techniques

    In recent years, composition of commercial culture media used in the IVF laboratory has evolved, with a range of media and buffers designed to provide optimal support to each stage of the IVF process, from oocyte isolation through fertilization and embryo cleavage out to the blastocyst stage of development.  A new generation of incubators is now available with rapid temperature, humidity and CO2/O2 recovery times providing superior culture environments. Evaluation of embryos with time-lapse systems has eliminated the need to remove embryos from the incubator and broader adoption of universal and international grading schemes for embryo evaluation and selection have been cited as contributors to higher pregnancy rates.11,12 Adoption of prenatal genetic screening with the opportunity to select a single euploid embryo for future frozen embryo transfer (FET) has been validated to improve success rates for women older than age 38 and possibly 35 to 38 but not for women younger than age 35, who are believed to produce a preponderance of euploid embryos.13

    • Advances in embryo cryopreservation

    The advent of vitrification as an essential innovation for development of a successful embryo cryopreservation program has allowed programs to cryopreserve embryos without detriment to the overall success rate. Embryo cryopreservation with subsequent FET offers superior results than fresh embryo transfer with higher single and cumulative success rates, even without PGS. It also confers lower risks of complications of placentation including previa, abruption and risk of LBW, VLBW, VPTB, and small for gestational age neonates.14

    • Economic disincentives to transfer of more than 1 embryo

    Historically, the biggest impediment to adoption of SET has been a strong preference on the part of some patients for twin offspring.15 This has largely been a consequence of a desire to complete a family in as short a time as possible, an under-appreciation of the risks of multiple gestation and additional, unintended economic penalties for patients electing SET, if multiple cycles were required to achieve a successful pregnancy. This economic driver has largely been eliminated in countries offering IVF coverage with obligate SET. More recently, insurance companies in the United States are requiring IVF patients to have SET performed using a variety of economic models to incentivize and penalize patients and providers to pursue SET. Several ART centers and their affiliates that provide financing now offer packages structured to eliminate some of the financial disincentives for SET. There is now evidence that patients are more likely to request SET when the financial model is more favorably aligned.


    NEXT: Conclusion and references

    Steven J. Ory, MD
    Dr. Ory is a professor of obstetrics and gynecology, Florida International University College of Medicine, Miami, and a partner at IVF ...

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