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    Elective single-embryo transfer: No longer elective



    In April 2017, the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology issued new guidelines calling for SET to be the standard first-line choice for all women younger than age 38.5 If a confirmed euploid embryo is available, SET should be performed up to age 42, the oldest age for which ASRM guidance is offered. The new guidelines were in part prompted by an extensive international experience attesting to the efficacy of SET and SET coupled with chromosomal analysis in older women.  Recent studies have confirmed that the cumulative pregnancy rate with serial SET is superior to transferring a comparable number of embryos at one time.16 This realization, along with the additional unanticipated maternal and neonatal advantages cited above, have undermined confidence that transfer with more than 1 embryo confers any meaningful advantage to the patient in an ART program performing optimally. The large body of evidence citing the effectiveness of IVF and recent advances promoting the safety of ART, including the widespread adoption of SET, have established IVF as a reasonable first-line alternative for many infertile couples rather than the treatment of last resort it was once regarded.



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    2. Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2015 Assisted Reproductive Technology National Summary Report. Atlanta (GA): US Dept of Health and Human Services; 2017.

    3. SART Data Release: 2015 Preliminary and 2014.  ASRM Press Release and Bulletin 2017; 19 (15).

    4. Kulkarni AD, Jamieson DJ, Jones HW, et al. Fertility Treatments and Multiple Births in the United States. New England Journal of Medicine. 2013;369(23):2218-2225.

    5. Penzias A, Bendikson K, Butts S, et al. Fertility and Sterility. Fertility and Sterility. Guidance on the limits to the number of embryos to transfer: a committee opinion. 2017;107(4):901-903.

    6. Keyhan S, Acharya KS, Acharya CR, et al. How compliant are in vitro fertilization member clinics in following embryo transfer guidelines? An analysis of 59,689 fresh first in vitro fertilization autologous cycles from 2011 to 2012. Fertility and Sterility. 2016;106(3).

    7. Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2015. National vital statistics report; vol 66, no.1. Hyattsville, MD: National Center for Health Statistics. 2017.

    8. Qin JB, Wang H, Sheng X, Xie Q, Gao S. Assisted reproductive technology and risk of adverse obstetric outcomes in dichorionic twin pregnancies: a systematic review and meta-analysis. Fertility and Sterility. 2016; 105(5):1180-1192.

    9. Sazonova A, Källen K, Thurin-Kjellberg A, Wennerholm U-B, Bergh C. Neonatal and maternal outcomes comparing women undergoing two in vitro fertilization (IVF) singleton pregnancies and women undergoing one IVF twin pregnancy. Fertility and Sterility. 2013;99(3):731-737.

    10. Martin AS, Chang J, Zhang Y, et al. Perinatal outcomes among singletons after assisted reproductive technology with single-embryo or double-embryo transfer versus no assisted reproductive technology. Fertility and Sterility. 2017; 107(4):954-960.

    11. Balaban B, Brison D, Calderon G, et al. The Istanbul consensus workshop on embryo assessment: proceedings of an expert meeting. Human Reproduction. 2011;26(6):1270-1283.

    12. Meseguer M, Rubio I, Cruz M, Basile N, Marcos J, Requena A. Embryo incubation and selection in a time-lapse monitoring system improves pregnancy outcome compared with a standard incubator: a retrospective cohort study. Fertility and Sterility. 2012; 98(6).

    13. Forman EJ, Upham KM, Cheng M, et al. Comprehensive chromosome screening alters traditional morphology-based embryo selection: a prospective study of 100 consecutive cycles of planned fresh euploid blastocyst transfer. Fertility and Sterility. 2013; 100(3):718-724.

    14. Maheshwari A, Pandey S, Shetty A, Hamilton M, Bhattacharya S. Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis. Fertility and Sterility. 2012; 98(2).

    15. Stillman RJ, Richter KS, Banks NK, Graham JR. Elective single embryo transfer: A 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice. Fertility and Sterility. 2009; 92(6):1895-1906.

    16. Mancuso AC, Boulet SL, Duran E, Munch E, Kissin DM, Voorhis BJV. Elective single embryo transfer in women less than age 38 years reduces multiple birth rates, but not live birth rates, in United States fertility clinics. Fertility and Sterility. 2016; 106(5):1107-1114. 

    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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