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Biennial Review of Infertility pp 171–183Cite as

Elective Single-Embryo Transfer

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Abstract

In the early days of IVF, replacement of several embryos in order to compensate for low implantation rates in the human was considered good clinical practice. Lack of funding, suboptimal embryo culture and selection techniques and pressure from patients led to a staggering 50% of all children born after IVF/ICSI belonging to a set of multiples. The first step towards a more reasonable approach came when it was shown that transferring two or three embryos did not influence the pregnancy rate but only the triplet rate. Unfortunately, this step in the right direction did n ot result in a decrease of twins. Although the challenge of a triplet pregnancy is much greater than that of a twin, the epidemic size of iatrogenic twinning results in a more widespread negative effect on neonatal, perinatal and maternal outcome. The challenge is to combine excellent pregnancy rates with a reduction in twinning rate from 25–30% to 5–10%. The second step has received much attention but little following: elective single-embryo transfer (eSET). Published data indicate the feasibility to perform judicious eSET. This is definitely the case in good prognosis patients (less than 36 years of age, first or second IVF/ICSI trial) and if there is a choice from several embryos. Embryo selection, still on the basis of an optimized morphology assessment using strict criteria and time intervals, is essential. Apart from the preventive effect on the complications associated with many (but not all) twin pregnancies, both health-economic considerations and neonatal outcome considerations also underpin the value of SET. Cryopreservation is a useful tool in an optimal strategy and management of all oocyte harvests.

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    Jan Gerris & Petra De Sutter

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    Gerris, J., Sutter, P.D. (2009). Elective Single-Embryo Transfer. In: Voorhis, B., Schlegel, P., Racowsky, C., Carrell, D. (eds) Biennial Review of Infertility. Humana Press. https://doi.org/10.1007/978-1-60327-392-3_11

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    • Print ISBN: 978-1-60327-391-6

    • Online ISBN: 978-1-60327-392-3

    • eBook Packages: MedicineMedicine (R0)

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