Single Embryo Transfer: The Québec Experience

Abstract

In August 2010, assisted reproduction became fully covered in Québec by the public healthcare system. With this coverage, the government imposed a strict elective single embryo transfer (eSET) policy. This led to a dramatic increase in eSET from 1.6 % before implementation of the program to 71 % three years later. As a result, high-order multiple births have been virtually eliminated, and the rate of ART-conceived twins has been greatly reduced. However, this benefit seems to be associated with a lower clinical pregnancy rate per fresh embryo transfer cycle: from 37.6 % to 22.4 %. Pregnancy rates after cumulative eSET of cryopreserved embryos seem to be similar, however. Analysis of hospital databases demonstrates that the clinical impact of eSET is reflected by lower premature birthrates and lower neonatal ICU admissions, both of which are applauded by high-risk obstetrics specialists and neonatologists. Infertile couples are grateful to have access to such treatment regardless of their financial ability to pay. Consequently, single embryo transfer has quickly become universally accepted in Québec and is now expected by almost all couples undergoing ART.