Journal of Assisted Reproduction and Genetics

, Volume 24, Issue 1, pp 11–15 | Cite as

Elective transfer of two embryos: Reduction of multiple gestations while maintaining high pregnancy rates

  • Donna Dowling-Lacey
  • Estella Jones
  • Jacob Mayer
  • Silvina Bocca
  • Laurel Stadtmauer
  • Sergio Oehninger
Assisted Reproduction


Purpose: To determine if the elective transfer of two embryos reduced the incidence of multiple gestations while maintaining high pregnancy rates. Methods: IVF patients and recipients of oocyte donation with an elective day-3 transfer of 2 or 3 embryos were studied. Result(s): In IVF, the elective transfer of 2 embryos resulted in similar pregnancy rate but significantly reduced the overall incidence of multiple gestations (20% versus 39%) when compared to the elective transfer of 3 embryos. Twin gestations decreased from 28% to 19%, and triplets significantly decreased from 9% to 1%. In oocyte donation, the elective transfer of 2 embryos resulted in similar pregnancy rate but also significantly reduced the overall incidence of multiple gestations (26% versus 48%), with twins decreasing from 34% to 24%, and with a significant reduction of triplets (13% versus 2%). Conclusions: In IVF and oocyte donation, the elective transfer of 2 embryos resulted in similar pregnancy rates and significantly reduced multiple gestation rates when compared to the elective transfer of 3 embryos.


Embryo quality Implantation IVF Multiple pregnancies Oocyte donation 


  1. 1.
    Adashi E, Barri P, Berkowitz R, Braude P, Bryan E, Carr J, et al. Infertility therapy-associated multiple pregnancies (births): an ongoing epidemic. Reprod Biomed Online 2003;7:515–42.PubMedCrossRefGoogle Scholar
  2. 2.
    Germond M, Primi MP, Urner F, Chanson A, Wirthner D, Senn A. Number of transferred embryos: how to reduce multiple pregnancies. Ann N Y Acad Sci 2004;1034:93–100.PubMedCrossRefGoogle Scholar
  3. 3.
    Bavister BD. Culture of preimplantation embryos: facts and artifacts. Hum Reprod Update 1996;1:91–148.CrossRefGoogle Scholar
  4. 4.
    Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Blastocyst score affects implantation and pregnancy outcome: towards a single blastocyst transfer. Fertil Steril 2000;73:1155–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Scott L, Alvero R, Leondires M, Miller B. The morphology of human pronuclear human embryos is positively related to blastocyst development and implantation. Hum Reprod 2000;15:2394–403.PubMedCrossRefGoogle Scholar
  6. 6.
    Van Blerkom J. Occurrence and developmental consequences of aberrant cellular organization in meiotically mature human oocytes after exogenous ovarian hyperstimulation. J Electron Microsc Tech 1990;16:324–46.PubMedCrossRefGoogle Scholar
  7. 7.
    Veeck L. Atlas of the human oocyte and early conceptus. Baltimore: Williams and Wilkins; 1991, p 121–144.Google Scholar
  8. 8.
    Jain T, Missmer SA, Hornstein MD. Trends in embryo transfer practice and in outcomes of the use of assisted reproductive technology in the United States. N Engl J Med 2004;350:1639–45.PubMedCrossRefGoogle Scholar
  9. 9.
    Karlstrom PO, Nygren KG, Wikland M. Does a shift to two embryo transfers after in vitro fertilization decrease the success and multiple birth rate? An analysis of assisted reproduction technologies in Sweden 1991–1996. Fertil Steril 1998;70(Suppl 1):711.Google Scholar
  10. 10.
    Ludwig M, Schöpper B, Katalinic A, Sturm R, Al-Hasani S, Diedrich K. Experience with the elective transfer of two embryos under the conditions of the German embryo protection law: results of a retrospective data analysis of 2573 transfer cycles. Hum Reprod 2000;15:319–24.PubMedCrossRefGoogle Scholar
  11. 11.
    Staessen C, Nagy ZP, Liu J, Janssenswillen C, Camus M, Devroey P, Steirteghem AC. One year’s experience with elective transfer of two good quality embryos in the human in-vitro and intracytoplasmic sperm injection programmes. Hum Reprod 1995;10:3305–12.PubMedGoogle Scholar
  12. 12.
    Templeton A, Morris JK. Reducing the risk of multiple births by transfer of two embryos after in vitro fertilization. N Engl J Med 1998;339:573–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Giannini P, Piscitelli C, Giallonardo A, Sbracia M, Morgia F, Torti M, Montigiani M, Schimberni M. Number of embryos transferred and implantation. Ann N Y Acad Sci 2004;1034:278–83.PubMedCrossRefGoogle Scholar
  14. 14.
    Gardner DK, Lane M, Stevens J, Schlenker T, Schoolcraft WB. Single blastocyst transfer: a prospective randomized trial. Fertil Steril 2004;81:551–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Gordts S, Campo R, Puttemans P, Brosens I, Valkenburg M, Norre J, Renier M, Coeman D, Gordts S. Belgian legislation and the effect of elective single embryo transfer on IVF outcome. Reprod Biomed Online 2005;10:436–41.PubMedGoogle Scholar
  16. 16.
    Mayor S. UK authority sets limits on number of embryos transferred. Br Med J 2004;10:65.CrossRefGoogle Scholar
  17. 17.
    Germond M, Senn A. A law affecting medically assisted procreation is on the way in Switzerland. J Assist Reprod Genet 1999;16:341–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Van Der Ven H, Montag M, Van Der Ven K. Performance of in vitro fertilization in Germany. Z Arztl Fortbild Qualitatssich 2002;96:369–74PubMedGoogle Scholar
  19. 19.
    Tiitinen A, Hydén-Granskog C, Gissler M. What is the most relevant standard of success in assisted reproduction?: the value of cryopreservation on cumulative pregnancy rates per single oocyte retrieval should not be forgotten. Hum Reprod 2004;19:2439–41.PubMedCrossRefGoogle Scholar
  20. 20.
    Strandell A, Bergh C, Lundin K. Selection of patients suitable for one embryo transfer may reduce the rate of multiple births by half without impairment of overall birth rates. Hum Reprod 2000;15:2520–5.PubMedCrossRefGoogle Scholar
  21. 21.
    Thurin A, Hausken J, Hillensjo T, Jablonowska B, Pinborg A, Strandell A, Bergh C. Elective single-embryo transfer versus double –embryo transfer in in vitro fertilization. N Engl J Med 2004;351:2440–2.CrossRefGoogle Scholar
  22. 22.
    van Montfoort A, Fiddelers A, Janssen J, Derhaag J, Dirksen C, Dunselman G, Land JA, Geraedts JP, Evers JL, Dumoulin JC. In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial. Hum Reprod 2006;21(2):338–43.PubMedCrossRefGoogle Scholar
  23. 23.
    Centers for Disease Control and Prevention. 2002 Assisted reproductive technology success rates: national summary and fertility clinic reports. Atlanta GA, USA 2004:20–71Google Scholar
  24. 24.
    American Society for Reproductive Medicine. Guidelines on number of embryos transferred. Fertil Steril 2004;82:773–4.CrossRefGoogle Scholar
  25. 25.
    Bustillo M. Imposing limits on the number of oocyte and embryos transferred: is it necessary/wise or naughty/nice? Hum Reprod 1997;12:1616–7.PubMedGoogle Scholar
  26. 26.
    Schieve LA, Peterson H, Meikle S, Jeng G, Danel I, Burnett N, Wilcox LS. Live-birth rates and multiple-birth risk using in vitro fertilization. JAMA 1999;282:1832–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Pandian Z, Bhattacharya S, Ozturk O, Serour GI, Templeton A. Number of embryos for transfer following in-vitro fertilization or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev 2005;4:CD003416. Review.Google Scholar
  28. 28.
    Arslan M, Bocca S, Mirkin S, Barroso G, Stadtmauer L, Oehninger S. Controlled ovarian hyperstimulation protocols for in vitro fertilization: two decades of experience after the birth of Elizabeth Carr. Fertil Steril 2005;84:555–69.PubMedCrossRefGoogle Scholar
  29. 29.
    Nyboe Anderson A, Gianaroli L, Nygren KG. Assisted reproductive technology in Europe, 2000. Results generated from European registers by ESHRE. Hum Reprod 2004;19:490–503.CrossRefGoogle Scholar
  30. 30.
    Hyden-Granskog C, Unkila-Kallio L, Halttunen M, Tiitinen A. Single embryo transfer is an option in frozen embryo transfer. Hum Reprod 2005;20:2935–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Tiitinen A, Unkila-Kallio L, Halttunen M, Hyden-Granskog C. Impact of elective single embryo transfer on the twin pregnancy rate. Hum Reprod 2003;18:1449–53.PubMedCrossRefGoogle Scholar
  32. 32.
    Pinborg A. IVF/ICSI twin pregnancies: risk and prevention. Hum Reprod Update 2005;11:575–93.PubMedCrossRefGoogle Scholar
  33. 33.
    Gleicher N, Barad D. The relative myth of elective single embryo transfer. Hum Reprod 2006;21:1337–44.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2006

Authors and Affiliations

  • Donna Dowling-Lacey
    • 1
  • Estella Jones
    • 1
  • Jacob Mayer
    • 1
  • Silvina Bocca
    • 1
  • Laurel Stadtmauer
    • 1
  • Sergio Oehninger
    • 1
  1. 1.The Jones Institute for Reproductive Medicine, Department of Obstetrics and GynecologyEastern Virginia Medical SchoolNorfolkUSA

Personalised recommendations