The Practice Committees of the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) on Monday issued a report calling for an increase in the use of elective single embryo transfer (SET) in good prognosis patients undergoing in vitro fertilization (IVF).
Historically, IVF required the use of multiple embryos in order to maximize the prospects of a successful live birth. However, by the late 1990’s it became clear that the number of high-order multiple gestations following IVF was unacceptably high. Embryology techniques had also improved, allowing the ASRM to develop guidelines limiting the number of embryos to transfer. First published in 1998 and revised several times in the subsequent years, these guidelines have led to a dramatic reduction in the number of embryos transferred and a subsequent reduction in high-order multiple births.
The committee examined a variety of studies, including randomized controlled trials and controlled studies to evaluate single vs. double embryo transfers, and concluded that in good prognosis patients SET could dramatically reduce multiple gestation rates while maintaining high pregnancy rates.
Among the factors the committee cited in determining whether a patient was a good candidate for SET included: patient under age 35, more than one high quality embryo available for transfer, those in their first or second IVF treatment cycle, those with prior successful IVF cycles, and recipient of donated eggs.
The committee cited several non-medical factors that had prevented wide-spread adoption of SET in the USA. Economic factors loomed large. Because a majority of patients pay for their medical treatments themselves, they have a strong financial, as well as, emotional interest in achieving a pregnancy in just one cycle. The committee recommends strong education programs for clinicians and patients on the advantages of SET. ASRM and SART have long called for better access to infertility care for patients; that call is now renewed in the context of increasing SET use.
“The clinical data now make it clear that in good prognosis patients, only one embryo should be transferred,” said Eric Widra, MD, Chair of the SART Practice Committee.
Roger Lobo, MD, President of the ASRM stated, “ASRM and its members are committed to the safest, best outcomes for patients. The work of our Practice Committee is an essential part of that commitment.”
The Committee Opinion on Elective Single Embryo Transfer can be found here.