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Ontario Government Announces It Will Publicly Fund Single Embryo Transfer IVF

April 17, 2014 – Experts Down The Hall – Ronald Feinberg

Source: The National Post (Canada) – April 9, 2014

The Ontario government recently announced it would fund a single cycle of IVF for Ontario residents for all forms of infertility, and will set $85 million aside over a period of 3 years to fund IVF. In addition, they are creating an advisory board to ensure fertility centers follow best practices, including performing single embryo transfer (SET) for IVF cycles.

Reproductive endocrinologists define SET as placing one embryo in the uterus or fallopian tubes during a fresh or frozen/thaw IVF cycle.

Reproductive endocrinologists define SET as placing one embryo in the uterus or fallopian tubes during a fresh or frozen/thaw IVF cycle. While many fertility centers transfer multiple embryos to increase the chance of a successful pregnancy, multiple studies have shown similar live birth rates regardless of the amount of embryos transferred.

From Our Expert, Dr. Ronald Feinberg

“SET is a hallmark of RADfertility patient care”

This news is great for Ontario and reflects what we know at RADfertility—single embryo transfer (SET) offers the best chance for a healthy pregnancy. RADfertility has one of the highest proportions of SETs in the U.S., and SET is a driving force for our success: our patients benefit from very high pregnancy rates and one of the lowest multiple rates in the country.

But what leads some centers to transfer multiple embryos if SET is so successful? Often, patients are understandably frustrated by the time it can take to achieve a successful pregnancy. Many people either do not have insurance or have very limited insurance, so it seems natural for both patients and providers to want to “speed up the process” and transfer multiple embryos.

The problem is, with some patients, transferring more than one embryo doesn’t necessarily increase their pregnancy rate at all. For instance, if you were under 32 years old, your pregnancy rate would not significantly increase if you transferred two embryos instead of one; however, transferring two embryos would increase the twin rate to 30%. In addition, one embryo still has the potential to split on its own—and, while not common, it is very possible for the two embryos to become triplets.

There is also cost to consider. You may not see the immediate cost-benefit to SET, but the cost of a multiple birth is much higher. A preterm baby’s neonatal intensive-care unit (NICU) stay can cost hundreds of thousands of dollars.

Multiple births also increase risks for mother and baby, including, but not limited to miscarriage, preterm birth and subsequent developmental and/or health consequences, gestational diabetes, preeclampsia, placentation issues and stillbirth. Many of our patients have suffered years of infertility and/or multiple miscarriages. The last thing we want is to purposefully increase a patient’s risk of a bad outcome.

Ultimately, providers should make SET easier for patients. Our IVF programs include several embryo transfers for the same cost, to make it more feasible for our patients to have a single embryo transfer, but not worry about the extra cost.

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