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Sequential Single Embryo Transfer Predicts A Cumulative Live Birth Rate Equal To Or Better Than Double Embryo Transfer

May 22, 2015 – Experts Down The Hall – Ronald Feinberg

Researchers analyzed over 175,000 IVF cycles from 2006 to 2012 and compared patients having two sequential single embryo transfer (SETs) to those having one double embryo transfer (DET).

The researchers evaluated and predicted cumulative live birth rate and multiple birth rates for sequential SET and DET in patients based on infertility diagnosis, age, body mass index (BMI), prior births, and number of IVF cycles. They found the multiple birth rate after sequential SET was significantly lower than DET. Specifically, the cumulative live birth rate during a second SET (23%–63.9%) from the same IVF cycle was significantly higher than one DET (21.8%–53.4%).

The goal of IVF has always been to achieve both high success rates and a healthy, singleton pregnancy.

Sequential SET also yielded healthier and less expensive outcomes for both mother and child. The cumulative multiple birth rate for SET was 2.7% for women 35 years old compared to 32.8% in women the same age who underwent a single DET; for women 40 years old, the cumulative multiple birth rate was 1.6% with SET compared to 20.9% with a single DET.

The researchers also found success with SET was related to BMI and age. An increase in BMI from 25 and 35 in women who were the same age and had the same diagnosis lowered the cumulative live birth rate by as much as 7 percentage points. Similarly, an increase in age for women from 25 years to 35 years with the same BMI and diagnosis lowered the cumulative live birth rate by 4–6 percentage points, and an increase in age from 35 years to 40 years lowered the cumulative live birth rate by 18–24 percentage points.

From Our Expert, Dr. Ronald Feinberg

“Patients and their future children should not have to endure the risks of double embryo transfer.”

The goal of IVF has always been to achieve both high success rates and a healthy, singleton pregnancy. However, various pressures on patients and practitioners has slowed the universal adoption of SET, largely because of a prevailing notion that more is better when it comes to embryo transfer. Unfortunately, this mentality has persisted, despite evidence that multiple birth is a common outcome. Health care costs of multiple births as well as the associated pain and suffering of mother and child vastly outweigh the cost of singleton pregnancies.

The majority of patients at RADfertility hope to achieve a healthy singleton pregnancy. For many patients, IVF will yield the highest chance of success in the shortest period of time. While the chance of success with a typical ovulation induction/intrauterine insemination cycle (OI/IUI) is roughly 10–15%, success with just one SET can be as high as 50–60% depending on age, diagnosis, and other factors.

For many years, data collected by the Society of Assisted Reproductive Technologies (SART) from U.S. member centers has shown DET does not double the chance of success compared to SET. This new analysis of SART IVF cycles continues to demonstrate that DET is neither necessary, nor recommended. In reality, DET may only increase the chance of getting pregnant by 10% over SET. Armed with these facts, it is difficult to justify wasting embryos and putting patients at risk of multiple births, which will place their babies at high risk for pain and suffering due to being born prematurely.

RADfertility has been a national leader in sequential SET. We have submitted multi-year data to SART and presented our IVF SET data at multiple national meetings of the American Society for Reproductive Medicine (ASRM). Good prognosis patients at our center who undergo a single blastocyst transfer will see an ongoing pregnancy rate of 50% to 60% whether using fresh or frozen embryos. For patients who have at least two chromosomally normal blastocysts, the cumulative live birth rate is well over 80% with sequential SET.

We also perform SET for women of older age at our center; however, it is important to focus on ovarian reserve and egg quality for these patients. Fortunately, in our IVF for ME™ program, we can identify chromosomally normal blastocysts with pre-implantation genetic screening (PGS), improving their prognosis.

We also aim for our patients to achieve optimal health prior to IVF, even if their BMI is not in a perfect range. Often, we recommend that patients work with our Director of Clinical Services, Rhonda Wright, who has had tremendous success guiding patients towards healthier life options.

All of these factors play a part in impacting IVF success. The economic pressures of IVF treatment are insurmountable for many patients who need IVF care. Current policies throughout most of the U.S., including Delaware, regarding health insurance coverage of IVF treatment are discriminatory and a relic of the past.

If sequential SET was implemented and mandated universally throughout the U.S., the cost savings would be $6.3 billion annually. These savings could then be used to give everyone with infertility a chance with IVF. Sequential SET is clearly the way to go for all IVF patients.

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