What is the most relevant standard of success in assisted reproduction? Redefining success in the context of elective single embryo transfer: evidence, intuition and financial reality

Human Reproduction
S Bhattacharya, Allan Templeton

Abstract

Treatment-related multiple pregnancy poses the biggest threat to the safety of IVF. Despite a double embryo transfer (DET) policy in most European centres, twin rates continue to be unacceptably high, at 20-35%. Elective single embryo transfer (SET) is an effective way to minimize twin pregnancies, but the debate surrounding its routine clinical use continues. A review of the literature was undertaken in order to seek evidence about the effectiveness of SET, and identify barriers to its acceptance in clinical practice. Data from randomized controlled trials (RCTs) indicate that SET results in lower live birth rates per fresh IVF cycle (odds ratio 0.53; 95% confidence interval 0.31-0.89; P = 0.02) in comparison with DET. Data on cumulative live birth rates are unavailable from RCTs, although the expectation is that these are comparable in the two groups. SET is unlikely to be suitable for all women undergoing IVF and outcomes may be sensitive to different laboratory protocols. The perceived effectiveness of SET is influenced by the way existing evidence is interpreted. Other factors affecting the routine use of SET include laboratory techniques, individual preferences and funding issues.

Citations

Dec 14, 2006·Journal of Assisted Reproduction and Genetics·Lars D M OttosenHans Jakob Ingerslev
Dec 17, 2008·Human Fertility : Journal of the British Fertility Society·T C S BonettiE Borges
Sep 30, 2005·Human Fertility : Journal of the British Fertility Society·Peter Braude
Jun 24, 2010·Reproductive Biomedicine Online·Hesham G Al-Inany, Pieter van Gelder
May 24, 2006·Fertility and Sterility·Ian S TummonAlan R Thornhill
Aug 16, 2005·American Journal of Obstetrics and Gynecology·Isaac Blickstein, Louis G Keith
Dec 25, 2004·Human Reproduction Update·Pedro N Barri
Apr 2, 2010·Reproductive Medicine and Biology·Wataru SatoToshinobu Tanaka
May 21, 2005·Human Reproduction·Maureen Porter, Siladitya Bhattacharya
Mar 1, 2007·JAMA : the Journal of the American Medical Association·Robert J Stillman

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