Elective Single Embryo Transfer

Multiple pregnancies are responsible for a significant number of serious pregnancy related complications including increased pre-term birth, increased cesarean birth, gestational diabetes, and pregnancy induced hypertension.  Assisted reproductive technologies are responsible for the majority of multi-fetal gestations and one of the best ways to reduce multiple births is to electively transfer only one embryo often referred to as eSET (elective single embryo transfer).  One of the many obstacles to eSET is patient reluctance to accept any reduction in the prospects for IVF success in a given cycle.  In states without mandated IVF coverage patients often refuse eSET because they wish to maximize the prospects for success in a given treatment cycle and avoid additional costs of frozen embryo transfer cycles.  A recent program incentivized eSET by offering couples who agreed to single embryo transfer free injectable medications, freezing of embryos, and storage of embryos for one year.

In this study 10 of 27 couples declined to participate because they wanted the chance to have twins in spite of a careful review of all of the potential complications of twin pregnancies. Among patients who had insurance for the planned IVF cycle as well as one additional IVF cycle, 4 couples declined to participate.  Despite high ongoing pregnancy rates in the eSET group (69.2%) 40% of eligible couples declined eSET because they wanted twins.

The authors conclude that short of mandating eSET, many couples in the US will not accept transfer of one embryo.