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Educating Patients about Single Embryo Transfer in IVF

by Leigh Ann Woodruff, March 21, 2012

The number of twin births has increased significantly in the United States — more than doubling from 1980 to 2009, according to a January report from the Centers for Disease Control and Prevention. Fertility treatment, including in vitro fertilization (IVF) with the transfer of two or more embryos, is part of the reason for the increase.

However, the twin trend may have peaked. Fertility doctors are increasingly advocating single embryo transfer (SET) for IVF, and the most recent statistics from the Society for Reproductive Technology for the year 2010 show a decrease in number of embryos transferred and number of twins born. For example, the average number of fresh, non-donor embryos transferred for women under 35 dropped slightly from 2.1 to 2.0 from 2009 to 2010, and the percentage of live births with twins decreased from 32.9 percent to 32.4 percent.

Individual fertility clinics are demonstrating success with increased implementation of single embryo transfer. For example, for Reproductive Science Center of the San Francisco Bay Area, the average number of fresh, non-donor embryos transferred for women under 35 was 1.9, and the percentage of live births with twins was 27.9. The fertility clinic's percentage of women deliberately choosing to have a single embryo transferred through in vitro fertilization (IVF) doubled in one year and increased tenfold since 2005.

Fertility patients may desire having twins, want to get more "bang for their buck" out of IVF (which many pay for out of pocket) or think that success is more likely when more than one embryo is transferred. "In some situations it is, but in young women with high-quality embryos, it is not significantly different," says Louis Weckstein, M.D., medical director of Reproductive Science Center.

The "idea" of twins may appeal, but fertility patients often get more than they bargained for in medical bills and high-risk pregnancies and births. "While twins are socially popular, they are also medically risky," says Dr. Weckstein. "Our ultimate goal for IVF patients is one healthy baby. Advancements in both technique and science have allowed for high success rates while using more conservative treatment options."

Dr. Weckstein says more patients are listening to fertility doctors' advice about using single embryo transfer. "We try hard to educate them about risks of multiple pregnancy to them and to the babies," Dr. Weckstein says. "We take time to discuss the risks and recommendations. We have a flip chart that outlines how risks go up for twins and triplets for prematurity, handicap and mortality."

When a woman carries twins, her risks are increased for premature birth, low birthweight babies, cesarean section, gestational diabetes and pre-eclampsia. This causes the health care bill to rise exponentially.

Ron Feinberg, M.D., a fertility doctor and medical director of Reproductive Associates of Delaware, is passionate about the importance of single embryo transfer, and his fertility clinic has one of the lowest twin birth rates in the country. According to SART data, the fertility clinic's average number of embryos transferred in the under 35 age group was 1.1, and the percentage of live births with twins in this age group was 6.6.

"What is needed now is strong advocacy at the insurer and employer level — and maybe at the government level — for states who have or are considering an IVF insurance mandate," he says. "I've been advocating for awhile that if patients and their providers were strongly incentivized to only carry out SET — via sufficient coverage for fresh and frozen IVF — then billions would be saved annually, and more people could have access to IVF."


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