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Single Embryo Transfer

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a blog by David Kreiner, M.D., F.A.C.O.G.

Thanks to IVF, one million babies have been born worldwide. Without it, they may never have been. This gift of life comes with a steep price tag, one that, according to the recent New York Times article “The Gift of Life and Its Price,” hits $1 billion per year due to premature births. This price tag does not include the emotional hardships, developmental problems and permanent handicaps resulting from these premature deliveries, which are almost always caused by multiple-embryo-transfer-induced multiple pregnancies.

According to the Centers for Disease Control, as reported in the same article, if elective single embryo transfer was performed on good prognosis patients, thousands of premature deliveries would be prevented, resulting in a $1.1 billion savings. That brings us to regulating how many embryos to transfer during the IVF procedure. At East Coat Fertility, we make it cost neutral to transfer only one embryo at a time by offering free cryopreservation, free embryo storage and free embryo transfers until a patient achieves a live birth, all for the cost of a single IVF cycle. Patients are encouraged by this program not to put all their eggs in one basket. The success rate with an elective fresh single embryo transfer with IVF at our program is 50 percent and with subsequent frozen embryo transfers it is more than 64 percent. It’s possible that East Coast Fertility is the only center in the country doing this. That’s the shame of it.

Fertility treatment without IVF is even more hazardous as many eggs developed with treatment may implant and lead to a hazardous multiple pregnancies. In a perfect world, where a patient’s welfare was put before insurance company interests, IVF would be a covered service for all people, and fertility medications in an uncontrolled IUI cycle would not be used anymore. In this perfect world, we would also regulate the number of embryos transferred.

It’s time to put the professional recommendations of the Society of Assisted Reproductive Technology (SART) into law. SART’s recommendations have flexibility built into them, by taking into account critical factors such as patient age, embryo quality and past experience.

Until we discourage the use of gonadotropins without IVF by offering IVF as a regulated covered alternative, we won’t eliminate risky multiple pregnancies. Until then, all of us -- society, the government, insurance companies and employers -- are to blame for letting these dangerous multiple pregnancies occur.

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