Elective Single Embryo Transfer (eSET); How Much Reasonable ?
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Elective Single Embryo Transfer (eSET);
How Much Reasonable ?Rifat H. Gürsoy ,M.D.
Gazi University School of MedicineDept. Of Ob/Gyn
Reproductive Endocrinology & InfertilityDivision
Ankara-TURKEY
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Background
• Multiple embryo tranfer during IVF has increased multiple pregnancy rates (MPR) causing maternal and perinatal morbidity
• Elective single embryo transfer (eSET) is now being considered as an effective means of reducing this iatrogenic complications
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Background
Women undergoing treatment with IVF face to an approximately 20-fold increased risk of twins and 400-fold risk of higher order pregnancies
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Background
When compared with single births, twins have a 4-fold increased risk of mortality and for triplets the risk is 6-fold higher.
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The Perinatal Mortality Rate in England(1995)
• General : 8.7 / per 1000• IVF singletons: 8.8 / per 1000• IVF twins :46.8 / per 1000• IVF triplets : 82.6 / per 1000• All IVF births: 22.6 / per 1000
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Multiple Gestations
• Increased incidence of preterm births• Handicapped infants
–Twins : 1/13–Triplets : 1/5
• Higher malformation rates with IVF/ICSI
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Obstetric Complications ofMultiple Gestations
• Miscarriage• Pregnancy Induced Hypertention• Gestational Diabetes• Premature Labour• Abnormal Delivery• Higher C/S indications
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Economic Impact ofMultiple Gestations
• The increased cost associated with prenatal care twin and higher order pregnancies
• The cost of the subsequent neonatal intensive care
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Parenthood of Multiple Gestations
• Practical dificulties• Residuel stress• Demand of more resources• Emotional stress
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Strategies to Minimise the Multiple Pregnancies
• Multi-fetal pregnancy reduction (MFPR)
• Individualised embryo transfer policy
• Blastocyst transfer• Elective single embryo transfer
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Elective Single Embryo Transfer(eSET)
Untill recently, eSET was not an optional in clinical practice, for fear tahat the overall success rates would decline , too far
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Reason of This Presumption
• Published data of single embryo transfer where only one embryo was available
• No opportunity for selection of more suitable embryos exists
• Poor potential of the only available embryo (around 10%)
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Single Embryo Transfer(Vilska ,1999-Finland)
PR (%)Only 1 embryo available 20.2After selection 29.7eSET + 1frozen/ thawed 47.3 (CPR)
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DET vs SET , LBR
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DET vs SET , CPR
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DET vs SET ,MPR
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DET vs SET ,Abortion
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DET vs SET+FZET , LBR
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DET vs SET+FZET ,CPR
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DET vs SET+FZET ,MPR
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DET vs 2 f-SET, LBR
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DET vs 2 f-SET, CPR
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DET vs 2 f-SET, MPR
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DET vs 2 f-SET, Abortion
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DET vs TET , MPR
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CONCLUSIONS-I
• In a single fresh IVF cycle, eSET is associated with a lower LBR than DET
• There is no significant difference in CLBR following SET+1 FZET and the LBR following a single cycle of DET
• MPR are lowered following SET compared with other transfer policies
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Registry• European Society of Human Reproduction & Embryology
(ESHRE)
• Australian & New Zealand Assisted Reproduction Database (ANZARD)
• The International Committee for Monitoring Assisted Reproductive Technology (ICMART)
• Canadian ART register
• Society of Assisted Reproductive Technology, USA (SART)
• Human Fertilization & Embryology authority (HFEA, UK)
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# 47 348 (20.0%) SET - Avrupa 2005 ; Sweden (69.4%), Finland (49.7%), Belgium (48.0%), Denmark (32.6%), Slovenia (30.0%), Bulgaria (8.5%), US 2007 (2.8%), Avustralya (56.9%), Kanada (11%), Latin Amerika (6.5%), Japonya (54.8%)
69.4
%
2.8
%
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CONCLUSIONS-II
• e-SET may be an effective policy regarding to lower the incidence of high order pregnancies
• But should not to be considered as the only and the sole choice