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Yes, Elective Single-Embryo Transfer Should Be the Standard of Care

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Book cover Biennial Review of Infertility

Abstract

Despite early warnings of assisted reproductive technology (ART) pioneers about the risks of multiple births, the desire to improve effectiveness of ART procedures led to the widespread practice of multiple-embryo transfer. Adverse consequences for both the pregnant mothers and their children followed suit. Recognizing the risk of multiple births, the field is gradually moving toward elective single-embryo transfer (eSET) as the standard of care in good-prognosis patients. Overwhelming evidence from observational studies and randomized control trials supports the view that reliance on eSET versus on double-embryo transfer in appropriate groups of patients reduces perinatal morbidity and mortality, improves the likelihood of a healthy singleton infant, and reduces healthcare costs. Effective strategies for overcoming the barriers toward widespread implementation of eSET include the provision of expanded insurance coverage for infertility therapy coupled with limits on the number of embryos to transfer, as well as ongoing patient education on the benefits of eSET and risks associated with multiple births. From clinical, economical, and public health perspectives, transferring one embryo at a time in the context of good-prognosis infertility patients will lead to the most desirable outcome of ART – a healthy singleton infant.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

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Authors and Affiliations

  1. Division of Reproductive Health, Women’s Health and Fertility Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Dmitry M. Kissin MD, MPH & Sheree L. Boulet DrPH, MPH

  2. Department of Obstetrics and Gynecology, Brown University, Providence, RI, USA

    Eli Y. Adashi MD, MS

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  1. Dmitry M. Kissin MD, MPH
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  2. Sheree L. Boulet DrPH, MPH
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  3. Eli Y. Adashi MD, MS
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Correspondence to Dmitry M. Kissin MD, MPH .

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Editors and Affiliations

  1. Professor, Departments of Surgery (Urology), Obstetrics and Gynecology, and Human Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA

    Douglas T. Carrell

  2. James J. Colt Professor of Urology, Chairman, Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA

    Peter N. Schlegel

  3. Professor, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA

    Catherine Racowsky

  4. Scientific Director, Reproductive Medicine Unit, S.I.S.M.E.R. s.r.l., Day Surgery Clinic della Riproduzione (SISMeR), Bologna, Bologna, Italy

    Luca Gianaroli

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Kissin, D.M., Boulet, S.L., Adashi, E.Y. (2015). Yes, Elective Single-Embryo Transfer Should Be the Standard of Care. In: Carrell, D., Schlegel, P., Racowsky, C., Gianaroli, L. (eds) Biennial Review of Infertility. Springer, Cham. https://doi.org/10.1007/978-3-319-17849-3_12

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