Elective transfer of only one embryo in IVF cycles reduces pregnancy chances, often ignores patients’ desire, and deprives patients of the right to self-determination without any compensatory benefits in risk reduction

In the latest OPINIONs piece, investigators at Center for Human Reproduction (CHR) extensively review the concept of elective single embryo transfer (eSET) in an attempt to reduce risks to mother and offspring, and concludes that the increasingly popular concept does not reduce risks while significantly reducing IVF pregnancy chances, and deprives patients’ fundamental right to make informed decisions.

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July 23, 2014 (New York, NY) – Elective single embryo transfer (eSET, placement of only 1 embryo into the patient’s uterus) during in vitro fertilization (IVF) cycles, originating in Finland, has gained increasing popularity around the world, more recently spreading into the United States. The concept stems from the assumptions that, because of higher risks to mothers and offspring, twin pregnancies after IVF should be considered adverse outcomes, and should be avoided, even if transfer of only 1 embryos significantly reduces pregnancy chances in comparison to transfer of 2 embryos.

Investigators from the Center for Human Reproduction (CHR) disagreeing with this opinion, published an OPINIONs commentary piece extensively uncovering the problems with arguments commonly made for eSET. Arguments for eSET are based on statistically incorrect analyses of outcome risks between singleton and twin deliveries, comparing unequal outcomes: delivery of 1 vs. 2 children. A correct analysis, comparing equal outcomes (1 twin vs. 2 singleton pregnancies) does not demonstrate clinically significant outcome differences in maternal and/or neonatal risks. Therefore, an infertility patient wishing for 2 or more children to complete her family reduces her pregnancy chances in IVF without significant compensatory benefits in risk reduction by undergoing eSET, despite the eSET proponents’ claims to the contrary.

In the latest OPINION commentary, CHR investigators conclude that automatic eSET, as is increasingly practiced at many IVF centers, deprives well-informed infertility patients of their right to self determination.

Published research from European as well as US investigators have repeatedly shown that a large majority of infertility patients, even if aggressively counseled on the exaggerated risks of twin pregnancies still desire twin pregnancies and that the degree of this desire, understandably, is statistically associated with advancing female age and increasing length of infertility experience.

CHR does not oppose eSET and, indeed, recommends eSET if a woman has contraindications to carrying a twin pregnancy or wishes to add only 1 more child to her family. However, when they wish to have 2 or more additional children, CHR opposes the automatic imposition of eSET.

“In these cases, it comes down to the patients’ right to self determination and to individualization of medical care,” explains Norbert Gleicher, MD, CHR’s Medical Director and Chief Scientist. “At CHR, where a large majority of patients failed multiple IVF cycles before presenting to us, and often received infertility treatments for many years, patients want to maximize their immediate pregnancy chances. If a pregnancy is a twin pregnancy, only so much better! They understand that they may never get a second chance to conceive.”

The full commentary can be found along with the complete series of OPINIONs on CHR’s website at www.centerforhumanreprod.com/chr_opinions.html

About Center for Human Reproduction
The Center for Human Reproduction (CHR), located in New York City, is one of the world’s leading and best known clinical and research centers in reproductive medicine and infertility. Independently vocal on issues impacting fertility patients, CHR has become known as a center of independent thinking in the profession, through its economic independence freed from political correctness and self-interests.


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Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.