Effect of the new legislation and single-embryo transfer policy in Turkey on assisted reproduction outcomes: preliminary results

Abstract

New legislation concerning assisted reproduction treatments was introduced in Turkey in March 2010 in order to reduce the number of multiple pregnancies. This new legislation limits the number of embryos to be transferred to one under 35 years of age in the first or second treatment cycles and to two in the third or further cycles or for 35 and older ages. The aim of this multicentre study was to investigate the effect of this new law on clinical pregnancy and multiple pregnancy rates. Outcomes were compared in equal periods of 2.5 months before and after the new law, and further investigation was conducted for two different age groups: <35 and ≥ 35. The clinical pregnancy rates decreased from 39.9 to 34.5% and multiple pregnancy rates decreased from 23.1 to 5.3% (P<0.001) for the overall population. The outcomes of the <35 age group and ≥ 35 age group were also similar to that of the overall population. These results suggest that under the new legislation multiple pregnancy rates are significantly reduced without causing a significant decline in the pregnancy rates.

Elective single-embryo transfer

“…Despite the more than tenfold rise in the use of eSET, both IRs (18% vs. 18%) and clinical PRs (32% vs. 31%) were not statistically different between these two time periods, while the multiple gestation rate dropped significantly from 31% to 23%. Multiple subsequent studies have reproduced these findings (10,16,18,22,50,51).…”

Elective Single Embryo Transfer: an update to UK Best Practice Guidelines

“…In 2010, turkey introduced new legislation mandating Set in women less than 35 years of age in the first or second cycle of treatment and limiting clinics to the transfer of two embryos in the third or subsequent treatment cycles and in women over the age of 35 years (Kultursay et al, 2015). Since the implementation of this policy, preliminary results reported from a small multi-centre study have shown a significant reduction in mpr, with a modest downward trend in clinical pregnancy rate (Cpr) from 39.9 % to 34.5 %, although this was not statistically significant (Kutlu et al, 2011).…”

Impact of the Number and Quality of Embryos Transferred in Multiple and Single Pregnancies

“…In addition to the clinical problems, multiple gestations also cause major economic and social consequences (Lee et al, 2006;Kalu et al, 2008;Paperstraten et al, 2008;Gerris, 2009;Kutlu et al, 2011;Martini et al, 2011;Lawlor & Nelson, 2012; Practice Committee of American Society for Reproductive Medicine, 2012). High costs are related to maternal hospitalization, cesarean section and neonatal intensive care, the most frequent (Kalu et al, 2008; Practice Committee of American Society for Reproductive Medicine, 2012).…”

“…The long-term costs are associated with chronic diseases, rehabilitation and investment in special education (Practice Committee of American Society for Reproductive Medicine, 2012). For these reasons, experts have tried to reduce the number of embryos transferred per cycle in order to reduce multiplicity without affecting pregnancy rate (Kalu et al, 2008;Kutlu et al, 2011; Practice Committee of American Society for Reproductive Medicine, 2012). In some places, guidelines have been created to suggest the number of embryos to be transferred according to patient age, embryo quality and failure in previous proceedings (Kalu et al, 2008;Bromer et al, 2009;Kutlu et al, 2011; The Practice Committee of the American Society of Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology, 2013).…”

“…For these reasons, experts have tried to reduce the number of embryos transferred per cycle in order to reduce multiplicity without affecting pregnancy rate (Kalu et al, 2008;Kutlu et al, 2011; Practice Committee of American Society for Reproductive Medicine, 2012). In some places, guidelines have been created to suggest the number of embryos to be transferred according to patient age, embryo quality and failure in previous proceedings (Kalu et al, 2008;Bromer et al, 2009;Kutlu et al, 2011; The Practice Committee of the American Society of Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology, 2013). Elsewhere, laws were created forcing assisted reproduction clinics to reduce this number, often times being mandatory to transfer a single embryo (Lee et al, 2006;Kalu et al, 2008;Kutlu et al, 2011; The Practice Committee of the American Society of Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology, 2013).…”