Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004–2012

Abstract

Objective To evaluate factors associated with elective single embryo transfer (eSET) utilization and its effect on assisted reproductive technology (ART) outcomes in the United States. Design Historical cohort Setting Not applicable Patient(s) Fresh IVF cycles of women 18–37 years using autologous oocytes with either one (SET) or two (DET) embryos transferred and reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System between 2004 and 2012. Cycles were categorized into four groups with[+] or without[−] supernumerary embryos cryopreserved. The SET group with embryos cryopreserved was designated as eSET. Interventions None Main Outcomes Measure(s) The likelihood of eSET utilization, live birth, and singleton non-low birthweight term live birth, modeled using logistic regression. Presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Result(s) The study included 263,375 cycles (21,917 SET[−]cryopreservation, 20,996 SET [+]cryopreservation, 103,371 DET[−]cryopreservation, and 117,091 DET[+]cryopreservation). The utilization of eSET (SET[+]cryopreservation) increased from 1.8% in 2004 to 14.9% in 2012 (aOR 7.66, 95% CI 6.87, 8.53), and was more likely with ART insurance coverage (1.60, 1.54–1.66), Asian race (1.26, 1.20–1.33), uterine factor diagnosis (1.48, 1.37–1.59), retrieval of ≥ 16 oocytes (2.85, 2.55–3.19), and the transfer of day 5–6 embryos (4.23, 4.06–4.40); eSET was less likely in women ages 35–37 years (0.76, 0.73–0.80). Compared to DET cycles, the likelihood of the ideal outcome, term non-low birthweight singleton live birth, was increased 45–52% with eSET. Conclusions Expanding insurance coverage for IVF would facilitate the broader use of eSET, and reduce the morbidity and healthcare costs associated with multiple pregnancies.

Patient and cycle characteristics predicting high pregnancy rates with single-embryo transfer: an analysis of the Society for Assisted Reproductive Technology outcomes between 2004 and 2013

“…The recommendation to use eSET in the United States has been inconsistently implemented, likely owing to an absence of financial subsidies for IVF, as well as patient and provider perceptions of reduced LBR (21)(22)(23). Analyses of national data in 2004-2012 have shown that eSET is more likely to occur in cases with insurance coverage, retrieval of R16 oocytes, and the transfer of blastocyst embryos (24). Application of a validated prediction model based on 2006-2012 national data demonstrated that the cumulative LBR is as good as or better with eSET over the course of one fresh and one frozen cycle than with double embryo transfer (DET) in a single cycle, while reducing the MBR by more than tenfold (25).…”

Judicious Fertility Treatment to Minimise the Risk of Multiple Pregnancy

“…In countries or regions where state funded or supported fertility treatment exists, the rates of single embryo transfer are far higher. The factor most influencing the likelihood a patient will undergo a single embryo transfer over a double or greater number embryo transfer is whether or not they have health insurance, a greater influencing factor than that of maternal age [33]. In Australia where fertility treatment is subsidised by the state and rates of health insurance are high, the rate of single embryo transfer is over 75% and reflected in the multiple pregnancy rate from IVF being below 6% [34].…”

The effect on twinning rate of transferring double vitrified-warmed embryos in women of advanced reproductive age: a retrospective study

“…Twin gestation also compound the health threats to women with advanced age, who have a three-time higher risk of pregnancy-related mortality than do younger counterparts (MacKay, Berg & Atrash, 2001). Ideally, the goal of ART is to achieve a singleton gestation (Styer et al, 2016;Thurin et al, 2004).…”