The Neonatal Consequences and Neonatal Cost of Reducing the Number of Embryos Transferred following IVF

Abstract

This clinical audit project examined the effects of change of policy between 1990 and 1993 transferring an average two (maximum three for particular cases) embryos to women undergoing IVF in the West of Scotland programme. All women who achieved clinical pregnancy in 1990 (92 women) and 1993 (93 women) as a result of the IVF programme were included in the study. The hospital records of women via the programme were analysed. The results of the study showed that there was a significant reduction in the rate of multiple pregnancy, preterm birth and low birth weight babies in the 1993 group (new policy). The cost of neonatal intensive care in 1993 for babies born following IVF was about nine times lower than that in 1990 (old policy). This study concluded that a policy of transferring two embryos (or three for particular cases) to women in an IVF programme, had improved the perinatal outcome and reduced the cost of the neonatal service for those babies.

Single or multiple embryo transfer following in vitro fertilisation for improved neonatal outcome: A systematic review of the literature

“…Limited data were available for the secondary outcomes. Fewer women had a clinical pregnancy after DET compared with transfer of three or more embryos (RR 0.82; 95% CI 0.71–0.94), as reported by eight studies describing 5559 women 28,32–34,36,40,43,44 . No difference was observed in pregnancy loss less than 20 weeks’ gestation.…”

“…Of the 17 included cohort studies, four were prospective, 28–31 eight retrospectively reviewed clinic or database records, 32–39 and five used historical controls 40–44 …”

“…None appeared to have calculated prestudy sample size. There were six studies that showed clearly pre‐existing similarities between the study populations, 28–30,32,36 seven showed similar treatment in the populations other than the numbers of embryos transferred, 28–32,36,38 and eight studies for which it was clear there were no losses to follow up 28–32,34,35,44 . Only four studies clearly defined the outcome measures 28,33,34,36 and four papers described multicentre studies 30,37,38,44 …”

“…Data comparing DET with transfer of three or more embryos was extracted from 12 cohort studies describing a total of 53 551 women (Table 5). 28,32–37,40–44 Six studies which included 49 379 participants showed that fewer women had a live birth of a healthy baby following DET compared with three or more embryos (RR 0.84; 95% CI 0.74–0.96) 35,37,40–42,44 . However, there was evidence of significant statistical heterogeneity ( P = 0.011).…”

“…However, there was evidence of significant statistical heterogeneity ( P = 0.011). Heterogeneity remained when the four trials that used historical controls were excluded, 40–42,44 although the direction of effect for the remaining studies 35,37 was towards a reduction of the incidence of live birth with DET, compared with transfer of three or more embryos (RR 0.83; 95% CI 0.71–0.98).…”