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Elective Single Embryo Transfer (eSET); How Much Reasonable ?

Elective Single Embryo Transfer (eSET); How Much Reasonable ?. Rifat H. Gürsoy ,M.D. Gazi University School of Medicine Dept. Of Ob/Gyn Reproductive Endocrinology & Infertility Division Ankara-TURKEY. Background.

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Elective Single Embryo Transfer (eSET); How Much Reasonable ?

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  1. Elective Single Embryo Transfer (eSET);How Much Reasonable ? Rifat H. Gürsoy ,M.D. Gazi University School of Medicine Dept. Of Ob/Gyn Reproductive Endocrinology & Infertility Division Ankara-TURKEY

  2. Background • Multiple embryo tranfer during IVF has increased multiple pregnancy rates (MPR) causing maternal and perinatal morbidity • Elective single embryo transfer (eSET) is now being considered as an effective means of reducing this iatrogenic complications

  3. Background Women undergoing treatment with IVF face to an approximately 20-fold increased risk of twins and 400-fold risk of higher order pregnancies

  4. Background When compared with single births, twins have a 4-fold increased risk of mortality and for triplets the risk is 6-fold higher.

  5. The Perinatal Mortality Rate in England(1995) • General : 8.7 / per 1000 • IVF singletons: 8.8 / per 1000 • IVF twins :46.8 / per 1000 • IVF triplets : 82.6 / per 1000 • All IVF births: 22.6 / per 1000

  6. Multiple Gestations • Increased incidence of preterm births • Handicapped infants • Twins : 1/13 • Triplets : 1/5 • Higher malformation rates with IVF/ICSI

  7. Obstetric Complications ofMultiple Gestations • Miscarriage • Pregnancy Induced Hypertention • Gestational Diabetes • Premature Labour • Abnormal Delivery • Higher C/S indications

  8. Economic Impact ofMultiple Gestations • The increased cost associated with prenatal care twin and higher order pregnancies • The cost of the subsequent neonatal intensive care

  9. Parenthood of Multiple Gestations • Practical dificulties • Residuel stress • Demand of more resources • Emotional stress

  10. Strategies to Minimise the Multiple Pregnancies • Multi-fetal pregnancy reduction (MFPR) • Individualised embryo transfer policy • Blastocyst transfer • Elective single embryo transfer

  11. Elective Single Embryo Transfer(eSET) Untill recently, eSET was not an optional in clinical practice, for fear tahat the overall success rates would decline , too far

  12. Reason of This Presumption • Published data of single embryo transfer where only one embryo was available • No opportunity for selection of more suitable embryos exists • Poor potential of the only available embryo (around 10%)

  13. Single Embryo Transfer(Vilska ,1999-Finland) PR (%) Only 1 embryo available 20.2 After selection 29.7 eSET + 1frozen/ thawed 47.3 (CPR)

  14. DET vs SET , LBR

  15. DET vs SET , CPR

  16. DET vs SET ,MPR

  17. DET vs SET ,Abortion

  18. DET vs SET+FZET , LBR

  19. DET vs SET+FZET ,CPR

  20. DET vs SET+FZET ,MPR

  21. DET vs 2 f-SET, LBR

  22. DET vs 2 f-SET, CPR

  23. DET vs 2 f-SET, MPR

  24. DET vs 2 f-SET, Abortion

  25. DET vs TET , MPR

  26. CONCLUSIONS-I • In a single fresh IVF cycle, eSET is associated with a lower LBR than DET • There is no significant difference in CLBR following SET+1 FZET and the LBR following a single cycle of DET • MPR are lowered following SET compared with other transfer policies

  27. Registry • European Society of Human Reproduction & Embryology (ESHRE) • Australian & New Zealand Assisted Reproduction Database (ANZARD) • The International Committee for Monitoring Assisted Reproductive Technology (ICMART) • Canadian ART register • Society of Assisted Reproductive Technology, USA (SART) • Human Fertilization & Embryology authority (HFEA, UK)

  28. 69.4% 2.8% # 47 348 (20.0%) SET - Avrupa 2005 ; Sweden (69.4%), Finland (49.7%), Belgium (48.0%), Denmark (32.6%), Slovenia (30.0%), Bulgaria (8.5%), US 2007 (2.8%), Avustralya (56.9%), Kanada (11%), Latin Amerika (6.5%), Japonya (54.8%)

  29. CONCLUSIONS-II • e-SET may be an effective policy regarding to lower the incidence of high order pregnancies • But should not to be considered as the only and the sole choice

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