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Meldrum DR, Adashi EY, Garzo VG, Gleicher N, Parinaud J, Pinborg A, Van Voorhis B. Prevention of in vitro fertilization twins should focus on maximizing single embryo transfer versus twins are an acceptable complication of in vitro fertilization. Fertil Steril 2018; 109:223-229. [PMID: 29447664 DOI: 10.1016/j.fertnstert.2017.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- David R Meldrum
- Reproductive Partners San Diego, San Diego, California; Division of Reproductive Endocrinology and Infertility, University of California, San Diego, California.
| | - Eli Y Adashi
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - V Gabriel Garzo
- Reproductive Partners San Diego, San Diego, California; Division of Reproductive Endocrinology and Infertility, University of California, San Diego, California
| | | | - Jean Parinaud
- Department of Reproductive Medicine, Paule de Viguier Hospital, Toulouse Teaching Hospital Group, Toulouse, France
| | - Anja Pinborg
- Fertility Clinic, Department of Obstetrics and Gynecology, Hvidovre University Hospital, Hvidovre, Copenhagen, Denmark
| | - Brad Van Voorhis
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Lopez-Regalado ML, Martínez-Granados L, González-Utor A, Ortiz N, Iglesias M, Ardoy M, Castilla JA. Critical appraisal of the Vienna consensus: performance indicators for assisted reproductive technology laboratories. Reprod Biomed Online 2018; 37:128-132. [PMID: 29857986 DOI: 10.1016/j.rbmo.2018.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 04/30/2018] [Accepted: 05/18/2018] [Indexed: 11/25/2022]
Abstract
The Vienna consensus, based on the recommendations of an expert panel, has identified 19 performance indicators for assisted reproductive technology (ART) laboratories. Two levels of reference values are established for these performance indicators: competence and benchmark. For over 10 years, the Spanish embryology association (ASEBIR) has participated in the definition and design of ART performance indicators, seeking to establish specific guidelines for ART laboratories to enhance quality, safety and patient welfare. Four years ago, ASEBIR took part in an initiative by AENOR, the Spanish Association for Standardization and Certification, to develop a national standard in this field (UNE 17900:2013 System of quality management for assisted reproduction laboratories), extending the former requirements, based on ISO 9001, to include performance indicators. Considering the experience acquired, we discuss various aspects of the Vienna consensus and consider certain discrepancies in performance indicators between the consensus and UNE 179007:2013, and analyse the definitions, methodology and reference values used.
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Affiliation(s)
- María Luisa Lopez-Regalado
- Unidad Reproducción, UGC Laboratorio Clínico y UGC Obstetricia y Ginecología, HU Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada (IBS Granada), (ibs.GRANADA) Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain.
| | - Luis Martínez-Granados
- Unidad Reproducción, UGC Laboratorio Clínico y UGC Obstetricia y Ginecología, HU Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada (IBS Granada), (ibs.GRANADA) Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain
| | - Antonio González-Utor
- Centro MasVida Reproducción, Avenida Reino Unido n°1 Local 3, 41012 Sevilla, Spain; CEIFER Biobanco, Avenida Reino Unido n°1 Local 3, 41012 Sevilla, Spain
| | - Nereyda Ortiz
- Instituto Europeo de Fertilidad, Paseo San Francisco de Sales 12, 28003, Madrid, Spain
| | - Miriam Iglesias
- Hospital Universitario Quirónsalud, Calle Diego de Velázquez 1, 28223, Pozuelo de Alarcón, Madrid, Spain
| | - Manuel Ardoy
- Clínica Reproducción Vivum, Calle Goya 105, 28009 Madrid, Spain; Sec. RHA. HGU Gregorio Marañón, Calle O'Donnell 48, 28007 Madrid, Spain
| | - Jose A Castilla
- Unidad Reproducción, UGC Laboratorio Clínico y UGC Obstetricia y Ginecología, HU Virgen de las Nieves, Instituto de Investigación Biosanitaria de Granada (IBS Granada), (ibs.GRANADA) Avenida de las Fuerzas Armadas 2, 18014 Granada, Spain; Centro MasVida Reproducción, Avenida Reino Unido n°1 Local 3, 41012 Sevilla, Spain; CEIFER Biobanco, Calle Maestro Bretón 1, 18004 Granada, Spain; Departamento Anatomía y Embriología Humana, Facultad de Medicina, Universidad de Granada, Avenida de la Investigación 11, 18071 Granada, Spain
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Kusunose M, Inoue Y, Kamisato A, Muto K. A Preliminary Study Exploring Japanese Public Attitudes Toward the Creation and Utilization of Human-Animal Chimeras: a New Perspective on Animals Containing “Human Material” (ACHM). Asian Bioeth Rev 2017. [DOI: 10.1007/s41649-017-0020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Prados N, Quiroga R, Caligara C, Ruiz M, Blasco V, Pellicer A, Fernández-Sánchez M. Elective single versus double embryo transfer: live birth outcome and patient acceptance in a prospective randomised trial. Reprod Fertil Dev 2017; 27:794-800. [PMID: 25128910 DOI: 10.1071/rd13412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 01/24/2014] [Indexed: 11/23/2022] Open
Abstract
The purpose of this study was to determine which strategy of embryo transfer has a better trade-off in live birth delivery rate versus multiple pregnancy considering patient acceptance: elective single embryo transfer (eSET) or elective double embryo transfer (eDET). In all, 199 women <38 years of age undergoing their first IVF treatment in a private centre were included in a prospective open-label randomised controlled trial. Patients were randomised into four groups: (1) eSET on Day 3; (2) eSET on Day 5; (3) eDET on Day 3; and (4) eDET on Day 5. Per patient, main analysis included acceptance of assigned group, as well as multiple and live birth delivery rates of the fresh cycle. Secondary analysis included the rates of subsequent cryotransfers and the theoretical cumulative success rate. Of 98 patients selected for eSET, 40% refused and preferred eDET. The live birth delivery rate after eDET was significantly higher after eDET versus eSET (65% vs 42%, respectively; odds ratio=1.6, 95% confidence interval 1.1-2.1). No multiple births were observed after eSET, compared with 35% after eDET. Although live birth delivery is higher with eDET, the increased risk of multiple births is avoided with eSET. Nearly half the patients refused eSET even after having been well informed about its benefits.
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Affiliation(s)
- Nicolás Prados
- Instituto Valenciano de Infertilidad (IVI) Sevilla, Avenida de la República Argentina 58, PC 41011, Sevilla, Spain
| | - Rocío Quiroga
- Instituto Valenciano de Infertilidad (IVI) Sevilla, Avenida de la República Argentina 58, PC 41011, Sevilla, Spain
| | - Cinzia Caligara
- Instituto Valenciano de Infertilidad (IVI) Sevilla, Avenida de la República Argentina 58, PC 41011, Sevilla, Spain
| | - Myriam Ruiz
- Instituto Valenciano de Infertilidad (IVI) Sevilla, Avenida de la República Argentina 58, PC 41011, Sevilla, Spain
| | - Víctor Blasco
- Instituto Valenciano de Infertilidad (IVI) Sevilla, Avenida de la República Argentina 58, PC 41011, Sevilla, Spain
| | - Antonio Pellicer
- Instituto Valenciano de Infertilidad (IVI), Parc Científic Universitat de València, Calle Catedrático Agustín Escardino 9, PC 46980, Paterna, Valencia, Spain
| | - Manuel Fernández-Sánchez
- Instituto Valenciano de Infertilidad (IVI) Sevilla, Avenida de la República Argentina 58, PC 41011, Sevilla, Spain
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Hammarberg K, Kirkman M, de Lacey S. Qualitative research methods: when to use them and how to judge them. Hum Reprod 2016; 31:498-501. [DOI: 10.1093/humrep/dev334] [Citation(s) in RCA: 321] [Impact Index Per Article: 40.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/07/2015] [Indexed: 11/13/2022] Open
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Wenze SJ, Battle CL, Tezanos KM. Raising multiples: mental health of mothers and fathers in early parenthood. Arch Womens Ment Health 2015; 18:163-176. [PMID: 25515039 PMCID: PMC4610720 DOI: 10.1007/s00737-014-0484-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 12/03/2014] [Indexed: 11/24/2022]
Abstract
The rate of twin and higher-order gestation births has risen dramatically in recent decades in the United States as well as other Western countries. Although the obstetrical and neonatal risks of multiple gestation pregnancies are well-documented, much less is known regarding the mental health impact on parents of multiples during the perinatal and early parenthood period. Given that parents of multiples face greater functional demands, as well as other pressures (financial, medical) this population may be at risk for heightened distress. We conducted a systematic review of quantitative, English language studies that assessed mental health outcomes of parents of multiples during pregnancy, in the first postpartum year, and in the period of early parenthood, including depression, anxiety, stress, and related constructs. Twenty-seven articles published between 1989 and 2014 met selection criteria and were included in the review. Studies utilized a wide range of methods and outcome constructs, often making comparisons difficult. Although some studies found no differences, most investigations that compared mental health outcomes in parents of multiples versus parents of singletons found that parents of multiples experience heightened symptoms of depression, anxiety, and parenting stress. We discuss gaps in the existing body of literature on parental mental health related to multiple gestation birth and conclude by discussing the need for novel intervention strategies to meet the needs of this growing population. Parents of multiples may experience worse mental health outcomes than parents of singletons. More research is needed, and future work should explore potential treatment and support options.
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Affiliation(s)
- Susan J Wenze
- Department of Psychology, Lafayette College, Easton, PA, 18042, USA.
- Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Cynthia L Battle
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
- Women & Infants' Hospital of Rhode Island, Providence, RI, USA
| | - Katherine M Tezanos
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
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Pandey S, Porter M, Bhattacharya S. What women want from women's reproductive health research: a qualitative study. Health Expect 2014; 18:2606-15. [PMID: 25182181 DOI: 10.1111/hex.12233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Researchers are being urged to involve patients in the design and conduct of studies in health care with limited insight at present into their needs, abilities or interests. This is particularly true in the field of reproductive health care where many conditions such as pregnancy, menopause and fertility problems involve women who are otherwise healthy. OBJECTIVE To ascertain the feasibility of involving patients and members of the public in research on women's reproductive health care (WRH). SETTING University and tertiary care hospital in north-east Scotland; 37 women aged 18-57. METHOD Four focus groups and one individual interview were audio-recorded and verbatim transcripts analysed thematically by two researchers using a grounded theory approach. RESULTS AND DISCUSSION Most participants were interested in WRH, but some participated to promote a health issue of special concern to them. Priorities for research reflected women's personal concerns: endometriosis, polycystic ovary syndrome, menopause, fertility risks of delaying parenthood and early post-natal discharge from hospital. Women were initially enthusiastic about getting involved in research on WRH at the design or delivery stage, but after discussion in focus groups, some questioned their ability to do so or the time available to commit to research. None of the respondents expected payment for any involvement, believing that the experience would be rewarding enough in itself. CONCLUSIONS Involving patients and public in research would include different perspectives and priorities; however, recruiting for this purpose would be challenging.
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Affiliation(s)
| | - Maureen Porter
- School of Medicine & Dentistry, University of Aberdeen, Aberdeen, UK
| | - Siladitya Bhattacharya
- Assisted Reproduction Unit, Aberdeen Maternity Hospital University of Aberdeen, Aberdeen, UK
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Newton C, Feyles V, Asgary-Eden V. Effect of mood states and infertility stress on patients' attitudes toward embryo transfer and multiple pregnancy. Fertil Steril 2013; 100:530-7. [DOI: 10.1016/j.fertnstert.2013.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 04/16/2013] [Accepted: 04/18/2013] [Indexed: 10/26/2022]
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Roberts SA, McGowan L, Vail A, Brison DR. The use of single embryo transfer to reduce the incidence of twins: Implications and questions for practice from the 'towardSET?' project. HUM FERTIL 2011; 14:89-96. [PMID: 21631244 DOI: 10.3109/14647273.2011.568037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In vitro fertilisation treatments where multiple embryos are transferred are associated with high multiple birth rates leading to a corresponding high infant morbidity. Here we review the results from a multidisciplinary project which aimed to combine state of the art statistical modelling of routine clinical data with consideration of patient perspectives to explore options for reducing multiple birth incidence by increased use of single embryo transfer (SET). Modelling was based on a large multicentre cohort, supplemented by analysis of HFEA register data. Patient perspectives were explored in qualitative interviews and focus groups. The data confirm the reduction of around one-third in the chance of a live birth for any couple in moving from double embryo transfer (DET) to SET in a fresh cycle. This can be somewhat offset by appropriate patient and cycle selection for SET, with many suggested schemes performing similarly, although many patients perceive such selection as unfair. If we take a complete cycle perspective, and consider the transfer of all good-quality embryos with cryopreservation then it is possible for SET to match or even outperform DET. However, the additional treatment cycles are seen by patients as physically and emotionally burdensome. Such treatments will require optimisation of embryo freezing policies and a number of options are explored.
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Affiliation(s)
- Stephen A Roberts
- Health Sciences-Methodology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
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McLernon DJ, Harrild K, Bergh C, Davies MJ, de Neubourg D, Dumoulin JCM, Gerris J, Kremer JAM, Martikainen H, Mol BW, Norman RJ, Thurin-Kjellberg A, Tiitinen A, van Montfoort APA, van Peperstraten AM, Van Royen E, Bhattacharya S. Clinical effectiveness of elective single versus double embryo transfer: meta-analysis of individual patient data from randomised trials. BMJ 2010; 341:c6945. [PMID: 21177530 PMCID: PMC3006495 DOI: 10.1136/bmj.c6945] [Citation(s) in RCA: 228] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2010] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the effectiveness of elective single embryo transfer versus double embryo transfer on the outcomes of live birth, multiple live birth, miscarriage, preterm birth, term singleton birth, and low birth weight after fresh embryo transfer, and on the outcomes of cumulative live birth and multiple live birth after fresh and frozen embryo transfers. DESIGN One stage meta-analysis of individual patient data. DATA SOURCES A systematic review of English and non-English articles from Medline, Embase, and the Cochrane Central Register of Controlled Trials (up to 2008). Additional studies were identified by contact with clinical experts and searches of bibliographies of all relevant primary articles. Search terms included embryo transfer, randomised controlled trial, controlled clinical trial, single embryo transfer, and double embryo transfer. Review methods Comparisons of the clinical effectiveness of cleavage stage (day 2 or 3) elective single versus double embryo transfer after fresh or frozen in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) treatments were included. Trials were included if the intervention differed only in terms of the intended number of embryos to be transferred. Trials that involved only blastocyst (day five) transfers were excluded. RESULTS Individual patient data were received for every patient recruited to all eight eligible trials (n=1367). A total of 683 and 684 women randomised to the single and double embryo transfer arms, respectively, were included in the analysis. Baseline characteristics in the two groups were comparable. The overall live birth rate in a fresh IVF cycle was lower after single (181/683, 27%) than double embryo transfer (285/683, 42%) (adjusted odds ratio 0.50, 95% confidence interval 0.39 to 0.63), as was the multiple birth rate (3/181 (2%) v 84/285 (29%)) (0.04, 0.01 to 0.12). An additional frozen single embryo transfer, however, resulted in a cumulative live birth rate not significantly lower than the rate after one fresh double embryo transfer (132/350 (38%) v 149/353 (42%) (0.85, 0.62 to 1.15), with a minimal cumulative risk of multiple birth (1/132 (1%) v 47/149 (32%)). The odds of a term singleton birth (that is, over 37 weeks) after elective single embryo transfer was almost five times higher than the odds after double embryo transfer (4.93, 2.98 to 8.18). CONCLUSIONS Elective single embryo transfer results in a higher chance of delivering a term singleton live birth compared with double embryo transfer. Although this strategy yields a lower pregnancy rate than a double embryo transfer in a fresh IVF cycle, this difference is almost completely overcome by an additional frozen single embryo transfer cycle. The multiple pregnancy rate after elective single embryo transfer is comparable with that observed in spontaneous pregnancies.
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Affiliation(s)
- D J McLernon
- Medical Statistics Team, Section of Population Health, University of Aberdeen, Aberdeen AB25 2ZD, UK.
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Roberts SA, McGowan L, Mark Hirst W, Vail A, Rutherford A, Lieberman BA, Brison DR. Reducing the incidence of twins from IVF treatments: predictive modelling from a retrospective cohort. Hum Reprod 2010; 26:569-75. [DOI: 10.1093/humrep/deq352] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Clua E, Tur R, Coroleu B, Boada M, Barri PN, Veiga A. Analysis of factors associated with multiple pregnancy in an oocyte donation programme. Reprod Biomed Online 2010; 21:694-9. [DOI: 10.1016/j.rbmo.2010.06.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 06/04/2010] [Accepted: 06/08/2010] [Indexed: 11/26/2022]
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Rai V, Betsworth A, Beer C, Ndukwe G, Glazebrook C. Comparing patients' and clinicians' perceptions of elective single embryo transfer using the attitudes to a twin IVF pregnancy scale (ATIPS). J Assist Reprod Genet 2010; 28:65-72. [PMID: 20862535 DOI: 10.1007/s10815-010-9484-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Accepted: 09/13/2010] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study evaluated a questionnaire originally developed for use with health professionals to explore and compare patients' and clinicians' perceptions of elective single embryo transfer and twin births. METHODS IVF clinicians and patients attending an independent Fertility clinic were surveyed using the Attitudes to a twin birth scale (ATIPS) comprising two subscales: attitudes to twins (A-Twin) and attitudes to elective single embryo transfer (A-SET). After refinement total sample scores showed both subscales were reliable with Cronbach's alpha >0.8 and item-total correlations >0.35. RESULTS Questionnaires were completed by 100 female IVF patients and 17 IVF clinicians. A-Twin subscale scores indicated neither the IVF clinicians nor female IVF patients demonstrated very positive attitudes to a twin birth although the IVF female patients were more in favour (t = 5.29, n = 117, p = <0.001). Responses suggest both groups would benefit from increased information about the risks of a twin birth for the baby. First cycle IVF female patients were significantly more positive about eSET (z = 3.94, n = 100, p = <0.001). Clinicians perceive both their colleagues' and female patients' negativity towards eSET; suggesting a role for education. CONCLUSIONS This study found the ATIPS to be a reliable measure which could be useful in evaluating interventions to promote single embryo transfer.
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Affiliation(s)
- Vibha Rai
- Division of Psychiatry, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Hope N, Rombauts L. Can an educational DVD improve the acceptability of elective single embryo transfer? A randomized controlled study. Fertil Steril 2010; 94:489-95. [DOI: 10.1016/j.fertnstert.2009.03.080] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Revised: 03/07/2009] [Accepted: 03/24/2009] [Indexed: 11/24/2022]
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Leese B, Denton J. Attitudes towards single embryo transfer, twin and higher order pregnancies in patients undergoing infertility treatment: a review. HUM FERTIL 2010; 13:28-34. [PMID: 20141337 DOI: 10.3109/14647270903586364] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The problems associated with twin and higher order pregnancies have assumed major importance, with international debate about multiple pregnancy; the single biggest risk with in vitro fertilisation (IVF). We have critically reviewed published papers on female patients' and their partners' views of single embryo transfer (SET) and twin or higher level pregnancies to identify the requirements needed to improve the acceptability of SET. Twenty relevant papers were identified and included in the review. Although the majority of IVF patients and their partners, in the more recent studies, exhibited a desire for twins rather than singletons, closer examination of the evidence revealed that elective SET (eSET) could become increasingly acceptable. As success rates of IVF have improved and the risks and consequences of multiple pregnancies are well-documented, patients have accepted the transfer of two rather than three embryos as standard practice. However, more would accept eSET if success rates approached those of double embryo transfer (DET). This emphasises the importance of improving success rates of eSET so that more patients can achieve a singleton birth with one IVF cycle. If patients were offered only SET, it is likely that this would be acceptable as the normal expectation of pregnancy is one baby. Measures to improve the acceptability of SET include: using eSET, especially with younger patients; including partners when providing risk information; improving eSET success rates; improving outcomes with cryopreserved embryos; changing reimbursement/free cycles to favour eSET; using legal enforcement.
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Affiliation(s)
- Brenda Leese
- Multiple Births Foundation, Queen Charlotte's and Chelsea Hospital, DuCane Road, London W12 0HS, UK.
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Min JK, Hughes E, Young D. [Single embryo transfer for in vitro fertilization]. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:477-494. [PMID: 20500958 DOI: 10.1016/s1701-2163(16)34503-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Elective Single Embryo Transfer Following In Vitro Fertilization. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010; 32:363-377. [DOI: 10.1016/s1701-2163(16)34482-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bonetti TCS, Melamed RMM, Braga DPAF, Madaschi C, Iaconelli A, Pasqualotto FF, Borges E. Assisted reproduction professionals' awareness and attitudes towards their own IVF cycles. HUM FERTIL 2009; 11:254-8. [DOI: 10.1080/14647270802245885] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Baruffi RLR, Mauri AL, Petersen CG, Nicoletti A, Pontes A, Oliveira JBA, Franco JG. Single-embryo transfer reduces clinical pregnancy rates and live births in fresh IVF and Intracytoplasmic Sperm Injection (ICSI) cycles: a meta-analysis. Reprod Biol Endocrinol 2009; 7:36. [PMID: 19389258 PMCID: PMC2680863 DOI: 10.1186/1477-7827-7-36] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Accepted: 04/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has become an accepted procedure to transfer more than one embryo to the patient to achieve acceptable ongoing pregnancy rates. However, transfers of more than a single embryo increase the probability of establishing a multiple gestation. Single-embryo transfer can minimize twin pregnancies but may also lower live birth rates. This meta-analysis aimed to compare current data on single-embryo versus double-embryo transfer in fresh IVF/ICSI cycles with respect to implantation, ongoing pregnancy and live birth rates. METHODS Search strategies included on-line surveys of databases from 1995 to 2008. Data management and analysis were conducted using the Stats Direct statistical software. The fixed-effect model was used for odds ratio (OR). Fixed-effect effectiveness was evaluated by the Mantel Haenszel method. Seven trials fulfilled the inclusion criteria. RESULTS When pooling results under the fixed-effect model, the implantation rate was not significantly different between double-embryo transfer (34.5%) and single-embryo transfer group (34.7%) (P = 0.96; OR = 0.99, 95% CI 0.78, 1.25). On the other hand, double-embryo transfer produced a statistically significantly higher ongoing clinical pregnancy rate (44.5%) than single-embryo transfer (28.3%) (P < 0.0001; OR:2.06, 95% CI = 1.64,2.60). At the same time, pooling results presented a significantly higher live birth rate when double-embryo transfer (42.5%) (P < 0.001; OR: 1.87, 95% CI = 1.44,2.42) was compared with single-embryo transfer (28.4%). CONCLUSION Meta-analysis with 95% confidence showed that, despite similar implantation rates, fresh double-embryo transfer had a 1.64 to 2.60 times greater ongoing pregnancy rate and 1.44 to 2.42 times greater live birth rate than single-embryo transfer in a population suitable for ART treatment.
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Affiliation(s)
- Ricardo LR Baruffi
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Ana L Mauri
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Claudia G Petersen
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Andréia Nicoletti
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
| | - Anagloria Pontes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, Sao Paolo, Brazil
| | - João Batista A Oliveira
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, Sao Paolo, Brazil
| | - José G Franco
- Center for Human Reproduction – Prof Franco Junior, Ribeirão Preto, Sao Paolo, Brazil
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University – UNESP, Botucatu, Sao Paolo, Brazil
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van Peperstraten A, Hermens R, Nelen W, Stalmeier P, Scheffer G, Grol R, Kremer J. Perceived barriers to elective single embryo transfer among IVF professionals: a national survey. Hum Reprod 2008; 23:2718-23. [DOI: 10.1093/humrep/den327] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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23
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van Peperstraten AM, Nelen WLDM, Hermens RPMG, Jansen L, Scheenjes E, Braat DDM, Grol RPTM, Kremer JAM. Why don't we perform elective single embryo transfer? A qualitative study among IVF patients and professionals. Hum Reprod 2008; 23:2036-42. [PMID: 18565969 DOI: 10.1093/humrep/den156] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Elective single embryo transfer (eSET) enables the prevention of multiple pregnancies after in vitro fertilization (IVF). However, in Europe, the multiple pregnancy rate after IVF remains stable at approximately 23%, with SET occurring in 15% of all IVF cycles. In most European clinics, the decision for the number of embryos transferred is established through a form of shared decision-making between patients and professionals. The aim of this study is to explore factors influencing this decision, in particular factors preventing eSET use. METHODS We performed explorative, semi-structured, in-depth interviews, based on two theoretical models. The interviews were performed among 19 Dutch IVF professionals and 20 patients who had just undergone IVF or were on the waiting list for IVF. The interviews were fully transcribed and two researchers independently scored the factors according to the models. RESULTS We identified a wide variety of factors, potentially influencing eSET use: 37 with the professionals and 26 among the patients. Examples of factors mentioned by both patients and professionals were: uncertainty about the eSET technique, couples' lack of knowledge about essential eSET aspects, absence of a reimbursement system which favours eSET, inadequate options to select couples suitable for eSET and inferior cryopreservation success rates. CONCLUSIONS This study demonstrates that both IVF professionals and patients identify numerous factors preventing eSET use in clinical practice. To estimate the impact of these factors identified, a quantitative confirmation and assessment of the magnitude of the effect is necessary.
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Affiliation(s)
- A M van Peperstraten
- Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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24
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Scotland GS, McNamee P, Peddie VL, Bhattacharya S. Safety versus success in elective single embryo transfer: women's preferences for outcomes of in vitro fertilisation. BJOG 2007; 114:977-83. [PMID: 17578474 DOI: 10.1111/j.1471-0528.2007.01396.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess whether women waiting to undergo in vitro fertilisation (IVF) view adverse outcomes associated with twin pregnancy as more desirable than having no pregnancy at all. DESIGN Women's preference values for five adverse birth outcomes associated with twin pregnancy were compared with their preference value for treatment failure (TF), i.e. no pregnancy at all. SETTING Aberdeen Fertility Centre, University of Aberdeen, UK. POPULATION A total of 74 women waiting to undergo IVF. METHODS The standard gamble method was used to elicit women's preference values for giving birth to a child with physical impairments (PI), cognitive impairments (CI), or visual impairments (VI), perinatal death (PD) without a subsequent pregnancy, premature delivery (PremD), and TF (no pregnancy). MAIN OUTCOME MEASURES Preference values were elicited on a scale where 1 represents giving birth to a healthy child and 0 represents immediate death. RESULTS The median preference values for having a child with PI, CI, or VI were 0.940, 0.970, and 0.975, respectively. The median values for PremD, PD, and TF were 0.955, 0.725, and 0.815, respectively. Having no child at all was valued significantly lower than having a child with PI, CI, or VI (P < 0.01) but significantly higher than PD (P < 0.01). CONCLUSIONS Some women waiting for IVF treatment view severe child disability outcomes associated with double embryo transfer as being more desirable than having no child at all. Women embarking on IVF may be influenced more strongly by considerations of 'treatment success' rather than future risks to their offspring.
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Affiliation(s)
- G S Scotland
- Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK.
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25
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Peddie VL, Porter M. Limitations of infertility treatment: psychological, social and cultural. ACTA ACUST UNITED AC 2007. [DOI: 10.2217/14750708.4.3.313] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Factors affecting patients’ attitudes toward single- and multiple-embryo transfer. Fertil Steril 2007; 87:269-78. [DOI: 10.1016/j.fertnstert.2006.06.043] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2006] [Revised: 06/20/2006] [Accepted: 06/20/2006] [Indexed: 11/20/2022]
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27
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COETZEE K, STEWART B, PEEK J, HUTTON J. Acceptance of single-embryo transfer by patients. Fertil Steril 2007; 87:207-9. [DOI: 10.1016/j.fertnstert.2006.05.065] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 05/24/2006] [Accepted: 05/24/2006] [Indexed: 11/25/2022]
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28
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Min JK, Claman P, Hughes E. Guidelines for the number of embryos to transfer following in vitro fertilization. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006; 28:799-813. [PMID: 17022921 DOI: 10.1016/s1701-2163(16)32246-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To review the effect of the number of embryos transferred on the outcome of in vitro fertilization (IVF), to provide guidelines on the number of embryos to transfer in IVF-embryo transfer (ET) in order to optimize healthy live births and minimize multiple pregnancies. OPTIONS Rates of live birth, clinical pregnancy, and multiple pregnancy or birth by number of embryos transferred are compared. OUTCOMES Clinical pregnancy, multiple pregnancy, and live birth rates. EVIDENCE The Cochrane Library and MEDLINE were searched for English language articles from 1990 to April 2006. Search terms included embryo transfer (ET), assisted reproduction, in vitro fertilization (IVF), ntracytoplasmic sperm injection (ICSI), multiple pregnancy, and multiple gestation. Additional references were identified through hand searches of bibliographies of identified articles. VALUES Available evidence was reviewed by the Reproductive Endocrinology and Infertility Committee and the Maternal-Fetal Medicine Committee of the Society of Obstetricians and Gynaecologists of Canada and the Board of the Canadian Fertility and Andrology Society, and was qualified using the Evaluation of Evidence Guidelines developed by the Canadian Task Force on the Periodic Health Exam. BENEFITS, HARMS, AND COSTS This guideline is intended to minimize the occurrence of multifetal gestation, particularly high-order multiples (HOM), while maintaining acceptable overall pregnancy and live birth rates following IVF-ET.
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29
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Saunders D. Role of patients, doctors, media and pharmaceutical companies in preventing multiple gestation: Introduction to Theme. Aust N Z J Obstet Gynaecol 2006. [DOI: 10.1111/j.1479-828x.2006.00616_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Redshaw M, Hockley C, Davidson LL. A qualitative study of the experience of treatment for infertility among women who successfully became pregnant. Hum Reprod 2006; 22:295-304. [PMID: 16959809 DOI: 10.1093/humrep/del344] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In a study in which 18,503 women who had recently given birth were interviewed, 460 women who had received treatment for infertility (2.6%) were asked to participate in a postal study. The aim was to investigate the experience of women who had undergone treatment for infertility and given birth as a consequence, focusing on perceptions of treatment and care. METHODS The study relies on responses to open-ended questions about the impact of treatment, how treatment could be improved and advice to policy makers. The text responses to these questions were analysed qualitatively. RESULTS A total of 230 women responded (50%). Emergent themes related to the treatment process, pain and distress, lack of choice and control, timing, emotional and financial costs, fairness and contrasts in care. CONCLUSIONS Women wished to be treated with respect and dignity and given appropriate information and support. They wanted their distress recognized, to feel cared for and to have confidence in health professionals in situations where outcomes are uncertain. Women acknowledged receiving care from motivated and skilled health professionals and value the children they have enormously. For many, there is now a sense of being complete, though for some this has been at great emotional and financial cost.
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Affiliation(s)
- M Redshaw
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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31
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Min JK, Claman P, Hughes E, Cheung AP, Claman P, Fluker M, Goodrow GJ, Graham J, Graves GR, Lapensée L, Min JK, Stewart S, Ward S, Chee-Man Wong B, Armson AB, Delisle MF, Farine D, Gagnon R, Keenan-Lindsay L, Morin V, Mundle W, Pressey T, Schneider C, Van Aerde J. Directive clinique en ce qui concerne le nombred’embryons à transférer à la suite de la fécondation in vitro. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2006. [DOI: 10.1016/s1701-2163(16)32248-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Le Lannou D, Griveau JF, Laurent MC, Gueho A, Veron E, Morcel K. Contribution of embryo cryopreservation to elective single embryo transfer in IVF–ICSI. Reprod Biomed Online 2006; 13:368-75. [PMID: 16984767 DOI: 10.1016/s1472-6483(10)61441-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Single embryo transfer is the best way to reduce the risk of multiple pregnancy in IVF-intracytoplasmic sperm injection (ICSI). Between June 2002 and December 2004, all patients (first cycle, female age <38 years) were offered the choice between having one (SET) or two (DET) embryos transferred. Among 493 couples, 428 had at least two good quality embryos, and among them, 32% opted for SET. The SET and DET populations were not comparable (patients in the SET group were younger and had more oocytes retrieved), and therefore a paired, case-control analysis was performed involving 130 SET couples and 130 DET couples, matched according to the female partners' ages and the numbers of embryos available. All of the SET patients, and 82% of the DET group, had at least one embryo cryopreserved, (3.9 versus 2.8 embryos). The option of SET was continued for the frozen-thawed embryo transfers. The pregnancy rate following embryo transfer was significantly lower after SET compared with DET for both fresh (27.6 versus 36.9%; P < 0.05) and frozen-thawed (14.4 versus 23.5%) embryos. However, the cumulative live birth rates following the transfer of fresh and frozen embryos were identical between the two groups (43 versus 45%), with a high prevalence of twins following DET (34 versus 0%).
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Affiliation(s)
- Dominique Le Lannou
- Unité de Biologie de la Reproduction-CECOS, CHR Hotel-Dieu, 35000 Rennes, France.
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de Klerk C, Heijnen EMEW, Macklon NS, Duivenvoorden HJ, Fauser BCJM, Passchier J, Hunfeld JAM. The psychological impact of mild ovarian stimulation combined with single embryo transfer compared with conventional IVF. Hum Reprod 2005; 21:721-7. [PMID: 16311295 DOI: 10.1093/humrep/dei395] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The objective of this study was to assess the psychological implications of mild ovarian stimulation combined with single embryo transfer (SET) during a first IVF cycle. METHODS We conducted a randomized controlled two-centre trial. Three hundred and ninety-one couples were randomized to undergo either mild ovarian stimulation with GnRH antagonist co-treatment and SET (n=199) or conventional GnRH agonist long protocol ovarian stimulation with double embryo transfer (DET) (n=192). Women completed the Hospital Anxiety and Depression Scale, the Hopkins Symptom Checklist and the Subjective Sleep Quality Scale at baseline, on the first day of ovarian stimulation and following embryo transfer. Affect was assessed daily with the Daily Record Keeping Chart from the first day of ovarian stimulation until the day treatment outcome became known. RESULTS The conventional IVF group experienced elevated levels of physical and depressive symptoms during pituitary downregulation. At oocyte retrieval, this group experienced more positive affect and less negative affect than the mild IVF group. In the conventional IVF group, cycle cancellation was associated with less positive and more negative affect. CONCLUSIONS During the first IVF treatment cycle, mild ovarian stimulation and SET does not lead to more psychological complaints than conventional IVF.
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Affiliation(s)
- C de Klerk
- Department of Medical Psychology and Psychotherapy, Erasmus MC, 3015 GD Rotterdam, and Department of Reproductive Medicine, University Medical Center, 3584 CX Utrecht, The Netherlands.
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