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Hum. Reprod. Advance Access originally published online on April 7, 2007
Human Reproduction 2007 22(6):1669-1674; doi:10.1093/humrep/dem059
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

eSET irrespective of the availability of a good-quality embryo in the first cycle only is not effective in reducing overall twin pregnancy rates

Aafke P.A. van Montfoort1,5, Audrey A.A. Fiddelers2, Jolande A. Land1,4, Carmen D. Dirksen2, Johan L. Severens2, Joep P.M. Geraedts3, Johannes L.H. Evers1 and John C.M. Dumoulin1

1 Research Institute Growth & Development (GROW), Department of Obstetrics and Gynaecology, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands 2 Research Institute Growth & Development (GROW), Department of Clinical Epidemiology and Medical Technology Assessment, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands 3 Research Institute Growth & Development (GROW), Department of Clinical Genetics, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands

5 Correspondence address. Research Institute Growth & Development (GROW), Department of Obstetrics and Gynaecology, Academic Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Tel: +31 43 3874760; Fax: +31 43 3874765; E-mail: avmn{at}sgyn.azm.nl

INTRODUCTION: In several clinics, elective single-embryo transfer (eSET) is applied in a selected group of patients based on age and the availability of a good-quality embryo. Whether or not eSET can be applied irrespective of the presence of a good-quality embryo in the first cycle, to further reduce the twin pregnancy rate, remains to be elucidated.

METHODS: In patients <38 years two transfer strategies were compared, which differed in the first cycle only: group A (n = 141) received eSET irrespective of the availability of a good-quality embryo, and group B (n = 174) received eSET when a good-quality embryo was available while otherwise they received double embryo transfer (DET; referred to as eSET/DET transfer policy). In any subsequent cycle, in both groups the eSET/DET transfer policy was applied.

RESULTS: After completion of their IVF treatment (including a maximum of three fresh cycles and the transfer of frozen–thawed embryos), comparable cumulative live birth rates (62.4% in group A and 62.6% in group B) and twin pregnancy rates (10.1 versus 13.4%) were found. However, patients in group A required significantly more fresh (2.0 versus 1.8) and frozen (0.8 versus 0.5) cycles.

CONCLUSIONS: The transfer of one embryo in the first cycle, irrespective of the availablity of a good-quality embryo, in all patients <38 years, is not an effective transfer policy for reducing the overall twin pregnancy rate.

Key words: assisted reproductive technologies/multiple pregnancy/single-embryo transfer

4 Present address: Department of Obstetrics and Gynaecology, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands

Submitted on November 10, 2006; resubmitted on January 9, 2007; accepted on February 13, 2007.


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