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Hum. Reprod. Advance Access first published online on October 27, 2005
This version published online on November 30, 2005
Human Reproduction, doi:10.1093/humrep/dei359
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© The Author 2005. 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
Received September 6, 2005
Revised September 19, 2005
Accepted September 26, 2005

Article

In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial

Aafke P.A. van Montfoort 1 *, Audrey A.A. Fiddelers 2, J. Marij Janssen 1, Josien G. Derhaag 1, Carmen D. Dirksen 2, Gerard A.J. Dunselman 1, Jolande A. Land 1, Joep P.M. Geraedts 3, Johannes L.H. Evers 1, and John C.M. Dumoulin 1

1 Research Institute Growth & Development (GROW), Department of Obstetrics & 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

* To whom correspondence should be addressed.
Aafke P.A. van Montfoort, E-mail: avmn{at}sgyn.azm.nl


  Abstract

BACKGROUND: Elective single embryo transfer (eSET) in a selected group of patients (i.e. young patients with at least one good quality embryo) reduces the number of multiple pregnancies in an IVF programme. However, the reduced overall multiple pregnancy rate (PR) is still unacceptably high. Therefore, a randomized controlled trial (RCT) was conducted comparing eSET and double embryo transfer (DET) in an unselected group of patients (i.e. irrespective of the woman’s age or embryo quality). METHODS: Consenting unselected patients were randomized between eSET (RCT-eSET) (n = 154) or DET (RCT-DET) (n = 154). Randomization was performed just prior to the first embryo transfer, provided that at least two 2PN zygotes were available. Non-participants received our standard transfer policy [SP-eSET in a selected group of patients (n = 100), otherwise SP-DET (n = 122)]. RESULTS: The ongoing PR after RCT-eSET was significantly lower as compared with RCT-DET (21.4 versus 40.3%) and the twin PR was reduced from 21.0% after RCT-DET to 0% after RCT-eSET. The ongoing PRs after SP-eSET and SP-DET did not differ significantly (33.0 versus 30.3%), with an overall twin PR of 12.9%. CONCLUSION: To avoid twin pregnancies resulting from an IVF treatment, eSET should be applied in all patients. The consequence would be a halving of the ongoing PR as compared with applying a DET policy in all patients. The transfer of one embryo in a selected group of good prognosis patients leads to a less drastic reduction in PR but maintains a twin PR of 12.9%.

Keywords: assisted reproductive technology/multiple pregnancy/randomized controlled trial/single embryo transfer.
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