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Hum. Reprod. Advance Access published online on September 4, 2008
Human Reproduction, doi:10.1093/humrep/den327
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© The Author 2008. 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

Perceived barriers to elective single embryo transfer among IVF professionals: a national survey

A.M. van Peperstraten1,2,5, R.P.M.G. Hermens2, W.L.D.M. Nelen1, P.F.M. Stalmeier3, G.J. Scheffer4, R.P.T.M. Grol2 and J.A.M. Kremer1

1 Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands 2 Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands 3 Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands 4 Department of Obstetrics and Gynaecology, Gelre Ziekenhuizen, PO Box 9014, 7300 DS Apeldoorn, The Netherlands

5 Correspondence address. Tel: +31-24-366-86-65; Fax: +31-24-366-85-97; E-mail: a.vanpeperstraten{at}obgyn.umcn.nl

BACKGROUND: After initial years of improvement, the multiple pregnancy rate after in vitro fertilization (IVF) in Europe now remains stable at 23% with single embryo transfer (SET) constituting 19% of all IVF cycles. Although elective SET prevents multiple pregnancies after IVF, couples and professionals apparently often decide to transfer more embryos. Previous qualitative research has identified factors that impede the use of elective SET. The aim of this study was to quantify those barriers among IVF professionals and to identify predictors of professionals’ willingness to perform elective SET.

METHODS: A national survey among all Dutch IVF professionals quantified the barriers suggested by a previous qualitative study and assessed characteristics of the professionals and clinics. Multivariate analysis identified predictors related to the willingness of IVF professionals to perform elective SET.

RESULTS: In total, 107 professionals participated. The most frequently mentioned barriers to elective SET use were suboptimal success rates associated with cryopreservation (96%), not seeing twin pregnancies as a complication (79%) and lack of a SET protocol (78%). Two variables seem to predict the professionals’ willingness to perform elective SET: university hospital of the initial fertility training (P< 0.01) and high scores of perceived barriers, e.g. professionals’ attitudes and skills (P < 0.01). The explained variance of these two variables was 25%.

CONCLUSIONS: This study has identified the main barriers to elective SET use and predictors for willingness of professionals to perform elective SET. This insight into the decision-making process could be critical in terms of increasing the use of elective SET.

Key words: in vitro fertilisation/single embryo transfer/shared decision-making/multiple pregnancy

Submitted on May 21, 2008; resubmitted on July 25, 2008; accepted on August 4, 2008.


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