Elective single embryo transfer: compromise or necessity?

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Abstract

The development of assisted reproductive technologies (ART) as well as the improvement of the methods used for their implementation caused changes in approaches to the management of patients. The main criterion for the effectiveness of ART is the birth of a healthy child, and many factors contribute to the achievement of this result. The question of the number of transferred embryos necessary to achieve the highest possible rate of live birth and the minimum number of complications in women undergoing ART is still relevant. When ART appeared, tactics of transferring several embryos into the uterine cavity were often preferred in order to increase the effectiveness of the programs or due to the lack of the possibility of embryo cryopreservation. Therefore, the use of ART has been associated for a long time with a high incidence of multiple pregnancies which often pose risks for the health of the mother and newborn, as well as the need for performing traumatic embryo reduction procedures. To date, the prevention of multiple pregnancies is a priority for reproductive medicine specialists, and therefore, in many countries, there is a tendency to choose elective single embryo transfer (eSET) as a preventive measure for multiple pregnancies. For this review, the scientific literature was analyzed to compare the effectiveness of eSET tactics and the transfer of two or more embryos in ART programs; the legal framework on this issue was studied as well.

Conclusion: Elective single embryo transfer should be recommended to all patients with a “good” prognosis of establishing pregnancy, since the rate of childbirth in this group is comparable to that in patients with the transfer of two embryos. The possibility of introducing eSET in patients with an “unfavorable” prognosis of pregnancy requires further discussion.

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About the authors

Anastasiya G. Syrkasheva

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Author for correspondence.
Email: a_syrkasheva@oparina4.ru
ORCID iD: 0000-0002-7150-2230

Dr. Med. Sci., Associate Professor, Senior Researcher at the Department of Assisted Reproductive Technology named after Professor B.V. Leonov

Russian Federation, Moscow

Daria M. Ermakova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: d_ermakova@oparina4.ru
ORCID iD: 0000-0002-8558-4687

PhD, Junior Researcher at the Clinical Trials Center

Russian Federation, Moscow

Malika U. Magamadova

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: m_magamadova@oparina4.ru

obstetrician-gynecologist at the Department of Assisted Reproductive Technology named after Professor B.V. Leonov

Russian Federation, Moscow

Nataliya V. Dolgushina

Academician V.I. Kulakov National Medical Research Centre for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia

Email: n_dolgushina@oparina4.ru
ORCID iD: 0000-0003-1116-138X

Dr. Med. Sci., Professor, Deputy Director for Scientific Work

Russian Federation, Moscow

References

  1. Ахмадеев Н.Р. Пациентки с многоплодной беременностью находятся в группе высокого риска перинатальных осложнений. Женское здоровье и репродукция. 2019; 6: 14-6. [Akhmadeev N.R. Patients with multiple pregnancies are at high risk of perinatal complications. Women's Health and Reproduction. 2019; (6): 14-6. (in Russian)].
  2. Калашников С.А., Сичинава Л.Г. Течение и исходы многоплодной беременности, наступившей при использовании вспомогательных репродуктивных технологий. Акушерство и гинекология. 2020; 10: 71-7. [Kalashnikov S.A., Sichinava L.G. The course and outcomes of multiple pregnancy following assisted reproductive technology. Obstetrics and Gynecology. 2020; (10): 71-7. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.10.71-77.
  3. D’Alton M., Breslin N. Management of multiple gestations. Int. J. Gynaecol. Obstet. 2020; 150(1): 3-9. https://dx.doi.org/10.1002/ijgo.13168.
  4. Templeton A., Morris J.K. Reducing the risk of multiple births by transfer of two embryos after in vitro fertilization. N. Engl. J. Med. 1998; 339(9): 573-7. https://dx.doi.org/10.1056/NEJM199808273390901.
  5. Dare M.R., Crowther C.A., Dodd J.M., Norman R.J. Single or multiple embryo transfer following in vitro fertilisation for improved neonatal outcome: a systematic review of the literature. Aust. N. Z. J. Obstet. Gynaecol. 2004; 44(4): 283-91. https://dx.doi.org/10.1111/ j.1479-828X.2004.00243.x.
  6. Pandian Z., Templeton A., Serour G., Bhattacharya S. Number of embryos for transfer after IVF and ICSI: a cochrane review. Hum. Reprod. 2005; 20(10): 2681-7. https://dx.doi.org/10.1093/humrep/dei153.
  7. Pandian Z., Bhattacharya S., Ozturk O., Serour G., Templeton A. Number of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst. Rev. 2009; (2): CD003416. https://dx.doi.org/10.1002/14651858.CD003416.pub3.
  8. Gelbaya T.A., Tsoumpou I., Nardo L.G. The likelihood of live birth and multiple birth after single versus double embryo transfer at the cleavage stage: a systematic review and meta-analysis Fertil. Steril. 2010; 94(3): 936-45. https://dx.doi.org/10.1016/j.fertnstert.2009.04.003.
  9. McLernon D.J., Harrild K., Bergh C., Davies M.J., de Neubourg D., Dumoulin J.C.M. et al. Clinical effectiveness of elective single versus double embryo transfer: meta-analysis of individual patient data from randomised trials. BMJ. 2010; 341: c6945. https://dx.doi.org/10.1136/ bmj.c6945.
  10. Grady R., Alavi N., Vale R., Khandwala M., McDonald S.D. Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis. Fertil. Steril. 2012; 97(2): 324-31. https://dx.doi.org/10.1016/ j.fertnstert.2011.11.033.
  11. Pandian Z., Marjoribanks J., Ozturk O., Serour G., Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst. Rev. 2013; (7): CD003416. https://dx.doi.org/10.1002/14651858.CD003416.pub4.
  12. Kamath M.S., Mascarenhas M., Kirubakaran R., Bhattacharya S. Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst. Rev. 2020; 8(8): CD003416. https://dx.doi.org/10.1002/14651858.CD003416.pub5.
  13. Ma S., Peng Y., Hu L., Wang X., Xiong Y., Tang Y. et al. Comparisons of benefits and risks of single embryo transfer versus double embryo transfer: a systematic review and meta-analysis. Reprod. Biol. Endocrinol. 2022; 20(12): 20. https://dx.doi.org/10.1186/s12958-022-00899-1.
  14. Peng Y., Ma S., Hu L., Wang X., Xiong Y., Yao M. et al. Effectiveness and safety of two consecutive cycles of single embryo transfer compared with one cycle of double embryo transfer: a systematic review and meta-analysis. Front. Endocrinol. (Lausanne). 2022; 13: 920973. https://dx.doi.org/10.3389/fendo.2022.920973.
  15. Xiao Y., Wang X., Gui T., Tao T., Xiong W. Transfer of a poor-quality along with a good-quality embryo on in vitro fertilization/intracytoplasmic sperm injection-embryo transfer clinical outcomes: a systematic review and meta-analysis. Fertil. Steril. 2022; 118(6): 1066-79. https://dx.doi.org/10.1016/ j.fertnstert.2022.08.848.
  16. Thurin A., Hausken J., Hillensjö T., Jablonowska B., Pinborg A., Strandell A., Bergh C. Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization. N. Engl. J. Med. 2004; 351(23): 2392-402. https://dx.doi.org/10.1056/NEJMoa041032.
  17. Lukassen H.G.M., Braat D.D., Wetzels A.M.M., Zielhuis G.A., Adang E.M.M., Scheenjes E., Kremer J.A.M. Two cycles with single ryo transfer versus one cycle with double embryo transfer: a randomized controlled trial. Hum. Reprod. 2005; 20(3): 702-8. https://dx.doi.org/10.1093/humrep/deh672.
  18. van Montfoort A.P.A., Fiddelers A.A.A., Janssen J.M., Derhaag J.G., Dirksen C.D., Dunselman G.A.J. et al. 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. Hum. Reprod. 2006; 21(2): 338-43. https://dx.doi.org/10.1093/humrep/ dei359.
  19. Fiddelers A.A.A., van Montfoort A.P.A., Dirksen C.D., Dumoulin J.C.M., Land J.A., Dunselman G.A.J. et al. Single versus double embryo transfer: cost-effectiveness analysis alongside a randomized clinical trial. Hum. Reprod. 2006; 21(8); 2090-7. https://dx.doi.org/10.1093/humrep/del112.
  20. Moustafa M.K., Sheded S.A., El Aziz Mousta M.A. Elective single embryo transfer versus double embryo transfer in assisted reproduction. Reprod. Biomed. Online. 2008; 17(1): 82-7. https://dx.doi.org/10.1016/s1472-6483(10)60297-0.
  21. López-Regalado M.L., Clavero A., Gonzalvo M.C., Serrano M., Martínez L., Mozas J. et al. Randomised clinical trial comparing elective single-embryo transfer followed by single-embryo cryotransfer versus double embryo transfer. Eur. J. Obstet. Gynecol. Reprod. Biol. 2014; 178: 192-8. https://dx.doi.org/10.1016/j.ejogrb.2014.04.009.
  22. 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. 2015; 27(5): 794-800. https://dx.doi.org/10.1071/RD13412.
  23. Clua E., Tur R., Coroleu B., Rodríguez I., Boada M., Gómez M.J. et al. Is it justified to transfer two embryos in oocyte donation? A pilot randomized clinical trial. Reprod. Biomed. Online. 2015; 31(2): 154-61. https://dx.doi.org/10.1016/j.rbmo.2015.04.013.
  24. Sitler C., Lustik M., Levy G., Pier B. Single embryo transfer versus double embryo transfer: a cost-effectiveness analysis in a Non-IVF Insurance mandated system. Mil. Med. 2020; 185(9-10): e1700-5. https://dx.doi.org/10.1093/milmed/usaa119.
  25. Lessey B.A. Assessment of endometrial receptivity. Fertil. Steril. 2011; 96(3): 522-9. https://dx.doi.org/10.1016/j.fertnstert.2011.07.1095.
  26. Arian S.E., Hessami K., Khatibi A., To A.K., Shamshirsaz A.A., Gibbons W. Endometrial receptivity array before frozen embryo transfer cycles: a systematic review and meta-analysis. Fertil. Steril. 2023; 119(2): 229-38. https://dx.doi.org/10.1016/j.fertnstert.2022.11.012.
  27. Cozzolino M., Diáz-Gimeno P., Pellicer A., Garrido N. Use of the endometrial receptivity array to guide personalized embryo transfer after a failed transfer attempt was associated with a lower cumulative and per transfer live birth rate during donor and autologous cycles. Fertil. Steril. 2022; 118(4): 724-36. https://dx.doi.org/10.1016/j.fertnstert.2022.07.007.
  28. Carvalho F., Coonen E., Goossens V., Kokkali G., Rubio C., Meijer-Hoogeveen M. et al.; ESHRE PGT Consortium Steering Committee. ESHRE PGT Consortium good practice recommendations for the organisation of PGT. Hum. Reprod. Open. 2020; 2020(3): hoaa021. https://dx.doi.org/10.1093/hropen/ hoaa021.
  29. (The writing group) for the participants to the 2022 Lugano RIF Workshop; Pirtea P., Cedars M.I., Devine K., Ata B., Franasiak J., Racowsky C. et al. Recurrent implantation failure: reality or a statistical mirage?: Consensus statement from the July 1, 2022 Lugano Workshop on recurrent implantation failure. Fertil. Steril. 2023; 120(1): 45-59. https://dx.doi.org/10.1016/ j.fertnstert.2023.02.014.
  30. Busnelli A., Somigliana E., Cirillo F., Baggiani A., Emanuele Levi-Setti P.E. Efficacy of therapies and interventions for repeated embryo implantation failure: a systematic review and meta-analysis. Sci. Rep. 2021; 11(1): 1747. https://dx.doi.org/10.1038/s41598-021-81439-6.
  31. Shi X., Tang Y., Liu C., Li W., Lin H., Mao W. et al. Effects of NGS-based PGT-a for idiopathic recurrent pregnancy loss and implantation failure: a retrospective cohort study. Syst. Biol. Reprod. Med. 2023 Jul 17: 1-12. https://dx.doi.org/10.1080/19396368.2023.2225679.
  32. Leese B., Denton J. Attitudes towards single embryo transfer, twin and higher order pregnancies in patients undergoing infertility treatment: a review. Hum. Fertil. (Camb). 2010; 13(1): 28-34. https://dx.doi.org/10.3109/ 14647270903586364.
  33. van den Akker O.B.A., Purewal S. Elective single-embryo transfer: persuasive communication strategies can affect choice in a young British population. Reprod. Biomed. Online. 2011; 23(7): 838-50. https://dx.doi.org/10.1016/ j.rbmo.2011.07.022.
  34. Højgaard A., Ottosen L.D.M., Kesmodel U., Ingerslev H.J. Patient attitudes towards twin pregnancies and single embryo transfer - a questionnaire study. Hum. Reprod. 2007; 22(10): 2673-8. https://dx.doi.org/10.1093/humrep/dem173.
  35. Klitzman R. Deciding how many embryos to transfer: ongoing challenges and dilemmas. Reprod. Biomed. Soc. Online. 2016; 3: 1-15. https://dx.doi.org/ 10.1016/j.rbms.2016.07.001.
  36. Ellison M.A., Hotamisligil S., Lee H., Rich-Edwards J.W., Pang S.C., Hall J.E. Psychosocial risks associated with multiple births resulting from assisted reproduction. Fertil. Steril. 2005; 83(5): 1422-8. https://dx.doi.org/10.1016/ j.fertnstert.2004.11.053.
  37. Pennings G. Belgian law on medically assisted reproduction and the disposition of supernumerary embryos and gametes. Eur. J. Health Law. 2007; 14(3): 251-60. https://dx.doi.org/10.1163/092902707x232971.
  38. Hafidzilhaj H., Imam Suprayogi R. Law of the Ministry No. 3305 (Official Gazette A΄17 27.1.2005). Application of medically assisted reproduction. 2005; 3305: 25-7.
  39. Abdel-Aal W., Ghaffar E.A., El Shabrawy O. Review of the Medical Research Ethics Committee (MREC), National Research Center of Egypt, 2003-2011. Curr. Med. Res. Opin. 2013; 29(10): 1411-7. https://dx.doi.org/10.1185/ 03007995.2013.815158.
  40. The Public Health (In Vitro Fertilization) Regulations, 1987, 27 April 1987. Annu. Rev. Popul. Law. 1987; 14: 347-50.
  41. Practice Committee of the American Society for Reproductive Medicine. Practice Committee of the Society for Assisted Reproductive Technology. Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertil. Steril. 2017; 107(4): 901-3. https://dx.doi.org/10.1016/ j.fertnstert.2017.02.107.
  42. Yamada M., Ishikawa T., Iwasa T., Oishi H., Osuka S., Oka K. et al. Guidelines for reproductive medicine in Japan. Reprod. Med. Biol. 2022; 21(1): e12483. 10.1002/rmb2.12483.

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