Practice patterns and outcomes with the use of single embryo transfer in the United States
Presented at the 64th annual meeting of the American Society for Reproductive Medicine, San Francisco, California, November 8–12, 2008.
Received 23 November 2008; received in revised form 13 February 2009; accepted 25 February 2009. published online 20 April 2009.
Objective
To evaluate factors associated with the use of elective single embryo transfer (eSET) and its effect on assisted reproductive technology (ART) outcome.
Design
Historical cohort.
Setting
Clinic-based data.
Patient(s)
A total of 69,028 ART cycles of autologous fresh embryo transfers with additional embryos cryopreserved during the same cycle performed during 2004–06 and reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database.
Intervention(s)
None.
Main Outcome Measure(s)
Factors associated with the number of embryos transferred, and the odds of pregnancy, live birth, and multiple-infant live birth by number of embryos transferred as adjusted odds ratios (AORs).
Result(s)
Single embryo transfer was used more with uterine factor (AOR 1.76) and less with male factor, endometriosis, or tubal factor (AOR 0.81, 0.72, 0.83, respectively). Compared with women aged <30 years, eSET was used less among women aged 35–39 years and ≥40 years (AOR 0.74 and 0.39, respectively). Compared with White women, eSET was used more with Asian (AOR 1.52) and less with Black or Hispanic women (AOR 0.73 and 0.67, respectively). Compared with eSET, the likelihood of pregnancy, live birth, or multiple-infant live birth was more likely with two embryos (AOR 1.33, 1.34, and 27.4, respectively).
Conclusion(s)
Elective SET, used more for younger women with specific diagnoses, is associated with slightly reduced likelihood of a live birth but much reduced likelihood of multiples.
aDepartment of Obstetrics, Gynecology, and Reproductive Biology and Department of Epidemiology, Michigan State University, East Lansing, Michigan
bDepartment of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan
cCenter for Reproductive Medicine and Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Wichita, Kansas
dDivision of Reproductive Endocrinology and Infertility, University of California, San Francisco, California
eSeattle Reproductive Medicine, Seattle, Washington
fDartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
Reprint requests: Barbara Luke, Sc.D., M.P.H., Dept. OB/GYN & Reproductive Biology, Michigan State University, B227 West Fee Hall, East Lansing, Michigan 48824 (FAX: 517-353-1663).
B.L. has nothing to disclose. M.B. has nothing to disclose. D.G. has nothing to disclose. M.C. has nothing to disclose. N.K. has nothing to disclose. J.S. has nothing to disclose.
Supported by the Society for Assisted Reproductive Technology.
ABSTRACT