Single Embryo Transfer
Single embryo transfer (SET) is not a big technical innovation, but rather more of an ideology, another way of defining success, not only through pregnancy rates in a single fresh cycle. Successful implementation of SET requires that everybody involved in
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Single Embryo Transfer Thorir Hardarson and Matts Wikland 60.1
Multiple Pregnancies – 730
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Pregnancy Results After SET – 730
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esults from Studies Comparing SET and Double Embryo R Transfer (DET) – 730
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The Swedish Experience of SET – 731
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Conclusion – 732
Review Questions – 732 References – 732
© Springer Nature Switzerland AG 2019 Z. P. Nagy et al. (eds.), In Vitro Fertilization, https://doi.org/10.1007/978-3-319-43011-9_60
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T. Hardarson and M. Wikland
Learning Objectives 55 The advantages and disadvantages with SET 55 The ideal patient for SET 55 Indications for DET
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Assisted reproduction technology (ART) is the single most effective method to treat infertility [1]. This high success rate has generally been achieved through replacement of multiple embryos resulting in a high multiple births rate, being 25% of all ART live births in the USA in 2014 [2, 3]. In the USA, the ASRM practice committee [4] recommended that between one and five embryos be replaced depending on the maternal age, number of IVF cycle, quality of the embryo, and/or the prognosis. It has been advocated that it should be up to the infertile couple and their physician to decide how many embryos should be transferred. In contrast, other countries like Sweden, Finland, Belgium, and Turkey have promoted a stricter line in the form of legislation/recommendations restricting the use of multiple embryo replacement. In those countries, the trend has been steadily toward reducing multiple pregnancies through the use of single embryo transfer (SET). Globally, however, there are large variations between how SET has been implemented, and even though countries like the USA have moved from 1% (2004) to 21% (2014) [3, 5], the rate of twin gestation has plateaued and 36% of all twins and 77% of higher-order multiples are still due to ART [6]. The annual expenditures for these iatrogenic preterm deliveries total 26 billion dollars of healthcare costs in the USA [7–9]. A situation likely to persist unless there are major changes in the way ART is viewed, funded, and legislated. 60.1
Multiple Pregnancies
The most important reason for decreasing the number of replaced embryos is the need to decrease the high incidence of multiple gestation and multiple birth rates (MBRs) produced through ART. In the USA, it has been estimated although ART only accounts for 1% of all births, ART births are 18% of all multiple births [10]. Despite that the majority of children born after multiple pregnancies are healthy, there are significant problems linked to multiple births both obstetrical and neonatal [11]. The obstetrical risks include hypertension, preeclampsia, preterm labor, anemia, and an increased Cesarean section rate. The neonatal risks include increased mortality, lower gestational age, low birth weight, and respiratory distress syndrome along with numerous other complications associated with preterm birth. In addition, long-term neurological complications have been associated with preterm birth along with th
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