A mandatory single blastocyst transfer policy with educational campaign in a United States IVF program reduces multiple gestation rates without sacrificing pregnancy rates

Ginny L Ryan, Amy E T Sparks, Christopher S Sipe, Craig H Syrop, Anuja Dokras, Bradley J Van Voorhis
Fertility and Sterility 2007, 88 (2): 354-60

OBJECTIVE: To reduce the twin rate in our IVF program.

DESIGN: A prospective educational study of infertile couples; a retrospective review of IVF outcomes before vs. after mandatory single embryo transfer (mSBT) policy change.

SETTING: University-based infertility center.

PATIENT(S): One hundred ten of 120 consecutive new infertile couples completed the educational study. Outcomes of all embryo transfers (n = 693) performed 17 months before and 17 months after mSBT were evaluated.

INTERVENTION(S): A 1-page educational summary of comparative risks of twins vs. singletons to maternal and child health.

MAIN OUTCOME MEASURE(S): Knowledge of twin risks and desired number of embryos transferred before and after education. Pregnancy rates, number of embryos transferred, and multiple-gestation rates before and after mSBT policy.

RESULT(S): After education, knowledge of twin risks improved and a significant number of subjects changed their desired outcome to a lower gestational number. There was no change in ongoing pregnancy rates with blastocyst transfer before and after mSBT (63% vs. 58%; NS). Program-wide number of embryos transferred (2.1 +/- 0.6 vs. 1.9 +/- 0.7) and multiple-gestation rates (35% vs. 19%) decreased significantly while pregnancy rates were maintained.

CONCLUSION(S): Simple educational materials can improve knowledge of twin pregnancy risks and affect decision making. In high-risk patients, mSBT results in pregnancy rates similar to two-blastocyst transfer, with decreased twin rates.

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