Elective Single Embryo Transfer Following In Vitro Fertilization

摘要: Abstract Objective To review the effect of elective single embryo transfer (eSET) compared with double (DET) following in vitro fertilization (IVF), and to provide guidelines on use eSET order optimize live birth rates minimize twin pregnancies. Options Rates birth, clinical pregnancy, multiple pregnancy DET are compared. Outcomes Live rates, cost-effectiveness. Evidence Published literature was retrieved through searches PubMed, Medline, The Cochrane Library 2009, using appropriate controlled vocabulary (e.g., transfer) key words transfer, fertilization, intracytoplasmic sperm injection, assisted reproductive technologies, blastocyst, pregnancy). Results were restricted English language systematic reviews, randomized trials/controlled trials, observational studies. There no date restrictions. Searches updated a regular basis incorporated guideline November 2009. Additional references identified bibliographies articles international medical specialty societies. Grey (unpublished) searching websites health technology assessment assessment-related agencies, practice collections, trial registries, national Values Available evidence reviewed by Joint Society Obstetricians Gynaecologist Canada–Canadian Fertility Andrology Clinical Practice Guidelines Committee Reproductive Endocrinology Infertility Gynaecologists Canada, qualified evaluation criteria outlined report Canadian Task Force Preventive Health Care. Benefits, Harms, Costs This is intended occurrence gestations while maintaining acceptable overall IVF-ET. Summary Statements 1.Indiscriminate application populations less than optimal prognosis for will result significant reduction effectiveness DET. (I) 2.In women aged 38 years over, may rate (II-2) 3.Selective small group good-prognosis patients be effective reducing an entire IVF population. (II-3) 4.Given high costs treatment, uptake would enhanced public funding treatment. Recommendations 1.Patients should informed reductions both after fresh when patients. (I-A) 2.Because cumulative followed frozen-thawed similar but not equivalent patients, strategy used avoid pregnancy. 3.Women 35 or less, their first second attempt, at least 2 good quality embryos available considered 4.In maximize eSET, cryopreservation programs place. 5.In maintain multiples achieved performed subsequent cycles. (II-2A) 6.Because blastocyst stage generally increases chance implantation cleavage who have blastocysts available. 7.In 36 37 years, embryos, particularly transfer. 8.In oocyte donor–recipient cycles donor has available, performed. (II-2B) 9.In obstetrical contraindications (III-B) 10.In achieve successful it essential patient physician education regarding risks (III-C) 11.When considering direct care societal costs, noted that significantly expensive Therefore, from cost-effectiveness perspective, indicated (III-A)