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Elective single embryo transfer criteria should be applied to frozen embryo transfer cycles


Melanie R. Freeman, PhD1, M. Shaun Hinds, BS1, C. Kay Howard, BS1, Julie Howard, BS1, and George A. Hill, MD2

1Ovation Fertility, Nashville, TN;  2Nashville Fertility Center, Nashville, TN

Objective:  To evaluate the outcomes for eSET (elective single embryo transfer) and eDET (elective double embryo transfer) in frozen embryo transfer cycles.

Design: Retrospective study

Materials and Methods: Data analysis of ongoing pregnancy and live birth rates, multiple pregnancy rates, and implantation rates (+fetal heart motion/# embryos transferred) of patients who qualified for eSET (<35 years old at the time of cryopreservation; > 1 cryopreserved blastocyst in storage) and who self-elected either eSET or eDET in 391 frozen embryo transfer (FET) cycles occurring between 2011 and 2015. FET outcomes were evaluated according to the patients’ election to have preimplantation genetic screening (PGS) or not (PGS patient; non-PGS patient) or fresh cycle outcome (negative outcome; pregnant and delivered in fresh cycle).  Proportion data were analyzed using Fisher’s exact test; P< 0.05 was considered to be statistically significant.

Results:  There were no statistically significant differences observed in ongoing pregnancy and live birth rates in FET for eSET vs. eDET in any of the patient groups evaluated.  Multiple pregnancy rates were significantly decreased in all eSET groups (0 – 5%), compared to eDET groups (30 – 44%).  Implantation rates were significantly higher for eSET vs. eDET in non-PGS patients (53% vs. 40%), but failed to reach a significant difference in the other groups.

Conclusions:  Similar ongoing pregnancy and live birth rates can be maintained while reducing the occurrence of multiple gestations with eSET compared to eDET in FET cycles.   This is important since fewer fresh embryo transfers are being done due to the increase in PGS and IVF cycle management.  If two or more cryopreserved blastocysts are available, eSET in FET cycles will provide additional future FET attempts while decreasing multiple pregnancy complications and fetal loss.  Furthermore, eSET represents a significant potential cost savings since current estimates for delivery of twins is five times, and triplets is 20 times the cost of delivery of a singleton1.

Support: None.

2011 – 2015 FET cycles PGS patients Non-PGS patients


Negative, Biochemical, or miscarriage in fresh cycle Pregnant & delivered

in fresh cycle

# Transfers 76 42 79 194 20 129 41 38
Ongoing/Delivered Pregnancy (%) 38 (50)1 27 (64)1 41 (52)4 117 (60)4 10 (50)7 73 (57)7 22 (54)10 23 (61)10
Singleton 37 16 40 79 10 51 21 15
Multiple (%) 1 (3)2 12 (44)2 1 (2)5 38 (32)5 08 22 (30)8 1 (5)11 8 (35)11
Implantation Rate (%) 39/76 (51)3 40/84 (48)3 42/79 (53)6 155/388 (40)6 10/20 (50)9 95/258 (37)9  

23/41 (54)12

31/76 (41)12

 Fisher’s Exact Test:  1P=0.176    2P=0.0001    3P= 0.75    4P=0.225   5P=0.0001    6P= 0.034    7P=1.0     8P=0.056  9P= 0.24    10P=0.65    11P=0.022   12P=0.124     

1Lemos EV, Zhang D, Van Voorhis BJ, Hu H. Healthcare Expenses Associated with Multiple Pregnancies versus Singletons in the United States.  Am J Obstet Gynecol 2013;209(6):586.

Ovation Fertility

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