Single-embryo transfer: a key strategy to reduce the risk for multiple pregnancy in assisted human reproduction

Author(s):  
Pilar Reimundo ◽  
Javier M. Gutiérrez Romero ◽  
Tamara Rodríguez Pérez ◽  
Ernesto Veiga

Abstract In the early days of assisted reproductive technology (ART), the main target was achieving gestation. Success rates were low, and multiple embryo transfers became common practice, with multiple pregnancies being 20 times higher than in natural conception. Multiple pregnancy is associated with a higher risk of complications for the mother and the baby than a singleton pregnancy. Added to healthcare costs, multiple pregnancy also involves other costs and psychosocial risks, with a high social and health costs. At present, success rates of assisted human reproduction (AHR) have improved dramatically, partially due to advances in laboratory techniques such as culture of blastocyst-stage embryos and vitrification. Additionally, there is a wide range of counseling, health and economic policies that have demonstrated being effective in increasing single-embryo transfer (SET) practices and reducing multiple pregnancies, which ensures satisfactory success rates. Therefore, single-embryo transfer emerges as the approach of choice for AHR to result in a full-term healthy newborn.

Author(s):  
Beth Atkinson ◽  
Emma Woodland

AbstractEmbryoGlue is available to patients at many in vitro fertilization clinics, usually at an additional cost. The efficacy of hyaluronan-enriched transfer medium (HETM) is supported by moderate quality evidence that indicates a significant improvement in clinical outcomes such as live birth rates for patients, including poorer prognosis women (i.e., maternal age factor [>35 years] and recurrent implantation failure). An increased multiple pregnancy rate has been reported with the use of HETM; therefore, a single embryo transfer policy should be considered in conjunction with the use of EmbryoGlue. There is no evidence to suggest that HETM has any detrimental impact, and therefore the use of HETM in clinics may be justified for a specific demographic of patients. Further robust evidence, in the form of meta-analyses or large-scale randomized controlled trials, is needed to build a sufficient consensus regarding the benefit of hyaluronan supplementation in embryo transfer media.


2015 ◽  
Vol 27 (1) ◽  
pp. 158
Author(s):  
M. Rubessa ◽  
K. K. Herzog ◽  
A. Ambrosi ◽  
J. W. Stewart ◽  
K. M. Polkoff ◽  
...  

Wide-spread use of IVF has significantly increased the number of multiple births (Janvier et al. 2011 J. Pediatr. 159, 409–413). A potential solution to this problem is to develop improved methods for embryo selection to permit single-embryo transfer. Identification of a noninvasive technique to assess embryo implantation potential in assisted reproduction would greatly increase success rates and lead to more efficient single-embryo transfer. The aim of this study was to assess whether there are metabolic differences among embryos produced by IVF and embryos obtained by parthenogenetic activation. Matured bovine cumulus-oocyte complexes were fertilized in vitro according to our standard procedures (Rubessa et al. 2011 Theriogenology 76, 1347–1355). Presumptive zygotes were placed in individual drops of 50 μL of SOF. Zygotes were incubated in a humidified mixture of 5% CO2, 6% O2, and 88% N2 in air at 39°C. For the parthenogenetic group, the oocytes were activated by 5 μM ionomycin in M199 + 10% FCS for 5 min, and incubation in 2 mM 6-DMAP in M199 + 10% FCS for 4 h. After 48 h, the zygotes were placed into WOW culture and the drops collected in tubes. The embryos were scored for quality on the basis of morphological criteria. Samples of media (40 μL) were added to 660 μL of a stock solution prepared by dissolving 5.0 mg of sodium 3-(trimethylsilyl)-2,2′,3,3′-tetradeuteropropionate in 50 mL of deuterium oxide. The sodium 3-(trimethylsilyl)-2,2′,3,3′-tetradeuteropropionate acted both as a chemical shift reference and as an internal standard for the purposes of quantitation. Samples were analysed on a Varian VNS-750 NB (750 MHz) spectrometer (Agilent Technologies, Santa Clara, CA, USA). Data were statistically analysed with ANOVA using the Generalized Linear Model (GLM) procedure (SAS, version 9, 1999, SAS Institute Inc., Cary, NC, USA), where the independent variable was the sample (IVF or parthenogenetic embryos and control media without embryos). Tukey's post-hoc test was used to perform multiple comparisons. The P-level was set at 0.05. All data were expressed as quadratic means with standard error of the means. The results, reported in Table 1, show that there were no statistical differences between embryo metabolites with IVF or parthenogenetic activation when we evaluated lactate, formate, myo-inositol, and pyruvate. However, we can see that there are differences when we focused on acetate and citrate. Parthenogenetic embryos produced more citrate than IVF embryos. It is well known that the Krebs cycle produces one molecule of acetate for each molecule of citrate. The present results support that as well with the concentration of acetate being greater in parthenogenetic than in the IVF embryos. These results are a first step in identifying noninvasive, quantitative parameters that indicate which embryos may be the most viable before transfer. Table 1.Results (least squares means ± s.e.)


2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Syuichi Ooki

The purpose of the present study was to examine the effect of single embryo transfer (SET) in assisted reproductive technology (ART) on the reduction of the multiple pregnancy rate. We also estimated the monozygotic (MZ) twinning rates according to the SET diffusion indirectly. A reverse sigmoid curve was assumed and examined using nationwide data of SET from 2007 to 2009 in Japan. The multiple pregnancy rate decreased almost linearly where the SET pregnancy rate was between about 40% and 80% of regression approximation. The linear approximation overestimated multiple pregnancy rates in an early period and underestimated multiple pregnancy rates in the final period. The multiple pregnancy rate seemed to be influenced by the improvement of the total pregnancy rate of ART in the early period and by the MZ twinning after SET in the final period. The estimated MZ twinning rate after SET was around 2%.


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