title: A mandatory single blastocyst transfer policy with educational campaign in a United States IVF program reduces multiple gestation rates without sacrificing pregnancy rates.
abstract: OBJECTIVE
  To reduce the twin rate in our IVF program.
  
  
  METHODS
  A prospective educational study of infertile couples; a retrospective review of IVF outcomes before vs. after mandatory single embryo transfer (mSBT) policy change.
  
  
  METHODS
  University-based infertility center.
  
  
  METHODS
  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.
  
  
  METHODS
  A 1-page educational summary of comparative risks of twins vs. singletons to maternal and child health.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242-1080, USA.
authors.forename: Ginny L
authors.initials: GL
authors.lastname: Ryan
authors.forename: Amy E T
authors.initials: AE
authors.lastname: Sparks
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Sipe
authors.forename: Craig H
authors.initials: CH
authors.lastname: Syrop
authors.forename: Anuja
authors.initials: A
authors.lastname: Dokras
authors.forename: Bradley J
authors.initials: BJ
authors.lastname: Van Voorhis
mesh_terms: D000328:Adult; D002452:Cell Count; D004624:Embryo Transfer; D005260:Female; D005307:Fertilization in Vitro / Q000331:legislation & jurisprudence*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011247:Pregnancy; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple / Q000706:statistics & numerical data*; D014427:Twins; D014481:United States