[Prospective evaluation of elective single-embryo transfer versus double-embryo transfer following in vitro fertilization: a two-year French hospital experience].
OBJECTIVE
Multiple embryo transfer is responsible for a high rate of multiple pregnancies (ICSI), with subsequent risks of premature birth and perinatal death. This prospective non randomized study aimed to assess the ability of an elective single-embryo transfer (eSET) policy to reduce the twin pregnancy rate, compared to a double embryo transfer (DET) approach.


METHODS
Between March 2005 and May 2006, 180 eligible women were proposed to benefit from an eSET transfer rather than a DET. Inclusion criteria were (i) age less than 37 years old; (ii) at least two good quality embryos available (three to five cells at day 2 or six to nine cells at day 3; less than 20% fragmentation and the absence of multinucleates blastomeres), after IVF or ICSI and (iii) no more than one previous failed treatment cycle. Outcome analysis included cycles with frozen-thawed embryo transfer (FET).


RESULTS
According to patients' decision, 107 and 73 women had an eSET (59.4%) and a DET (40.6%) respectively. No differences were found between eSET and DET groups regarding demographics and biologicals parameters. The clinical pregnancy rate (PR) per transfer was 43.9% in eSET group and 57.5% in DET group (p=0.07). The twin pregnancy rates were 0 and 14.3%, in eSET and DET groups, respectively (p=0.007). The cumulative PR per patient, including the outcome of performed FET cycles, was 63.6% in eSET group and 61.6% in DET group. In this case, the cumulative twin pregnancy rates were 2.9 and 15.6% in eSET and DET groups, respectively (p=0.02).


CONCLUSIONS
Our data show that in a selected population of women, transferring one fresh embryo and then, if required, one or two frozen-thawed embryos significantly reduces the twin pregnancy rate without decreasing the overall pregnancy rate. This study supports the policy of eSET in this subgroup of patients.
Leniaud
L
L
Service d'histologie-embryologie-cytogénétique, laboratoire de biologie de la reproduction, CHU Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), avenue du 14-Juillet, 93140 Bondy, France.
Poncelet
C
C
Pôle femmes et enfants, CHU Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), 93140 Bondy, France.
Porcher
R
R
Service de biostatistiques, CHU Saint-Louis, Assistance publique-Hôpitaux de Paris (AP-HP), 75010 Paris, France.
Martin-Pont
B
B
Service d'histologie-embryologie-cytogénétique, laboratoire de biologie de la reproduction, CHU Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), avenue du 14-Juillet, 93140 Bondy, France.
Cédrin-Durnerin
I
I
Pôle femmes et enfants, CHU Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), 93140 Bondy, France.
Hugues
J-N
JN
Pôle femmes et enfants, CHU Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), 93140 Bondy, France.
Wolf
J-P
JP
Service d'histologie-embryologie-cytogénétique, laboratoire de biologie de la reproduction, CHU Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), avenue du 14-Juillet, 93140 Bondy, France.
Sifer
C
C
Service d'histologie-embryologie-cytogénétique, laboratoire de biologie de la reproduction, CHU Jean-Verdier, Assistance publique-Hôpitaux de Paris (AP-HP), avenue du 14-Juillet, 93140 Bondy, France. Electronic address: christophe.sifer@jvr.aphp.fr.
D000328:Adult; D000367:Age Factors; D004624:Embryo Transfer / Q000379:methods*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods; D006801:Humans; D018579:Patient Selection; D011247:Pregnancy; D018873:Pregnancy Rate; D011272:Pregnancy, Multiple; D020554:Sperm Injections, Intracytoplasmic; D014427:Twins