Pregnancy outcomes in a university hospital after legal requirement for single-embryo transfer.
OBJECTIVE
To present our in vitro fertilization outcomes after implementation of the Turkish government policy limiting the number of transferred embryos to one, in women under the age of 35, and two, in women over age 35; and to demonstrate the feasibility of this policy.


METHODS
We retrospectively reviewed the records of 423 patients who underwent ovarian stimulation, oocyte pick-up, intracytoplasmic sperm injection and embryo transfer due to primary or secondary infertility over a 22-month time interval. Clinical pregnancy was defined as a fetal heartbeat in the seventh gestational week. Embryo transfers were carried out on day 3 or 5. Descriptive statistics are given as the number of subjects and percentages.


RESULTS
A total of 353 embryo transfers were performed: 261 (73.9%) were single-embryo transfer (244 (69.1%) elective and 17 (4.8%) non-elective) and 92 (26.1%) were double-embryo transfer. Of the 244 elective single-embryo transfers, 6.6% (n=16) were performed using frozen-thawed embryos. The average patient age was 29.6±4.5 years in the single-embryo group and 36.5±2.4 years in the double-embryo group. The cumulative pregnancy rates per oocyte pick-up were similar in both groups: 41% (n=107) in the single-embryo group and 43.4% (n=40) in the double-embryo group (p=0.678). The cumulative live birth rate of the single-embryo group (32.1%) was not statistically different from the double-embryo group (35.8%) (p=0.518). The twin pregnancy rate after single-embro transfer was significantly lower than with double-embryo transfer (2.8% (n=3) vs. 32.5% (n=13); p<0.001) and 62.5% of the twin pregnancies occurred in women 35 years or older who underwent double-embryo transfer. No significant difference in the spontaneous abortion rates was recorded between the single- and double-embryo transfer groups (16 (6.1%) vs. 6 (6.5%); p=0.894).


CONCLUSIONS
Single-embryo transfer results in a pregnancy rate comparable to double-embryo transfer, with a significantly reduced multiple pregnancy rate. Double-embryo transfer in patients over age 35 should be reconsidered because of the resulting high rate of multiple pregnancy.
Gülhane Military Medicine Faculty, Obstetrics and Gynecology, Ankara, Turkey. Electronic address: ercanmutlu@yahoo.com.
Cihangir Mutlu
CM
Ercan
Selçuk University Selçuklu Medicine Faculty, Obstetrics and Gynecology, Konya, Turkey. Electronic address: ozlemsecilmis@hotmail.com.
Ozlem Secilmis
OS
Kerimoglu
Akdeniz University Medicine Faculty, Obstetrics and Gynecology, Antalya, Turkey. Electronic address: mehmetsakinci@hotmail.com.
Mehmet
M
Sakinci
Gülhane Military Medicine Faculty, Histology and Embryology, Ankara, Turkey. Electronic address: cemk@gata.edu.tr.
Cem
C
Korkmaz
Gülhane Military Medicine Faculty, Obstetrics and Gynecology, Ankara, Turkey. Electronic address: durunk1@gmail.com.
Namik Kemal
NK
Duru
Gülhane Military Medicine Faculty, Obstetrics and Gynecology, Ankara, Turkey. Electronic address: aliergun@hotmail.com.
Ali
A
Ergun
D000328:Adult; D005260:Female; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D056826:Single Embryo Transfer / Q000706:statistics & numerical data*
In vitro fertilization; Multiple pregnancy; Single embryo transfer