title: Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States, 2004-2012.
abstract: To evaluate factors associated with elective single-embryo transfer (eSET) utilization and its effect on assisted reproductive technology outcomes in the United States.
  
  
  
  Historical cohort.
  
  
  
  Not applicable.
  
  
  
  Fresh IVF cycles of women aged 18-37 years using autologous oocytes with either one (SET) or two (double-embryo transfer [DET]) embryos transferred and reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System between 2004 and 2012. Cycles were categorized into four groups with ([+]) or without ([-]) supernumerary embryos cryopreserved. The SET group with embryos cryopreserved was designated as eSET.
  
  
  
  None.
  
  
  
  The likelihood of eSET utilization, live birth, and singleton non-low birth weight term live birth, modeled using logistic regression. Presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs).
  
  
  
  The study included 263,375 cycles (21,917 SET[-]cryopreservation, 20,996 SET[+]cryopreservation, 103,371 DET[-]cryopreservation, and 117,091 DET[+]cryopreservation). The utilization of eSET (SET[+]cryopreservation) increased from 1.8% in 2004 to 14.9% in 2012 (aOR 7.66, 95% CI 6.87-8.53) and was more likely with assisted reproductive technology insurance coverage (aOR 1.60, 95% CI 1.54-1.66), Asian race (aOR 1.26, 95% CI 1.20-1.33), uterine factor diagnosis (aOR 1.48, 95% CI 1.37-1.59), retrieval of ≥16 oocytes (aOR 2.85, 95% CI 2.55-3.19), and the transfer of day 5-6 embryos (aOR 4.23, 95% CI 4.06-4.40); eSET was less likely in women aged 35-37 years (aOR 0.76, 95% CI 0.73-0.80). Compared with DET cycles, the likelihood of the ideal outcome, term non-low birth weight singleton live birth, was increased 45%-52% with eSET.
  
  
  
  Expanding insurance coverage for IVF would facilitate the broader use of eSET and may reduce the morbidity and healthcare costs associated with multiple pregnancies.
authors.affiliation: Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, Massachusetts. Electronic address: astyer@mgh.harvard.edu.
authors.forename: Aaron K
authors.initials: AK
authors.lastname: Styer
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University College of Human Medicine, East Lansing, Michigan.
authors.forename: Barbara
authors.initials: B
authors.lastname: Luke
authors.affiliation: Department of Obstetrics and Gynecology, University of Rochester School of Medicine, Rochester, New York.
authors.forename: Wendy
authors.initials: W
authors.lastname: Vitek
authors.affiliation: Department of Obstetrics and Gynecology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Mindy S
authors.initials: MS
authors.lastname: Christianson
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Valerie L
authors.initials: VL
authors.lastname: Baker
authors.affiliation: Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
authors.forename: Alicia Y
authors.initials: AY
authors.lastname: Christy
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: Alex J
authors.initials: AJ
authors.lastname: Polotsky
mesh_terms: D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D015925:Cryopreservation / Q000639:trends; D016208:Databases, Factual; D010064:Embryo Implantation; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro / Q000639:trends; D006801:Humans; D007246:Infertility / Q000175:diagnosis / Q000191:economics / Q000503:physiopathology / Q000628:therapy*; D019458:Insurance Coverage / Q000191:economics; D007348:Insurance, Health / Q000191:economics; D050498:Live Birth; D016015:Logistic Models; D008423:Maternal Age; D016017:Odds Ratio; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D011247:Pregnancy; D018873:Pregnancy Rate; D012307:Risk Factors; D056826:Single Embryo Transfer / Q000009:adverse effects / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Assisted reproductive technology; elective single-embryo transfer; in vitro fertilization; multiple pregnancy