Can An Educational DVD Improve The Acceptability Of Elective Single Embryo Transfer? A Randomized Controlled Study

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A number of studies have clearly demonstrated that single embryo transfer (SET) can significantly reduce the incidence of twins without affecting cumulative live birth rates per couple. Use of SET, however, is associated with a small reduction in pregnancies per treatment cycle that appears to contribute to the reluctance of couples to pursue elective SET (eSET). Previous studies suggest that although most couples given a brochure and extended counseling have improved knowledge of the risks of multiple pregnancies, they fail to appreciate the importance of reducing the number of embryos transferred. Because current methods of educating patients on this issue have been unsuccessful, it is clear that a novel approach to influence patient attitudes is required. This randomized controlled trial compared the effectiveness of an educational DVD with that of an educational brochure in changing patient attitudes toward eSET. The DVD and the brochure presented identical information on the outcomes and risks of twin pregnancies conceived after eSET versus eDET (elective double embryo transfer). Both decisional aids were provided to new couples starting their first cycle of in vitro fertilization at a private Australian clinic in 2007. A total of 131 couples were randomized to either the brochure group (standard counseling plus a brochure, n = 67) or the DVD group (standard counseling plus a DVD, n = 64). In the DVD, interviews were conducted both with health professionals who discussed risks of multiple pregnancies and with mothers who had experienced either uncomplicated or complicated twin pregnancies. The primary study outcome measure was the proportion of patients preferring eSET after exposure to the brochure or DVD. The fertility history and demographics were similar in the brochure and DVD groups. Both groups showed significantly improved knowledge of the dependence of pregnancy and twin rates on the number of embryos transferred. However, there was greater acceptability of eSET among patients in the DVD group after intervention (DVD group: 82.6% (76/92) versus brochure group: 66.7% (68/102; P = 0.014). Patients initially undecided on the number of embryos to transfer were significantly more likely to prefer eSET (DVD group: 86% vs. brochure group: 42.3%; P = 0.0003). These findings show that provision of an educational DVD achieves greater acceptance and preference of eSET among patients compared with the use of a brochure and suggest that the use of the DVD may be a more effective method for delivering health-risk information to couples commencing in vitro fertilization.