Abstract
Objective: This study aimed to evaluate the effectiveness of elective single embryo transfer (eSET) versus double embryo transfer (DET) in frozen embryo transfer cycles following in vitro fertilization (IVF) treatment in good prognosis patients. The outcome would provide medical data for the multiple pregnancy rate reduction in IVF treatment.
 Methods: This multicenter retrospective cohort study was performed in patients undergoing the first frozen embryo transfer (FET) cycles at IVF centers which belonged to the IVFMD Group, Vietnam, from January 2018 to May 2020. Patients were divided into four groups, based on the number of embryos transferred, as follows: Group 1: one good quality day-3 embryo (eSET D3), Group 2: one good quality day-5 embryo (eSET D5), Group 3: two good quality day-3 embryos (DET D3), and Group 4: two good quality day-5 embryos (DET D5). The primary outcome of the study was live birth rates (LBR) after the first FET. Secondary outcomes were also analyzed, including pregnancy outcomes (β-hCG positive, clinical pregnancy, miscarriage < 12 weeks, ongoing pregnancy 12 weeks, miscarriage < 20 weeks, and multiple birth rates [MBR]), as well as neonatal outcomes (birth weight and gestational age at birth).
 Results: There were 819 patients, of which 819 FET cycles were analyzed, including 132 eSET D3, 278 eSET D5, 140 DET D3, and 269 DET D5. LBR and MBR values were significantly lower in the eSET D3 group than in the DET D3 group (LBR: 22.7% vs 39.3%, p = 0.002; MBR: 3.3% vs 29.1%, p < 0.001, respectively). MBR was also significantly lower in eSET D5 compared with DET D5 (9.6% vs 38.3%, p < 0.001), while LBR was comparable between the two groups (41.4% vs 42.8%, p < 0.74). Birth weight and gestational age at birth were similar between eSET and DET, regardless of day-3 or day-5 embryo transfer.
 Conclusions: Among infertile, good prognosis women undergoing FET, the eSET significantly decreased multiple birth rates compared with double embryo transfer, while still sustaining an acceptable rate of live birth as well as pregnancy and neonatal outcomes.
Highlights
The success of an in vitro fertilization (IVF) cycle is equal to achieving the birth of a healthy baby
Objective: This study aimed to evaluate the effectiveness of elective single embryo transfer versus double embryo transfer (DET) in frozen embryo transfer cycles following in vitro fertilization (IVF) treatment among good prognosis patients
The results show that the first dose of folliclestimulating hormones (FSH) and the trigger by human chorionic gonadotropin (hCG) in the single embryo transfer (SET) group of patients were both lower than the same in the DET group (p < 0.05)
Summary
The success of an in vitro fertilization (IVF) cycle is equal to achieving the birth of a healthy baby. In addition to the improvement of LBR, the status of multiple pregnancies commonly occurred following IVF treatment, accounting for about 31 — 41% This was higher than those following natural conception, totaling around 3.4% according to the U.S Centers for Disease Control and Prevention from 2013 to 2016 2,3. Multiple pregnancies result in many consequences connected to both physical health and psychology for both the mother and child due to the higher risk of miscarriage, preterm birth, low birth weight, very low birth weight, and so on 4,5. It has been established as being necessary to ensure the safety of IVF treatment by controlling the multiple pregnancy rate. Many IVF centers all over the world have considered using eSET rather than DET in potential patients in order to reduce the multiple pregnancy rate 7–13. eSET was first recommended in 2004 by the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) as an alternative to replace DET to reduce the multiple pregnancy rate in the transfer cycles of fresh embryos
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