Impact of patient preference on rate of double embryo transfer and resultant twin gestation

Abstract

Significant strides have been made in the United States to encourage single embryo transfer and minimize the occurrence and resultant risks associated with twin gestations. While the medical community has recognized the need for refinement and demonstrated the success of single embryo transfer, patient choice and education remains a significant factor in reproductive medicine and resultant obstetrical outcomes. This study aims to assess the impact of patient choice on number of embryo transfer and resultant twin gestation. Patients undergoing in vitro fertilization (IVF) between 2013 and 2016 at Mayo Clinic, Rochester were reviewed. Patients under 35 who received a double embryo transfer, which resulted in a twin pregnancy, were included in this review. The embryo transfer consent forms and transfer reports were reviewed. The planned number of embryos transferred, actual number of embryos transferred and embryo grade were assessed. Consent forms for number of embryos to transfer are signed prior to starting an IVF cycle. Our practice is to encourage good prognosis patients to consent to transfer 1-2 embryos, allowing the final decision on whether to transfer one or two embryos to be made by the embryology and physician team after assessment of embryo quality on day of transfer. If grade A blastocysts are in culture, a single embryo is transferred. Subsequent clinical pregnancy rate, including number of fetal heart beats, was calculated. 129 fresh and 75 frozen cycles were analyzed. In patients undergoing fresh double embryo transfers who were less than 30, there was a 55% clinical pregnancy rate and a 42% twin rate. In patients between age 30 and 35, there was a 50% clinical pregnancy rate with a 40% twin rate. 28 fresh double embryo transfers resulted in twin pregnancies. Among these, 21 (75%) had requested the transfer of 2 day 5 embryos despite our recommendations. Seven patients (25%) had requested the transfer of 1-2 day 5 embryos. In patients undergoing frozen double embryo transfers who were less than 30, there was a 67% clinical pregnancy rate and 0% twin rate. Patients aged 30-35 who underwent frozen double embryo transfer had a 44% clinical pregnancy rate and 46% twin rate. 13 frozen double embryo transfers resulted in twin pregnancies. Among these, 11 (85%) had requested the transfer of 2 day 5 embryos despite our recommendations and 2 (15%) patients had requested the transfer of 1-2 embryos. The majority of twin pregnancies that occur after IVF from good prognosis patients are from patients who request that two embryos are transferred despite our recommendations to consider single embryo transfer. This observational study identifies the significant impact of patient choice on number of embryos transferred and resultant rates of multiple gestations.