Abstract
For the purpose of reducing maternal and neonatal morbidity, elective single transfer (eSET) in in vitro fertilization (IVF) was first proposed in 1999. The purpose of this review is to summarize recent oral debate between a proponent and an opponent of expanded eSET utilization in an attempt to determine whether a blanket eSET policy, as is increasingly considered, is defensible. While eSET is preferable when possible, and agreed upon by provider and patient, selective double embryo transfer (DET) must be seriously entertained if deemed more appropriate or is desired by the patient. Patient autonomy, let alone prolonged infertility and advancing age, demand nothing less. Importantly, IVF-generated twins represent only 15.7% of the national twin birth rate in the United States. Non-IVF fertility treatments have been identified as the main cause of all multiple births for quite some time. However, educational and regulatory efforts over the last decade, paradoxically, have exclusively only been directed at the practice of IVF, although IVF patient populations are rapidly aging. It is difficult to understand why non-IVF fertility treatments, usually applied to younger women, have so far escaped attention. This debate on eSET utilization in association with IVF may contribute to a redirection of priorities.
Highlights
Elective single embryo transfer was first proposed in 1999 by Finnish investigators with the argument that twin pregnancies increase maternal and neonatal risks to offspring in association with fertility treatments and should be avoided.[1]
Assuming this to be the case, and in full appreciation of the previously noted twin birth rate high of 33.9 per 1,000 live births, one has to wonder about the concentration on in vitro fertilization (IVF)-generated twins by the medical profession, insurance companies, and government agencies, when IVF-generated twins represent only 15.7% of the national twin birth rate.[23]
With prevention of naturally conceived twins impossible, and IVF contributing so little, it appears time to concentrate on the primary culprit in a large majority of fertility treatment-related twin pregnancies and in higher-order multiple pregnancies
Summary
Elective single embryo transfer (eSET) was first proposed in 1999 by Finnish investigators with the argument that twin pregnancies increase maternal and neonatal risks to offspring in association with fertility treatments and should be avoided.[1]. A full-length report has yet to be published, though an abbreviated summary appeared in Fertility Sterility in 2014 strongly encouraging expanded use of eSET.[6] Additional publications saw press in support of this policy.[7,8] A preliminary draft of the final report, circulated among members of an advisory expert panel the Hastings Center had gathered in a two-day symposium, offered, a more subtle assessment, and was more reflective of some opinions opposed to the expanded utilization of eSET.[7]
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