Elective Single Embryo Transfer Following In Vitro Fertilization / Clinical Practice Guidelines | SOGC

Elective Single Embryo Transfer Following In Vitro Fertilization

APRIL JOGC AVRIL 2010 363
JOINT SOGC–CFAS CLINICAL PRACTICE GUIDELINE
No. 241, April 2010

This clinical practice guideline has been prepared by the Joint Society of Obstetricians and Gynaecologist of Canada–Canadian Fertility and Andrology Society Clinical Practice Guidelines Committee, reviewed by the Reproductive Endocrinology and Infertility Committee of the SOGC and the IVF Directors Special Interest Group of the CFAS, and approved by the Executive and Council of the Society of Obstetricians and Gynaecologists of Canada and the Board of the Canadian Fertility and Andrology Society.

PRINCIPAL AUTHORS
Jason K. Min, MD, Ottawa ON
Ed Hughes, MD, Hamilton ON
David Young, MD, Halifax NS
JOINT SOGC-CFAS

CLINICAL PRACTICE GUIDELINES COMMITTEE
Matt Gysler, MD (Co-Chair), Mississauga ON
Robert Hemmings, MD (Co-Chair), Montreal QC
Anthony P. Cheung, MD, Vancouver BC
Gwendolyn J. Goodrow, MD, Cambridge ON
Ed Hughes, MD, Hamilton ON
Jason Min, MD, Ottawa ON
Vyta Senikas, MD, Ottawa ON
Benjamin Chee-Man Wong, MD, Calgary AB
David Young, MD, Halifax NS

REPRODUCTIVE ENDOCRINOLOGY AND INFERTILITY COMMITTEE
Anthony Cheung, MD (Chair), Vancouver BC
Sony Sierra, MD (Co-Chair), Toronto ON
Belina Carranza-Mamane, MD, Sherbrooke QC
Allison Case, MD, Saskatoon SK
Cathy Dwyer, RN, Toronto ON
James Graham, MD, Calgary AB
Jon Havelock, MD, Burnaby BC
Robert Hemmings, MD, Montreal QC
Francis Lee MD, Winnipeg MB
Kim Liu MD, Toronto ON
Tannys Vause, MD, Ottawa ON
Benjamin Chee-Man Wong, MD, Calgary AB
Disclosure statements have been received from all members of the committees.

Abstract

Objective: To review the effect of elective single embryo transfer (eSET) compared with double embryo transfer (DET) following in vitro fertilization (IVF), and to provide guidelines on the use of eSET in order to optimize live birth rates and minimize twin pregnancies.

Options: Rates of live birth, clinical pregnancy, and multiple pregnancy following eSET and DET are compared.

Outcomes: Live birth, clinical pregnancy, and multiple pregnancy rates, and cost-effectiveness.

Evidence: Published literature was retrieved through searches of PubMed, Medline, and The Cochrane Library in 2009, using appropriate controlled vocabulary (e.g., elective single embryo transfer) and key words (e.g., embryo transfer, in vitro fertilization, intracytoplasmic sperm injection, assisted reproductive technologies, blastocyst, and multiple pregnancy). Results were restricted to English language systematic reviews, randomized controlled trials/controlled clinical trials, and observational studies.

There were no date restrictions. Searches were updated on a regular basis and incorporated in the guideline to November 2009.

Additional references were identified through searches of bibliographies of identified articles and international medical specialty societies. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical
practice guideline collections, clinical trial registries, and national and international medical specialty societies.

Values: Available evidence was reviewed by the Joint Society of Obstetricians and Gynaecologist of Canada–Canadian Fertility and Andrology Society Clinical Practice Guidelines Committee and the Reproductive Endocrinology and Infertility Committee of the Society of Obstetricians and Gynaecologists of Canada, and was qualified using the evaluation of evidence criteria outlined in the report of the Canadian Task Force on Preventive Health Care.

Benefits, Harms, and Costs: This guideline is intended to minimize the occurrence of twin gestations while maintaining acceptable overall live birth rates following IVF-ET.

Summary Statements
1. Indiscriminate application of eSET in populations with less than optimal prognosis for live birth will result in a significant reduction in effectiveness compared with DET. (I)

2. In women aged 38 years and over, eSET may result in a significant reduction in live birth rate compared with DET. (II-2)

3. Selective application of eSET in a small group of good-prognosis patients may be effective in reducing the overall multiple rate of an entire IVF population. (II-3)
4. Given the high costs of treatment, uptake of eSET would be enhanced by public funding of IVF treatment. (II-2)

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