Navigating the world of fertility treatments can be overwhelming, but new revisions to embryo transfer guidelines offer some clarity. Our clinic has been a frontrunner in the practice of transferring a single embryo at a time, utilizing advanced genetic testing and embryo freezing techniques for future use. In fact, we opt for single-embryo transfers in over 90% of our patients, resulting in a twin rate of just 6%. This is a stark contrast to the national average, where less than 30% of patients undergo elective single embryo transfer (eSET).
Data from 2013 indicated that clinics performing more eSETs for women under 38 experienced lower rates of multiple pregnancies without compromising birth rates. Similarly, for women aged 42 and younger, transferring one euploid blastocyst significantly decreases the odds of twins while maintaining pregnancy rates comparable to those achieved with two untested blastocysts.
While progress has been made in reducing multiple gestations, they still pose various risks such as preterm delivery and low birth weight. These serious concerns have prompted the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) to update their guidelines. They now recommend limiting embryo transfers to one euploid embryo for patients of all ages with a favorable prognosis.
Key Recommendations
- Women under 35 should strongly consider eSET.
- Those aged 35 to 37 are advised to pursue eSET.
- For patients aged 38 to 40, transferring no more than two blastocysts or three cleavage-stage embryos is recommended, with a preference for a single blastocyst if euploid embryos are available.
- Women aged 41 or 42 may transfer up to three blastocysts or four cleavage-stage embryos, yet a single-blastocyst transfer is preferred when euploid embryos are present.
- Caution is advised for women over 43 using their own eggs, as the risk of multiples rises with age.
In situations where patients have a favorable prognosis but have not conceived after several high-quality embryo transfers, it may be reasonable to consider transferring an additional embryo following a thorough discussion about the risks. Special cases, such as patients with conditions that could worsen with a multiple pregnancy, should limit transfers to one.
It’s crucial for individual clinics to adjust their practices based on their own data while striving to maintain high pregnancy rates and minimize multiple births. This approach has been a cornerstone of our practice, as we proudly embrace the eSET methodology and have consistently transferred a single embryo for many women over 40.
In summary, the revisions to embryo transfer guidelines aim to improve patient outcomes by reducing the incidence of multiple pregnancies while maintaining high success rates. For more information on fertility treatments, check out our other blog posts like this fun comparison of baby versus puppy bowl, or explore resources on treating infertility.
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