Single-embryo transfer reduces clinical pregnancy rates and live births in fresh IVF and Intracytoplasmic Sperm Injection (ICSI) cycles: a meta-analysis

<p>Abstract</p> <p>Background</p> <p>It has become an accepted procedure to transfer more than one embryo to the patient to achieve acceptable ongoing pregnancy rates. However, transfers of more than a single embryo increase the probability of establishing a multiple gestation. Single-embryo transfer can minimize twin pregnancies but may also lower live birth rates. This meta-analysis aimed to compare current data on single-embryo versus double-embryo transfer in fresh IVF/ICSI cycles with respect to implantation, ongoing pregnancy and live birth rates.</p> <p>Methods</p> <p>Search strategies included on-line surveys of databases from 1995 to 2008. Data management and analysis were conducted using the Stats Direct statistical software. The fixed-effect model was used for odds ratio (OR). Fixed-effect effectiveness was evaluated by the Mantel Haenszel method. Seven trials fulfilled the inclusion criteria.</p> <p>Results</p> <p>When pooling results under the fixed-effect model, the implantation rate was not significantly different between double-embryo transfer (34.5%) and single-embryo transfer group (34.7%) (<it>P </it>= 0.96; OR = 0.99, 95% CI 0.78, 1.25). On the other hand, double-embryo transfer produced a statistically significantly higher ongoing clinical pregnancy rate (44.5%) than single-embryo transfer (28.3%) (<it>P </it>< 0.0001; OR:2.06, 95% CI = 1.64,2.60). At the same time, pooling results presented a significantly higher live birth rate when double-embryo transfer (42.5%) (P < 0.001; OR: 1.87, 95% CI = 1.44,2.42) was compared with single-embryo transfer (28.4%).</p> <p>Conclusion</p> <p>Meta-analysis with 95% confidence showed that, despite similar implantation rates, fresh double-embryo transfer had a 1.64 to 2.60 times greater ongoing pregnancy rate and 1.44 to 2.42 times greater live birth rate than single-embryo transfer in a population suitable for ART treatment.</p

Long term costs and effects of reducing the number of twin pregnancies in IVF by single embryo transfer: the TwinSing study

Contains fulltext : 87274.pdf (publisher's version ) (Open Access)BACKGROUND: Pregnancies induced by in vitro fertilisation (IVF) often result in twin gestations, which are associated with both maternal and perinatal complications. An effective way to reduce the number of IVF twin pregnancies is to decrease the number of embryos transferred from two to one. The interpretation of current studies is limited because they used live birth as outcome measure and because they applied limited time horizons. So far, research on long-term outcomes of IVF twins and singletons is scarce and inconclusive. The objective of this study is to investigate the short (1-year) and long-term (5 and 18-year) costs and health outcomes of IVF singleton and twin children and to consider these in estimating the cost-effectiveness of single embryo transfer compared with double embryo transfer, from a societal and a healthcare perspective. METHODS/DESIGN: A multi-centre cohort study will be performed, in which IVF singletons and IVF twin children born between 2003 and 2005 of whom parents received IVF treatment in one of the five participating Dutch IVF centres, will be compared. Data collection will focus on children at risk of health problems and children in whom health problems actually occurred. First year of life data will be collected in approximately 1,278 children (619 singletons and 659 twin children). Data up to the fifth year of life will be collected in approximately 488 children (200 singletons and 288 twin children). Outcome measures are health status, health-related quality of life and costs. Data will be obtained from hospital information systems, a parent questionnaire and existing registries. Furthermore, a prognostic model will be developed that reflects the short and long-term costs and health outcomes of IVF singleton and twin children. This model will be linked to a Markov model of the short-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies to enable the calculation of the long-term cost-effectiveness. DISCUSSION: This is, to our knowledge, the first study that investigates the long-term costs and health outcomes of IVF singleton and twin children and the long-term cost-effectiveness of single embryo transfer strategies versus double embryo transfer strategies

Contribution of cryopreservation in a mandatory SET policy: analysis of 5 years of application of law in an academic IVF center.

To analyse treatment outcomes after SET law enforcement and to evaluate the contribution of cryopreservation in a SET policy.Journal ArticleSCOPUS: cp.jinfo:eu-repo/semantics/publishe

Injeção intracitoplasmática de espermatozóides: questões éticas e legais Intracytoplasmatic sperm injection: ethical and legal questions

O presente trabalho enfoca a técnica da fertilização in vitro por meio de injeção intracitoplasmática de espermatozóide (ICSI), abordando seus aspectos técnicos, bem como, questões éticas e legais que permeiam tal prática. Essa técnica se diferencia das demais por corresponder à injeção de um único espermatozóide vivo no citoplasma do ovócito, sendo uma das principais alternativas atuais para a infertilidade masculina, principalmente nos casais em que o homem tem uma diminuição significativa na quantidade ou na motilidade dos espermatozóides. Vale ressaltar, que as técnicas de reprodução assistida vêm se desenvolvendo rapidamente, dando ensejo a questões polêmicas, como as relativas ao início da vida embrionária e à manipulação genética, o que implica que se deve refletir sobre este assunto, levando-se em consideração os limites éticos. Nesse sentido, é preciso, urgentemente regulamentar o tema, mesmo com os progressos alcançados pelo novo Código Civil e pela Lei de Biossegurança.<br>This article focuses on the in vitro fertilization technique that uses intracytoplasmatic sperm injection and addresses both the technical and ethical and legal aspects of this. This technique differs from others as it involves the injection of a single live sperm into the cytoplasm of the oocyte and is one of the principal alternative treatments for male infertility, mainly for couples where the man has a significantly reduced sperm-count or sperm-mobility. It is worth pointing out that rapid advances are being made in assisted reproduction and this has given rise to controversial issues relating to the beginning of embryonic life and genetic manipulation. It is thus important to reflect on this subject and consider where ethical boundaries lie. There is therefore urgent need for regulation in this area, despite the advances already achieved by the new Civil Code and Biosafety Law