Elective single embryo transfer: A 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice
Elective single embryo transfer: A 6-year progressive implementation of 784 single blastocyst transfers and the influence of payment method on patient choice
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DOI：
10.1016/j.fertnstert.2008.09.023
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发表时间：
2009-12-01
影响因子：
6.7
通讯作者：
Graham, James R.
中科院分区：
文献类型：
--
作者：
Stillman, Robert J.;Richter, Kevin S.;Graham, James R.
目的：评估通过在6年内逐步实施选择性单胚胎移植（eSET）在选定患者中减少双胎妊娠的努力。设计：回顾性分析。设置：私人诊所IVF中心。患者：接受15，418个连续IVF-ET周期的不孕妇女。干预措施：IVF-ET，包括选择预后良好且多胎妊娠风险高的患者中的囊胚期eSET。主要结局指标：妊娠、多胎妊娠、付款方式。结果：自体eSET与双胚泡移植的妊娠率相似（65% vs. 63%），而双胎率要低得多（1% vs. 44%）。对于供体卵母细胞的受体，eSET的妊娠率略低（63%对74%），而双胞胎率低得多（2%对54%）。总体妊娠率没有下降，尽管随着时间的推移，eSET的使用急剧上升（2002年至2007年期间，所有自体移植的1.5%至8.6%，所有移植给供体卵母细胞受体的2.0%至22.5%）。总体单胎妊娠率增加，而双胎妊娠率随着时间的推移显着下降。使用eSET是显着更常见的患者与保险范围内或谁参加我们的共享风险money-back guaranteeprogram. Conclusions（S）：选择性eSET使用预后良好的患者可以显着减少双胎妊娠，而不影响妊娠率。当患者摆脱了移植多个胚胎的经济压力时，他们更有可能选择eSET。（Fertil Steril（R）2009;92：1895-906.（C）2009年由美国生殖医学协会。
Objective: To evaluate efforts to reduce twin pregnancies through progressive implementation of elective single embryo transfer (eSET) among select patients over a 6-year period.Design: Retrospective review.Setting: Private practice IVF center.Patient(s): Infertile women undergoing 15,418 consecutive IVF-ET cycles.Intervention(s): IVF-ET, including blastocyst-stage eSET among select patients with good prognosis and high risk of multiple pregnancy.Main Outcome Measure(s): Pregnancy, multiple pregnancy, method of payment.Result(s): Pregnancy rates were similar for autologous eSET versus double-blastocyst transfer (65% vs. 63%), while twin rates were much lower (1% vs. 44%). For recipients of donor oocytes, pregnancy rates were slightly lower with eSET (63% vs. 74%), while twin rates were much lower (2% vs. 54%). There was no decrease in overall pregnancy rates, despite a dramatic rise in eSET use over time (1.5% to 8.6% of all autologous transfers and 2.0% to 22.5% of all transfers to donor oocyte recipients between 2002 and 2007). Overall singleton pregnancy rates increased, while twin pregnancy rates declined significantly over time. Use of eSET was significantly more common among patients with insurance coverage or who were participating in our Shared Risk money-back guarantee program.Conclusion(s): Selective eSET use among good-prognosis patients can significantly reduce twin pregnancies without compromising pregnancy rates. Patients are more likely to choose eSET when freed from financial pressures to transfer multiple embryos. (Fertil Steril (R) 2009;92:1895-906. (C)2009 by American Society for Reproductive Medicine.)