There has been a lot of talk about SET (Single Embryo Transfer) following the birth of octuplets to the woman in California known as “Octomom.” A SET can be an elective single embryo transfer (eSET) or a medical single embryo transfer (mSET).
mSET is recommended for those patients with certain uterine abnormalities, short stature and chronic medical conditions deeming any pregnancy high risk.
eSET is being promoted by reproductive endocrinologists to reduce the incidence of multiple births.
This can be a very hard sell for physicians because patients want to get the most for their dollar. Patients associate the transfer of more embryos with higher pregnancy rates. The transfer of multiple embryos was common in the early years of IVF because of low implantation (embryo attaching to uterus) rates. IVF implantation and pregnancy rates have improved over the years. In fact, the Seattle Reproductive Medicine practice study concluded that a single blastocyst (5 day embryo) transfer can be performed in good-prognosis patients without compromising pregnancy rates and twin rates can be significantly reduced with eSET.
Most patients are unaware of the risks of multiple births. Multiple pregnancies are risky for infant and mother. A major risk for the infant is preterm delivery. The mother is at increased risk for hypertension, gestation diabetes and preeclampsia. Last month, the New York Times ran an article highlighting the trouble with twin deliveries.
In my opinion, the goal for IVF should be a singleton delivery. This can be accomplished by educating patients. Patients should consult with their physicians and decide if they would be a candidate for an eSET.
