Outcome and feasibility of elective single embryo transfer (eSET) policy for the first and second IVF/ICSI attempts

Objective: This study assesses the outcome and the feasibility of an elective single embryo transfer (eSET) policy for the first and second IVF/ICSI attempts.

Study design: This is a retrospective analysis performed on 611 couples attempting a first IVF cycle in Clermont-Ferrand University Hospital, France. eSET was offered to the couples when they had 2 embryos with at least one of good quality at day 2 for their first and second IVF/ICSI cycles.

Results: Among the couples selected for the study, 442 underwent an eSET and 341 a double embryo transfer (DET). The cumulative ongoing pregnancy rate (OPR) and the cumulative delivery rate (DR), including fresh and frozen embryo transfer, did not differ statistically between the two groups, respectively 40.7% and 30.9% in the eSET group and 42.5% and 34.6% in the DET group. The twin pregnancy rate was lower in the eSET group (0.7% vs. 21.2%; p<0.0001) and neonatal and obstetrical outcomes were better than in the DET group. For the first attempt, the global twin rate (including eSET and DET) was 7.1% and the proportion of eSET was high, 67.6%, but for the second attempt the eSET rate was only 16.9%, with an increased global twin rate of 21.4% (p=0.042).

Conclusion: In a selected population an eSET strategy decreases the twin pregnancy rate without decreasing the delivery rate, with a better outcome for the infants than DET. However, eSET is well accepted by patients only for the first attempt even though the pregnancy rate is not statistically different for the second.