ELECTIVE SINGLE EMBRYO TRANSFER (ESET) – Victory Reproductive Care
 

Embryo Transfer

Embryo transfer is done at the clinic in a very calm setting. The current recommendation is to consider first freezing embryos and then transferring the embryos into the patient as this improves success rates and results in a safer pregnancy, with less complications. However, in some cases embryos can be transferred fresh, such as when frozen embryo transfers have previously failed, or with natural IVF cycles. takes place two to six days after egg retrieval.

On the day of egg retrieval or several weeks prior to the time of embryo transfer, your doctor might recommend that you begin taking estrogen and progesterone supplements to make the lining of your uterus more receptive to implantation. Your doctor will work with you to determine which medications to use and when to use them.

The procedure is usually painless, although you might experience mild cramping. A speculum is first placed into the vagina and the cervix visualized. The cervix is then cleared of all mucous and an outer catheter is placed into the cervix. A syringe containing one or more embryos suspended in a small amount of fluid is attached to the end of the catheter. Using the syringe, the embryologist places the embryo or embryos into your uterus under careful ultrasound guidance. If successful, an embryo will implant in the lining of your uterus within 24 hours of transfer.

AFTER THE EMBRYO TRANSFER

After the embryo transfer, you can resume your normal daily activities. In general, we advise that you avoid extremes of stress, exertion, heat, or cold. We want you to find ways to minimize your stress as much as possible, so do whatever will result in the least amount of anxiety or concern.

RESULTS

About 12 days to two weeks after embryo transfer, your doctor will test a sample of your blood to detect whether you're pregnant. If you're pregnant, we will take care of you at VRC, or refer you to any specialist that you wish to see for your pregnancy. If you're not pregnant, you'll stop taking progesterone and likely get your period within a week. If you don't get your period or you have unusual bleeding, contact your doctor. If you're interested in attempting another cycle of in vitro fertilization (IVF), your doctor might suggest steps you can take to improve your chances of getting pregnant through IVF. The chances of giving birth to a healthy baby after using IVF depend on various factors, including:

Maternal age. The younger you are, the more likely you are to get pregnant and give birth to a healthy baby using your own eggs during IVF.

Women age 41 and older are often counseled to consider using donor eggs during IVF to increase the chances of success.

Embryo status. Transfer of embryos that are more developed is associated with higher pregnancy rates compared with less developed embryos (day two or three). However, not all embryos survive the development process. Talk with your doctor or other care provider about your specific situation.

Reproductive history. Women who've previously given birth are more likely to be able to get pregnant using IVF than are women who've never given birth. Success rates are lower for women who've previously used IVF multiple times but didn't get pregnant. Cause of infertility. Having a normal supply of eggs increases your chances of being able to get pregnant using IVF. Women who have severe endometriosis are less likely to be able to get pregnant using IVF than are women who have unexplained infertility.

Lifestyle factors. Women who smoke typically have fewer eggs retrieved during IVF and may miscarry more often. Smoking can lower a woman's chance of success using IVF by 80 percent. Obesity can decrease your chances of getting pregnant and having a baby. Use of alcohol, recreational drugs, excessive caffeine and certain medications also can be harmful. Talk with your doctor about any factors that apply to you and how they may affect your chances of a successful pregnancy.
DECIDING HOW MANY EMBRYOS TO TRANSFER
Many are familiar with the phrase, “To be or not to be—that is the question.” Though this sentiment originally appeared in William Shakespeare’s Hamlet, it is now an expression for situations in which there are difficult choices to make. One such situation that we experience regularly at Victory Reproductive Care is the patient’s decision regarding how many embryos to transfer during an in vitro fertilization (IVF) cycle. There was a time when IVF technology was in its infancy and fertility specialists routinely transferred multiple embryos, largely due to the uncertain ability of the individual embryos to implant. The outcome of this practice, when implantation did occur, was a significant increase in the conception of twins, triplets, and even higher-order pregnancies. Today, with improved clinical and embryology techniques, when transferring embryos in patients with a good prognosis for success, the rate of twins goes up to 43 percent among those receiving two blastocyst embryos (2BET). This is compared to 1 percent among those receiving a single embryo (this is the result of one embryo splitting, also known as natural twinning). This represents a 20-plus fold increase in the rate of twins. Similarly, the rate of triplets among patients doing a single embryo transfer is 0 percent and, because of natural splitting, goes up to 1 to 2 percent among the group receiving 2BET. Thus, when transferring two embryos, one of the embryos (and less frequently both embryos) can split to produce identical twins. This rate represents more than a 100-fold increase when compared to single embryo transfer.
THE GROWTH OF ESET
Over time, data have shown increased health risks associated with multiple pregnancies. With experience, careful observations of outcomes, and improvements in embryo culture techniques, elective single embryo transfer (eSET) has become a very good option for patients. Patients can now have a healthy singleton pregnancy—removing the risks commonly associated with multiple pregnancies—and their chances for success remain very similar. Despite the success of eSET, however, there remains a lot of hesitancy on this issue, which we hope we can alleviate here. The American Society for Reproductive Medicine (ASRM) has published transfer guidelines based on a variety of factors, including the: Age of the female partner (younger than 35 years old to older than 40 years old) Clinical outlook for a successful outcome (favorable and unfavorable) Developmental stage of the embryo (day 5 to 6 at the blastocyst stage) ASRM bases its recommendations, which include groups of patients for which physicians recommend eSET, on the best available national evidence. Since their publication, numerous other studies have supported these same findings. It’s no surprise that the majority of reputable fertility centers in the United States adhere to these guidelines, which intend to maximize success and minimize the incidence of pregnancies with multiple conceptions and their potential complications. Based on our own clinical excellence and published data, Victory Reproductive Care not only supports the ASRM guidelines, but we also have our own recommendations for patients beyond the ASRM, due to our higher rates of embryo implantation and success. Among couples being treated with IVF, there are many excellent candidates for eSET that we can identify before and/or as their treatment progresses. These patients are usually younger than 38 years old, going through their first IVF treatment cycle, or have had a pregnancy in a previous IVF cycle. They also may have one or more top-quality embryos (usually blastocysts) available for transfer, or those patients using donor eggs. We’ve found that the pregnancy rate after an embryo transfer is similar if we transfer one embryo (eSET) or two embryos (2BET). These success rates are incredibly important in light of the risks associated with multiple pregnancies.
RISKS INVOLVED IN MULTIPLE PREGNANCIES
The higher the rate of multiple pregnancies (twins, triplets, etc.), the greater the frequency and severity of risk for both the mother and the babies. The increase in risk translates into higher rates of complications for the mothers, including miscarriages, bleeding, bed rest, and obstetrical complications (such as gestational diabetes or pregnancy-induced hypertension) and the need for more cesarean sections. The babies in multiple pregnancies can also be adversely affected by smaller sizes, growth of one twin at the expense of the other (twin-twin transfusion syndrome), premature delivery, need for intensive care after birth, developmental disabilities, cerebral palsy, and even increased mortality rates. Therefore, for those patients who meet the recommended guidelines for eSET, the only difference in transferring one or two embryos is an increased risk for the mother and the child(ren). This situation then raises the question: Why not opt for an eSET when such an option is present? For some patients who have been trying for a long time without success, their hope is that transferring more embryos will increase pregnancy rates. As mentioned previously, however, this is not accurate since eSET provides very similar success rates as transferring multiple embryos, but without the many risks associated with multiple pregnancies. For some patients, a single embryo transfer might be medically necessary (i.e., not a matter of patient choice or preference). But for others at Victory Reproductive Care, they can choose to transfer two embryos—but this decision should follow a discussion of the advantages and disadvantages of each option with their physician based on the data and the risks above. Victory Reproductive Care is proud to acknowledge that the rate of patients selecting eSET in our practice is among the highest in the nation, thereby lowering risks to patients and their offspring without significantly compromising success. Based on solid data collected from thousands of treatment cycles over many years of experience at Victory Reproductive Care—and confirmed by many other studies in the United States and Canada —when one faces a choice between eSET or multiple embryo transfers, the best and safest answer is often eSET.