Rıfat H. Gürsoy_Elective Single Embryo Transfer (eSET).ppt ...

P.O. Number Terms Rep Ship Via F.O.B. Project
Quantity Item Code Description Price Each Amount
Elective Single Embryo
Transfer (eSET);
How Much Reasonable ?
Rifat H. Gürsoy ,M.D.
Gazi University School of Medicine
Dept. Of Ob/Gyn
Reproductive Endocrinology & Infertility
Division
Ankara-TURKEY
Total

Background
•Multiple embryo tranfer during IVF has
increased multiple pregnancy rates (MPR)
causing maternal and perinatal morbidity
•Elective single embryo transfer (eSET) is
now being considered as an effective
means of reducing this iatrogenic
complications

Background
Women undergoing treatment
with IVF face to an approximately
20-fold increased risk of twins and
400-fold risk of higher order
pregnancies

Background
When compared with single
births, twins have a 4-fold
increased risk of mortality and for
triplets the risk is 6-fold higher.

The Perinatal Mortality Rate in England
(1995)
•General : 8.7 / per 1000
•IVF singletons: 8.8 / per 1000
•IVF twins :46.8 / per 1000
•IVF triplets : 82.6 / per 1000
•All IVF births: 22.6 / per 1000

Multiple Gestations
•Increased incidence of preterm births
•Handicapped infants
–Twins : 1/13
–Triplets : 1/5
•Higher malformation rates with
IVF/ICSI

Obstetric Complications of
Multiple Gestations
•Miscarriage
•Pregnancy Induced Hypertention
•Gestational Diabetes
•Premature Labour
•Abnormal Delivery
•Higher C/S indications

Economic Impact of
Multiple Gestations
•The increased cost associated
with prenatal care twin and higher
order pregnancies
•The cost of the subsequent
neonatal intensive care

Parenthood of Multiple Gestations
•Practical dificulties
•Residuel stress
•Demand of more resources
•Emotional stress

Strategies to Minimise the Multiple
Pregnancies
•Multi-fetal pregnancy reduction
(MFPR)
•Individualised embryo transfer
policy
•Blastocyst transfer
•Elective single embryo transfer

Elective Single Embryo Transfer
(eSET)
Untill recently, eSET was not an
optional in clinical practice, for
fear tahat the overall success
rates would decline , too far

Reason of This Presumption
•Published data of single embryo transfer
where only one embryo was available
•No opportunity for selection of more
suitable embryos exists
•Poor potential of the only available embryo
(around 10%)

Single Embryo Transfer
(Vilska ,1999-Finland)
PR (%)
Only 1 embryo available 20.2
After selection 29.7
eSET + 1frozen/ thawed 47.3 (CPR)

DET vs SET , LBR

DET vs SET , CPR

DET vs SET ,MPR

DET vs SET ,Abortion

DET vs SET+FZET , LBR

DET vs SET+FZET ,CPR

DET vs SET+FZET ,MPR

DET vs 2 f-SET, LBR

DET vs 2 f-SET, CPR

DET vs 2 f-SET, MPR

DET vs 2 f-SET, Abortion

DET vs TET , MPR

CONCLUSIONS-I
•In a single fresh IVF cycle, eSET is
associated with a lower LBR than DET
•There is no significant difference in CLBR
following SET+1 FZET and the LBR
following a single cycle of DET
•MPR are lowered following SET compared
with other transfer policies

Registry
• European Society of Human Reproduction &
Embryology (ESHRE)
• Australian & New Zealand Assisted Reproduction
Database (ANZARD)
• The International Committee for Monitoring Assisted
Reproductive Technology (ICMART)
• Canadian ART register
• Society of Assisted Reproductive Technology, USA
(SART)
• Human Fertilization & Embryology authority (HFEA, UK)

2.8%
69.4%
# 47 348 (20.0%) SET -Avrupa 2005 ; Sweden (69.4%), Finland (49.7%),
Belgium (48.0%), Denmark (32.6%), Slovenia (30.0%), Bulgaria (8.5%),
US 2007 (2.8%), Avustralya (56.9%), Kanada (11%), Latin Amerika (6.5%),
Japonya (54.8%)

CONCLUSIONS-II
•e-SET may be an effective policy
regarding to lower the incidence of high
order pregnancies
•But should not to be considered as the
only and the sole choice