Safety Versus Success In Elective Single Embryo Transfer: Women's Preferences For Outcomes Of In Vitro Fertilisation

Main Category: Fertility
Also Included In: Women's Health / Gynecology;  Pregnancy / Obstetrics
Article Date: 31 Jul 2007 - 4:00 PDT

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New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology (BJOG) will reveal that some women waiting for in-vitro fertilisation (IVF) treatment would prefer to give birth to a child with chronic disability associated with a multiple birth due to double embryo transfer, than opt for safer single embryo transfer because they believe their chances of success are reduced.

Researchers at the University of Aberdeen looked at safety versus success in elective single embryo transfer, with a focus on women's preferences for the outcomes of IVF.

They discovered that the prospect of experiencing a live birth is of utmost importance to some women with fertility problems and risks to potential offspring may be given less weight when making decisions regarding treatment.

The study took place at Aberdeen Fertility Centre from November 2004 until March 2006 and included 74 women who were due to start IVF treatment. The participants' preferences were tested when faced with six different birth scenarios: giving birth to a child with physical impairments; giving birth to a child with cognitive impairments; giving birth to a child with visual impairments; experiencing perinatal death; premature birth; and treatment failure where all treatment was unsuccessful and there was no pregnancy for the duration of the woman's life.

Results showed that the majority of participants (54/68) valued giving birth to a child with a chronic disability higher than never giving birth at all.

The traditional practice of transferring two or more embryos during IVF treatment has lead to a 20-fold increased risk of twins and a 400-fold increase in the risk of triplets or more. This is of concern because twin pregnancies are associated with increased complications and mortality for both mother and child, as well as increased costs to the health service.

Judicious use of elective single embryo transfer in couples at risk of twins is an effective method for reducing twin pregnancies from IVF. Some prospective parents see this as a less successful option than double embryo transfer and many are unwilling to undergo multiple attempts at replacing a single embryo at a time in order to provide comparable success rates.

In some parts of the UK, once a couple has experienced successful IVF, they are no longer eligible for further NHS funding and therefore have a preference for twins as a chance to have more than one child.

The study highlights the need for medical professionals and clinics to improve patient information about the risks associated with twin pregnancy and to reassure couples that single embryo transfer does not compromise their overall chances of having a child.

Lead researcher, Graham. S. Scotland, Research Fellow, University of Aberdeen said: "Our results suggest that, at the present time, information on the risks associated with twin pregnancy may not be enough to deter some women in the UK from choosing double embryo transfer, given their perception that it will improve their chance of a live birth."

"A more appropriate way to minimise risks without risking poor outcomes would be to encourage uptake of single embryo transfer in a climate which permits a greater number of funded treatments to couples".

Professor Philip Steer, BJOG editor-in-chief, said: "Today a growing proportion of women conceive via assisted reproduction, yet there is limited appreciation amongst the general population regarding the risks involved in multiple births for both mother and child. This study reveals that a significant number of prospective parents value the experience of parenthood ahead of the risk of significant disability to their child."

"The results offer an opportunity to look at the information being disseminated to those undergoing IVF treatment regarding the potential risks of double embryo transfer, as well as reassuring them that their chances of success are not significantly reduced by single embryo transfer."

BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Blackwell Publishing. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote 'BJOG' or 'BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal.

Reference

Scotland G, McNamee P, Peddie V, Bhattacharya S. Safety versus success in elective single embryo transfer: women's preferences for outcomes of in vitro fertilisation. BJOG 2007; DOI: 10.1111/j.1471-0528.2007.01396.x.

Royal College of Obstetricians and Gynaecologists