1) Elective single embryo transfer (eSET) can reduce the incidence of multiple pregnancies and their associated risks without decreasing overall pregnancy rates. A Danish study found the twinning rate dropped from 30% to 14% with increased eSET. 2) Assisted reproduction is associated with higher rates of low birthweight and preterm births due primarily to higher multiple gestation rates. Single embryo transfer can help address this issue. 3) While neonatal outcomes are generally worse for assisted reproduction twins compared to naturally conceived twins, outcomes appear comparable between IVF/ICSI and non-IVF/ICSI twins when accounting for low birthweight and preterm births. Increased application of single embryo transfer could further reduce risks

2. Assisted Reproduction and
how it affects fetal
Morbidity & Mortality
ELDEEB M.W , MANSY A.,
HARFOSH GH.,
DARWISH Y., MOHSEN E.
FOUDA E .

3. Effect of Single Embryo Transfer
on Pregnancy outcome
• One of the most problematic issues of
assisted reproduction is the high
incidence of multiple pregnancies,
resulting from transfer of more than
one embryo.
• Young women who have good quality
embryos are particularly at risk .

4. • The only strategy to reduce the
incidence of multiple pregnancies
“including twin pregnancies” after
assisted reproduction is elective single
embryo transfer (eSET).
• A 5 years appraisal study conducted in
Denmark showed that the proportion
of eSET increased from 1.5% (1997-
1998) to 17.5% (1999-2002) of all
transfers & in 2002, 20% of all transfer
were SET.

5. • Comparing these two periods, the
overall pregnancy rate of 35 and
34% per transfer, respectively, was
obtained, while the overall twinning
rate dropped from 30 to 21%.
• In 2002 The twinning rate dropped
to 14%.

6. These results showed that
a decline in the twinning
rate is feasible without a
drop in overall pregnancy
rates.

7. • A review considers the value of single
embryo transfer (SET) to prevent
multiple pregnancies (MP) after IVF/ICSI.
• The incidence of MP (twins and higher
order pregnancies) after IVF/ICSI is much
higher (∼30%) than after natural
conception (∼1%).
• Approximately half of all neonates are
multiples.

8. • neonatal and long-term consequences
for the health of these children are
enormous and costs are extremely
high.

9. Experience with SET
remains largely European
although the need to
reduce MP is accepted
worldwide.

10. • Embryo selection is performed using
one or more of embryo
characteristics.

11. ● Available evidence suggests that, for
the overall population, day 3 and day 5
selection yield similar results but better
than day 2 selection results.

12. Effect of ART on Fetal Birth Weight
• The increased risk of low birth weight
associated with the use of ART has
been attributed largely to the higher
rate of multiple gestations.

13. • A study conducted in USA comparing 42.463
infants born by ART to 3.389.098 infants born
spontaneously.

14. • The study concluded that:
–The use of ART is associated with a
significant number of low-birth-weight
and very-low-birth-weight infants, in
part because of :
1) Absolute increases in multiple
gestations
2) higher rates of low birth weight among
singleton infants conceived with ART.

15. Neonatal Outcomes & Congenital
Anomalies Among ART
• Neonatal problems after IVF is worse than in the
general population with similar maternal age,
parity and social standing, mainly due to the
large proportion of multifetal births after IVF.
• The higher prevalence of heart malformations
dose not solely arise from multiplicity but from
other causes.
• in order to improve neonatal outcome after IVF,
the number of embryos transferred should be
limited to a minimum.

16. Limited data on neonatal
outcome in IVF/ICSI
twins are available in the
literature.

17. • In Denmark, one‐third of twin
pregnancies are the result of
IVF/ICSI treatment.
• A study conducted comparing 80
children conceived via ICSI and
450 children conceived via IVF.

18. • The Mean gestational age was
significantly lower in the ICSI group
(p=0.001).
• After ICSI, the birth weight
(p=0.008) and mean APGAR values
after 1 minutes and after 10
minutes were lower compared to
that of the IVF group (p=0.016 &
p=0.047, respectively).

19. • Moreover, ICSI-conceived children
had to be hospitalized more often at
a neonatal intensive care unit
(p=0.004).
• There was no difference in pH of
umbilical artery or in major
congenital malformations between
the two groups.

20. • A study was conducted on neonatal
morbidity and mortality in twin
including 3438 (3393 live‐born) IVF/ICSI
and 10362 (10239 live‐born)
non‐IVF/ICSI twins born between 1995
and 2000.
• Despite increased low birth weight and
more NICU admissions among IVF/ICSI
twins, neonatal outcome in IVF/ICSI
twins seems to be comparable with that
of non‐IVF/ICSI twins.

23. IFC Pregnancy rate per year
%PregnancyTotal CasesYear
31.8%421322005
41.2%801942006
34.2%892602007
43.9%1323012008
41.7%1283072009
44.7%1834092010
49.9%2324652011
48.9%2725562012
49.1%2334752013

24. 0
100
200
300
400
500
600
2005 2006 2007 2008 2009 2010 2011 2012 2013
Total Cases
Pregnancy
%

25. IFC Fetal Reduction Cases
Fetal Reduction Cases
432010
362011
492012
242013

26. Conclusion
• Single embryo transfer (SET) is
associated with lower
perinatal morbidity &
mortality.

27. • The application of SET should be
supported by other measures:
1. Reimbursement of IVF/ICSI (earned
back by reducing costs),
2. Optimized cryopreservation to
augment cumulative pregnancy rates
per oocyte retrieval
3. Standardized format for reporting
results.

28. • To make SET the standard of care in the
appropriate target group, there is a
need for:
1. More clinical studies,
2. Intensive counselling of patients,
3. Increased sense of responsibility in
patients,
4. Health care providers
5. Health insurers.