TY - JOUR
T1 - Single-embryo transfer implies quality of care in reproductive medicine
AU - De Neubourg, Diane
AU - Dancet, Eline A F
AU - Pinborg, Anja
N1 - Copyright © 2022. Published by Elsevier Ltd.
PY - 2022/11
Y1 - 2022/11
N2 - This review appraises evidence on the difference between single- and double-embryo transfer (SET, DET) in assisted reproductive technology (ART) regarding the four healthcare quality dimensions most important to fertility patients and doctors. Regarding safety, not only does DET create the uncontested perinatal risks of twin pregnancies, but compelling evidence has added that singleton pregnancies after a vanishing twin also have poorer perinatal outcomes. SET is as effective as DET, as shown by meta-analyses of randomized controlled trials, comparing two cycles of SET versus DET and shown by cumulative live birth rates of entire ART trajectories of up to six cycles. Proposing SET, which is safer than DET and as effective, as the gold standard is not irreconcilable with patient-centred care if patients are thoroughly informed on the reasoning behind the proposition and welcomed to challenge whether it fits their personal values. The cost-efficiency of SET is clearly higher, which has even induced certain countries to start reimbursing ART on the condition that SET is used. In conclusion, SET should be the gold standard offered to all patients. The question is not whether to apply SET but how to apply it in terms of patient selection, patient-centred counselling and coverage of treatment.
AB - This review appraises evidence on the difference between single- and double-embryo transfer (SET, DET) in assisted reproductive technology (ART) regarding the four healthcare quality dimensions most important to fertility patients and doctors. Regarding safety, not only does DET create the uncontested perinatal risks of twin pregnancies, but compelling evidence has added that singleton pregnancies after a vanishing twin also have poorer perinatal outcomes. SET is as effective as DET, as shown by meta-analyses of randomized controlled trials, comparing two cycles of SET versus DET and shown by cumulative live birth rates of entire ART trajectories of up to six cycles. Proposing SET, which is safer than DET and as effective, as the gold standard is not irreconcilable with patient-centred care if patients are thoroughly informed on the reasoning behind the proposition and welcomed to challenge whether it fits their personal values. The cost-efficiency of SET is clearly higher, which has even induced certain countries to start reimbursing ART on the condition that SET is used. In conclusion, SET should be the gold standard offered to all patients. The question is not whether to apply SET but how to apply it in terms of patient selection, patient-centred counselling and coverage of treatment.
KW - DEET
KW - Embryo Transfer/methods
KW - Female
KW - Fertilization in Vitro
KW - Humans
KW - Pregnancy
KW - Pregnancy Rate
KW - Quality of Health Care
KW - Reproductive Medicine
KW - Quality
KW - Reproductive medicine
KW - Single-embryo transfer (SET)
UR - http://www.scopus.com/inward/record.url?scp=85135316132&partnerID=8YFLogxK
U2 - 10.1016/j.rbmo.2022.04.001
DO - 10.1016/j.rbmo.2022.04.001
M3 - Review
C2 - 35927209
VL - 45
SP - 899
EP - 905
JO - Reproductive BioMedicine Online
JF - Reproductive BioMedicine Online
SN - 1472-6483
IS - 5
ER -