Elective single embryo transfer trends and predictors of a good perinatal outcome United States 1999 to 2010

Capsule:
Elective single ET in the United States increased from 1999–2010. One-third of elective single ET among 35–37-year-olds resulted in a good perinatal outcome; transfer guidelines could be expanded.

Authors:
Marissa L. Steinberg, B.A., Sheree Boulet, Dr.P.H., Dmitry Kissin, M.D., M.P.H., Lee Warner, Ph.D., M.P.H., Denise J. Jamieson, M.D., M.P.H.

Volume 99, Issue 7, Pages 1937-1943, June 2013

Abstract:

Objective:
To assess trends in elective single 27 embryo transfer (eSET), and identify factors associated with a good perinatal outcome.

Design:
Retrospective cohort study.

Setting:
Clinic-based data.

Patient(s):
A total of 886,686 fresh, non-donor cycles reported to the National Assisted Reproductive Technology Surveillance System (NASS) during 1999–2010, of which 17,166 met criteria for eSET.

Intervention(s):
None.

Main Outcome Measure(s):
Rates of eSET and good perinatal outcome (term, singleton infant with normal birth weight).

Result(s):
In 2010, eSET comprised 5.6% of all fresh transfers, representing an 8-fold increase since publication of first guidelines recommending eSET in 2004. Compared with other embryo transfers, eSET were nearly twice as likely to result in a good perinatal outcome (37.1% vs. 18.9%, respectively). Among women using eSET, those aged <35 and 35–37 had a good perinatal outcome (40.2% and 32.5%, respectively). In multivariable, log-binomial analyses, factors positively associated with a good perinatal outcome included: male factor infertility, day 5 embryo transfer, and having ≥3 supernumerary embryos for cryopreservation.

Conclusions:
Between 1999 and 2010, national rates of eSET increased. Given the frequency of good perinatal outcomes among women aged 35–37, guidelines for eSET could be expanded to include patients in this age group with favorable prognoses.

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