Factors associated with the use of elective single embryo transfer and pregnancy outcomes in the United States 2004 2012

Authors:
Aaron K. Styer, M.D., Barbara Luke, Sc.D., M.P.H., Wendy Vitek, M.D., Mindy S. Christianson, M.D., Valerie L. Baker, M.D., Alicia Y. Christy, M.D., M.H.S.C.R., Alex J. Polotsky, M.D., M.Sc.

Abstract:

Objective:
To evaluate factors associated with elective single-embryo transfer (eSET) utilization and its effect on assisted reproductive technology outcomes in the United States.

Design:
Historical cohort.

Setting:
Not applicable.

Patient(s):
Fresh IVF cycles of women aged 18–37 years using autologous oocytes with either one (SET) or two (double-embryo transfer [DET]) embryos transferred and reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System between 2004 and 2012. Cycles were categorized into four groups with ([+]) or without ([−]) supernumerary embryos cryopreserved. The SET group with embryos cryopreserved was designated as eSET.

Intervention(s):
None.

Main Outcomes Measure(s):
The likelihood of eSET utilization, live birth, and singleton non–low birth weight term live birth, modeled using logistic regression. Presented as adjusted odds ratios (aORs) and 95% confidence intervals (CIs).

Result(s):
The study included 263,375 cycles (21,917 SET[−]cryopreservation, 20,996 SET[+]cryopreservation, 103,371 DET[−]cryopreservation, and 117,091 DET[+]cryopreservation). The utilization of eSET (SET[+]cryopreservation) increased from 1.8% in 2004 to 14.9% in 2012 (aOR 7.66, 95% CI 6.87–8.53) and was more likely with assisted reproductive technology insurance coverage (aOR 1.60, 95% CI 1.54–1.66), Asian race (aOR 1.26, 95% CI 1.20–1.33), uterine factor diagnosis (aOR 1.48, 95% CI 1.37–1.59), retrieval of ≥16 oocytes (aOR 2.85, 95% CI 2.55–3.19), and the transfer of day 5–6 embryos (aOR 4.23, 95% CI 4.06–4.40); eSET was less likely in women aged 35–37 years (aOR 0.76, 95% CI 0.73–0.80). Compared with DET cycles, the likelihood of the ideal outcome, term non–low birth weight singleton live birth, was increased 45%–52% with eSET.

Conclusion(s):
Expanding insurance coverage for IVF would facilitate the broader use of eSET and may reduce the morbidity and healthcare costs associated with multiple pregnancies.

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