COMMENTARY

Top Assisted Reproductive Technology Literature From 2014

Peter Kovacs, MD, PhD

Disclosures

December 18, 2014

In This Article

Editor's Note: Keeping up with the medical literature is hard work. Dr Peter Kovacs has made it a bit easier by summarizing three studies published in 2014 that are likely to change practice.

Progress in Embryo Selection

It has been recognized for a long time that from both maternal and neonatal aspect, a singleton pregnancy is the safest. However, when a single embryo is transferred electively, the efficacy will likely not be the highest. While many of our patients will be served well with the elective transfer of a single embryo only, it may not be the best option when all parameters (age, embryo quality, infertility history, response to treatment, etc.) are considered. We therefore have to individualize this step of the treatment as well.

The aim of any assisted reproductive technology (ART) treatment is to result in the delivery of a full-term, healthy child. Success rates have improved significantly during more than three decades of ART, but multiple pregnancy rates have also increased significantly. The introduction of stricter transfer policies have lowered the number of high-order multiple pregnancies but have not made a significant impact on twin rates.[1,2,3]

A multiple pregnancy, even a twin pregnancy, is known to carry extra maternal and neonatal risks and is known to be associated with significant healthcare expenses.[4] Therefore, even stricter transfer policies are needed. The majority of twin pregnancies could be avoided by elective single-embryo transfer (SET). SET is likely to lower the pregnancy and delivery rates too when compared with the transfer of two embryos. Patients and providers, therefore, would not welcome a universal SET transfer policy unless it is backed up by proper insurance coverage.

The results of these three papers could help to further improve our ability to identify the best embryo for transfer.

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