American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2017, 5(7), 181-186
DOI: 10.12691/ajmcr-5-7-4
Open AccessArticle

Single and Dual Embryo Transfer, How Far We Are?

Abu Marar E1, and Al-Hasani S2

1IVF Department, Bnoon Center, Riyadh, Saudi Arabia

2IVF Consulting, Luebeck, Germany

Pub. Date: August 01, 2017

Cite this paper:
Abu Marar E and Al-Hasani S. Single and Dual Embryo Transfer, How Far We Are?. American Journal of Medical Case Reports. 2017; 5(7):181-186. doi: 10.12691/ajmcr-5-7-4


Since decades back, specifically since the development of infertility treatment was progressively advancing, the multiple pregnancy is increasing drastically and of the major contributors to this increment is assisted reproductive technology ART, which reflects an increased risk for both mother and fetus other than being a health hazard. We reviewed the literature systematically to explore and compare the dual embryo transfer DET with single embryo transfer SET weather electively or not in more viewpoints like financially, and scientifically and finding out which of these policies may give better outcome by analyzing both in a neutral broad spectrum manner. Our results were given upon some clinical trials, and in part upon other articles found in the literature, but the comparison between all these articles found to be unreliable due to the huge variation between them all, ending up finally that SET has the advantage of minimizing the twinning and multiple pregnancy rate MPR. On the other hand SET has less benefit when compared to DET in the matter of implantation rate IR, ongoing pregnancy rate OPR, but a comparable results may be obtained when applying elective single embryo transfer eSET of frozen-thawed embryo. We concluded that larger clinical trials should still be encouraged for such comparison especially in applying same criteria for both methods.

assisted reproductive technology twins single embryo transfer and double embryo transfer

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[1]  Nygren, K.G. and Andersen, A.N. (2001b) Assisted reproductive technology in Europe, 1998. Results generated from European registers by ESHRE. European IVF-monitoring programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Hum. Reprod., 16, 2459-2471.
[2]  Centers for Disease Control and Prevention, American Society for Assisted Reproductive Technology. 2005 Assisted Reproductive Technology Success Rates:National Summary and Fertility Clinic Reports. Atlanta: Centers for Disease Control and Prevention, 2007.
[3]  Fauser BC, Bouchard P, Coelingh Bennink HJ, et al. Alternative approaches in IVF. Human Reprod Update 2002; 8: 1-9.
[4]  Vail A, Gardener E. Common statistical errors in the design and analysis of subfertility trials. Human Reprod 2003; 18: 1000-04.
[5]  Min JK, Breheny SA, MacLachlan V, Healy DL. What is the most relevant standard of success in assisted reproduction? The singleton, term gestation, live birth rate per cycle initiated: the BESST endpoint for assisted reproduction. Hum Reprod 2004; 19: 3-7.
[6]  Bart CJM Fauser, Paul Devroy, Nick S Macklon. Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet 2005; 365: 1807-16.
[7]  Gerris J, De Neubourg D, Mangelschots K, Van Royen E, Van de Meersche M, Valkenburg M. Prevention of twin pregnancy after in-vitro fertilization or intracytoplasmic sperm injection based on strict embryo criteria: a prospective randomized clinical trial, Hum Reprod 1999; 14: 2581-2587.
[8]  Martikainen H, Tiitinen A, Tomas C, Tapanainen J, Orava M,Tuomivaara L, Vilska S, Hyden-Granskog C, Hovatta O. One versus two embryo transfer after IVF and ICSI: a randomized study. Hum Reprod 2001; 16: 1900-1903.
[9]  Gardner DK, Surrey E, Minjarez D, Leitz A, Stevens J, Schoolcraft WB.Single blastocyst transfer: a prospective randomized trial. Fertil Steril 2004; 81: 551-555.
[10]  Thurin A, Hausken J, Hillensjo T, Jablonowska B, Pinborg A, Strandell A, Bergh C. Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med 2004; 351: 2392-2402.
[11]  Lukassen HG, Braat DD, Wetzels AM, Zielhuis GA, Adang EM, Scheenjes E, Kremer JA. Two cycles with single embryo transfer versus one cycle with double embryo transfer: a randomized controlled trial. Hum Reprod 2005; 20: 702-708.
[12]  van Montfoort AP, Fiddelers AA, Janssen JM, Derhaag JG, Dirksen CD, Dunselman GA, Land JA, Geraedts JP, Evers JL, Dumoulin JC. In unselected patients, elective single embryo transfer prevents all multiples, but results in significantly lower pregnancy rates compared with double embryo transfer: a randomized controlled trial. Hum Reprod 2006; 21: 338-343.
[13]  Vilska S, Tiitinen A, Hyden-Granskog C, Hovatta O. Elective transfer of one embryo results in an acceptable pregnancy rate and eliminates the risk of multiple birth. Hum Reprod 1999; 14: 2392-2395.
[14]  Tiitinen A, Halttunen M, Harkki P, Vuoristo P, Hyden-Granskog C. Elective single embryo transfer: the value of cryopreservation. Hum Reprod 2001; 16: 1140-1144.
[15]  Gerris J, De Sutter P, De Neubourg D, Van Royen E, Vander Elst J, Mangelschots K, Vercruyssen M, Kok P, Elseviers M, Annemans L et al. A real-life prospective health economic study of elective single embryo transfer versus two-embryo transfer in first IVF/ICSI cycles. Hum Reprod 2004; 19: 917-923.
[16]  van Montfoort AP, Dumoulin JC, Land JA, Coonen E, Derhaag JG, Evers JL. Elective single embryo transfer (eSET) policy in the first three IVF/ICSI treatment cycles. Hum Reprod 2005; 20: 433-436.
[17]  Veleva Z, Vilska S, Hyden-Granskog C, Tiitinen A, Tapanainen JS, Martikainen H. Elective single embryo transfer in women aged 36–39 years. Hum Reprod 2006; 21: 2098-2102.
[18]  Veleva Z, Karinen P, Tomas C, Tapainen JS, Martikainen H. Elective single embryo transfer with cryopreservation improves the outcome and diminishes the costs of IVF/ICSI. Hum Reprod 2009; 24: 1632-1639.
[19]  David K. James, Philip J Steer, Carl P. Weiner, Bernard Gonik. High risk pregnancy1999; 2nd edition: 129-148.
[20]  D. Keith Edmonds. Dewhurst’s textbook of Obstetrics & Gynaecology; Blackwell Publishing 2007; 7th edition: 166-176.
[21]  A. Nyboe Andersen, V. Goossens, A.P. Ferraretti, S. Bhattacharya, R. Felberbaum, J. de Mouzon, K.G. Nygren, The European IVF-monitoring (EIM) Consortium, for the European Society of Human Reproduction and Embryology (ESHRE). Hum Reprod 2008; 23: 756-771.
[22]  ESHRE. The European IVF Monitoring programme (EIM), for the European society of Human Reproduction and Embriology (ESHRE). Assisted Reproductive Technology in Europe 2004. Results generated from European Registers by ESHRE. Hum Reprod 2008; 23: 756-771.
[23]  Dube J, Dodds L & Armson BA (2002) Does chorionicity or zygocity predict adverse perinatal outcomes in twins? Am J Obstet Gynecol 186: 579-83.
[24]  Sebire NJ, Snijders RJ, Hughes K et al. (2997) The hidden mortality of monochorionic twin pregnancies. Br J Obstet Gynecol 104: 1203-7.
[25]  Moustafa MK, Sheded SA, El Aziz Mousta MA. Elective single embryo transfer versus double embryo transfer in assisted reproduction. Reprod Biomed Online. 2008; 17(1): 82-7.
[26]  Fiddelers AA, van Montfoort AP, Dirksen CD, Dumoulin JC, Land JA, Dunselman GA, Janssen JM, Severens JL, Evers JL. Single versus double embryo transfer: Cost-effectiveness analysis alongside a randomized clinical trial. Hum Reprod. 2006; 21(8): 2090-7.
[27]  Baruffi RL, Mauri AL, Petersen CG, Nicoletti A, Pontes A, Oliveira JB, Franco JG Jr. Single-embryo transfer reduces clinical pregnancy rates and live births in fresh IVF and Intracytoplasmic Sperm Injection (ICSI) cycles: a meta-analysis. Reprod Biol Endocrinol. 2009 Apr 23; 7: 36.
[28]  Bhattacharya S, Templeton A. What is the most relevant standard of success in assisted reproduction? Redefining success in the context of elective single embryo transfer: evidence, intuition and financial reality. Hum Reprod. 2004 Sep; 19(9): 1939-42. Epub 2004 Jun 24.
[29]  Scotland GS, McNamee P, Bhattacharya S. Is elective single embryo transfer a cost-effective alternative to double embryo transfer? BJOG. 2007 Jan; 114(1):5-7. Epub 2006 Nov 2.
[30]  De Sutter P, Van der Elst J, Coetsier T, Dhont M. Single embryo transfer and multiple pregnancy rate reduction in IVF/ICSI: a 5-year appraisal. Reprod Biomed Online. 2003 Jun; 6(4): 464-9.
[31]  Hamberger L, Hardarson T, Nygren KG. Avoidance of multiple pregnancy by use of single embryo transfer. Minerva Ginecol. 2005 Feb; 57(1): 15-9.
[32]  Dickey RP, Sartor BM, Pyrzak R. What is the most relevant standard of success in assisted reproduction?: no single outcome measure is satisfactory when evaluating success in assisted reproduction; both twin births and singleton births should be counted as successes. Hum Reprod. 2004 Apr; 19(4): 783-7. Epub 2004 Mar 11.
[33]  Poikkeus P, Gissler M, Unkila-Kallio L, Hyden-Granskog C, Tiitinen A. Obstetric and neonatal outcome after single embryo transfer. Hum Reprod. 2007 Apr; 22(4):1073-9. Epub 2007 Jan 24.
[34]  Yanaihara A, Yorimitsu T, Motoyama H, Ohara M, Kawamura T. Clinical outcome of frozen blastocyst transfer; single vs. double transfer. J Assist Reprod Genet. 2008 Nov-Dec; 25(11-12): 531-4. Epub 2008 Nov 7.
[35]  Scotland GS, McNamee P, Peddie VL, Bhattacharya S. Safety versus success in elective single embryo transfer: women's preferences for outcomes of in vitro fertilisation. BJOG. 2007 Aug; 114(8): 977-83. Epub 2007 Jun 18.
[36]  Gerris J, Van Royen E. Avoiding multiple pregnancies in ART: a plea for single embryo transfer. Hum Reprod. 2000 Sep; 15(9): 1884-8. Review.
[37]  Söderström-Anttila V, Vilska S, Mäkinen S, Foudila T, Suikkari AM. Elective single embryo transfer yields good delivery rates in oocyte donation. Hum Reprod. 2003 Sep; 18(9): 1858-63.
[38]  Söderström-Anttila V, Vilska S. Five years of single embryo transfer with anonymous and non-anonymous oocyte donation. Reprod Biomed Online. 2007 Oct; 15(4): 428-33.
[39]  van Montfoort AP, Fiddelers AA, Land JA, Dirksen CD, Severens JL, Geraedts JP, Evers JL, Dumoulin JC. eSET irrespective of the availability of a good-quality embryo in the first cycle only is not effective in reducing overall twin pregnancy rates. Hum Reprod. 2007 Jun; 22(6): 1669-74. Epub 2007 Apr 7.
[40]  Pandian Z, Bhattacharya S, Ozturk O, Serour GI, Templeton A. Number of embryos for transfer following in-vitro fertilisation or intra-cytoplasmic sperm injection. Cochrane Database Syst Rev. 2004 Oct 18; (4): CD003416. Update in: Cochrane Database Syst Rev. 2009; (2): CD003416.
[41]  De Sutter P, Gerris J, Dhont M. A health-economic decision-analytic model comparing double with single embryo transfer in IVF/ICSI. Hum Reprod. 2002 Nov; 17(11): 2891-6.
[42]  Sunde A. Significant reduction of twins with single embryo transfer in IVF. Reprod Biomed Online. 2007; 15 Suppl 3: 28-34.
[43]  De Neubourg D, Gerris J. What about the remaining twins since single-embryo transfer? How far can (should) we go? Hum Reprod. 2006 Apr; 21(4): 843-6. Epub 2006 Jan 12.
[44]  Van Peperstraten AM, Kreuwel IA, Hermens RP, Nelen WL, Van Dop PA, Grol RP, Kremer JA. Determinants of the choice for single or double embryo transfer in twin prone couples. Acta Obstet Gynecol Scand. 2008; 87(2): 226-31.
[45]  Dare MR, Crowther CA, Dodd JM, Norman RJ. Single or multiple embryo transfer following in vitro fertilisation for improved neonatal outcome: a systematic review of the literature. Aust N Z J Obstet Gynaecol. 2004 Aug; 44(4): 283-91.
[46]  Kalu E, Thum MY, Abdalla H. Reducing multiple pregnancy in assisted reproduction technology: towards a policy of single blastocyst transfer in younger women. BJOG. 2008 Aug; 115(9): 1143-50. Epub 2008 May 30.
[47]  Dhont M. Single-embryo transfer. Semin Reprod Med. 2001 Sep; 19(3): 251-8.
[48]  Pandian Z, Templeton A, Serour G, Bhattacharya S. Number of embryos for transfer after IVF and ICSI: a Cochrane review. Hum Reprod. 2005 Oct; 20(10): 2681-7.
[49]  Højgaard A, Ottosen LD, Kesmodel U, Ingerslev HJ. Patient attitudes towards twin pregnancies and single embryo transfer - a questionnaire study. Hum Reprod. 2007 Oct; 22(10): 2673-8. Epub 2007 Sep 1.
[50]  Delbaere I Implantation of the human embryo: clinical and epidemiological aspects. Verh K Acad Geneeskd Belg. 2008; 70(4): 257-83.
[51]  Styer AK, Wright DL, Wolkovich AM, Veiga C, Toth TL. Single-blastocyst transfer decreases twin gestation without affecting pregnancy outcome. Fertil Steril. 2008 Jun;89(6):1702-8. Epub 2007 Jul 20.