Fertility treatments can be complex and often require patients to make many decisions. One of the toughest questions for patients undergoing in vitro fertilization (IVF) and donor egg treatment is “How many embryos should I transfer?” This is an important question, and we understand why patients might struggle for the right answer.
For starters, some patients might want twins! The idea of building a family with only one round of treatment sounds enticing. Another reason is that patients want to try to optimize their chances of success. Nobody wants a cycle to fail, and transferring more than one embryo may seem like the logical way to increase the chance of success. Lastly, fertility treatment is expensive and the idea of having to find the funds to repeat a treatment cycle can seem overwhelming.
The goal at Shady Grove Fertility (SGF) is to help patients achieve a pregnancy and to optimize the odds of delivering a healthy baby. The best way to do this is to transfer one embryo at a time. The care team at Shady Grove Fertility has taken on the mission of educating patients about the real risks that occur more often with a multiple pregnancy and encouraging the use of elective single embryo transfer (eSET) in patients with a good prognosis for pregnancy.
Single embryo transfers have led to a substantial decrease in the rates of – and risk from – multiple pregnancy among women using their own eggs, as well as women using donor eggs, without any decrease in pregnancy rates.
What is elective single embryo transfer (eSET)?
eSET is elective single embryo transfer, a process by which one good quality blastocyst embryo is transferred back to the patient. The embryos that survive to the blastocyst stage of development are more likely implant and develop. Blastocyst embryos have a much higher chance of implanting than other embryos, therefore fewer embryos are required to achieve a pregnancy.
“When you choose eSET, you are giving yourself the best possible chance for a safe pregnancy and a healthy baby,” explains Robert Stillman, M.D., Shady Grove Fertility’s Medical Director Emeritus. “Now we can confidently tell an increasing proportion of our patients that they won’t be sacrificing their chances of pregnancy to achieve that peace of mind and safety for their baby.”
Reducing risks of in vitro fertilization (IVF)
While some individuals and couples needing fertility treatment may see double embryo transfers as a way to increase the chances of having more than one child, there are risks for the pregnant person and babies associated with a multiple pregnancy.
“There is a misconception that IVF commonly leads to twins or multiples,” shares Dr. Quinton Katler, SGF Atlanta physician, whose recent research addresses the decline in twin pregnancies from IVF. “While that may have been true in the mid-1990s, we have witnessed improvements in laboratory practices and treatment protocols that now place single embryo transfers as the standard of care, which still maintains high pregnancy rates. Our goal is for singleton pregnancies, as this reduces the complications that come with multiples.”
Since 2005, when the eSET initiative became commonplace at Shady Grove Fertility, pregnancy rates continue to rise while the rate of twins continues to decline.
Learn more about SGF’s single embryo transfer success rate.
SGF financial programs support single embryo transfers
It has been shown that patients who have insurance coverage for IVF or donor egg transfer fewer embryos per cycle since their fears of being unsuccessful and having to pay for another cycle are lessened. When insurance is not available, Shady Grove Fertility’s financial programs can help minimize the psychological and economic pressures on patients.
For instance, in the Shared Risk 100% Refund Program, for one fixed fee, patients may attempt up to six IVF cycles or donor egg treatment. If the treatments do not result in a delivery, the patients will receive a 100% refund of the fee (some exclusions apply). Since Shared Risk also includes any subsequent frozen embryo transfer cycles, patients in the Shared Risk Program have demonstrated they are more likely to transfer a single embryo because all is not riding on the one cycle. Armed with the knowledge that additional cycles may be attempted with no additional cost relieves pressure from the “number of embryos to transfer” decision.
Patient-centered care at SGF
At SGF we take a patient-centered approach to fertility care backed by evidence-based practices. Every patient has a different circumstance and individualized treatment plan. If you have questions about how many embryos to transfer, please discuss with your physician.
Medical contributions by:
Robert J. Stillman, M.D.
Medical Director Emeritus
For more information or to schedule an appointment with one of our physicians, please call our New Patient Center at 888-761-1967 or submit this brief form.
Editor’s note: This article was originally published in October 2014 and has been updated for accuracy and comprehensiveness as of April 2023.
