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How many embryos should be transferred?
Title: ASRM publishes new recommendations on embryo transfer
Source: ASRM Bulletin Volume 1, Number 24, November 9, 1999
Summary: The American Society for Reproductive Medicine (ASRM) announced the
release of new guidelines with recommendations for the number of embryos to
transfer when performing in vitro fertilization (IVF) and related procedures.
Although multifetal pregnancy reduction is possible to reduce fetal number, its
use does not completely eliminate associated risks of multiple pregnancy and may
result in the loss of all fetuses and have adverse psychological consequences for
patients. The ASRM makes the following recommendations: 1) Programs should create
and use their own data in regard to patient characteristics and the number of
embryos to be transferred. 2) The number transferred should be agreed upon by
the physician and the patient, informed consent documents completed, and the
information recorded in the clinical record. In the event the program does not
have data available, the following is recommended: 1) In patients with the most
favorable prognosis, usually no more than 2 quality embryos should be
transferred. 2) In patients with above average prognosis (female <35 without
cryopreserved embryos), usually no more than 3 quality embryos should be
transferred. 3) In those with an average prognosis (female age 35-40), usually no
more than 4 quality embryos should be transferred. 4) For patients with below
average prognosis (female >40 years or multiple failed cycles), no more than 5
quality embryos transferred. In donor egg cycles, the age of the donor should be
used in determining the number of embryos to transfer. Since all oocytes may not
fertilize when GIFT is performed, one more oocyte than embryo may be transferred
for each prognostic category.
Comment: Back when we were transferring more than 3 embryos we had
quadruplets in
each of the above 4 groups. The above guidelines are new in that a reduction to 2
embryos is suggested in good prognosis patients. Why not just put a limit of 2
embryos on all patients? We would end the need for selective abortion and
significantly reduce the dollar load necessitated by complication of multiple
gestation. Of course this needs to be met by insurance coverage for infertility
and IVF that would decrease the "go for broke" attitude. You will be seeing a lot
about reduction of multiple pregnancy rate in all forms of the press. Why is this
issue so hard when the solution is so simple?
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