Elective single embryo transfer (eSET): A safe option in IVF

What is Single Embryo transfer or SET?

Single embryo transfer (SET)is an elective procedure where a single good quality embryo is chosen from the available embryos and transferred into the uterus. Single embryo transfer can be done in a frozen embryo transfer or in a fresh cycle. The embryo of interest can also be checked for genetic abnormalities prior to transfer by Preimplantation Genetic Screening (PGS). It is a method to avoid multiple pregnancy.

What are its features?

The main feature of Single Embryo Transfer was found that the percent of low birth weight babies decreases with elective Single Embryo Transfer (eSET).

The health of children born after in vitro fertilization (IVF) has been followed up since the beginning of clinical infertility treatment. The increased risk of premature births among twin pregnancy is the main cause of morbidity & mortality among IVF children. Rate of preterm in IVF is as high as 30.3% while its only 6.3% in control group or general population.

Who should avail eSET?

• Women with chronic illness like Diabetes Mellitus, chronic Hypertension, renal diseases.
• Women with obesity.
• Women with Turners syndrome, history of 2nd trimester loss or uterine malformations increasing the risk of premature delivery are candidates for SET.
• Oocyte donation program is a situation with relatively higher pregnancy rate & eSET gives excellent pregnancy rate.
• Women of age group less than 35 with many good quality embryos.

What are the complications related to multiple pregnancies which can be prevented by eSET?

• Important risk related to multiple pregnancy is the complications related to premature delivery like low birth weight, neonatal respiratory distress syndrome, asphyxia, hypothermia, hypoglycemia, cerebral hemorrhage, infection, jaundice etc .
• Risk of neurological diagnosis is significantly higher in twins, congenital anomalies are more common in twin pregnancies, congenital heart disease is more common among twins than singleton.
• Complications specific to twin pregnancy like discordant growth or growth restriction in twins, Twin Twin Transfusion Syndrome (TTTS), Twin reversed Arterial Perfusion (TRAP) syndrome.
• Prenatal morbidity, Neonatal intensive care unit (NICU) admission, economic burden.
• Maternal complications like excessive vomiting i.e Hyperemesis gravidarum in multiple pregnancy, Preeclampsia, Gestational Diabetes Mellitus, PPH (Postpartum Hemorrhage) are more common in multiple pregnancy.
• Stress for caring more than one baby, postpartum depression, increased family stress.

What is the advantage of SET?

Elective single embryo transfer is a method to avoid multiple pregnancies, the advantage of this method is complications related to multiple pregnancy in both mother & the infant can be prevented.

Why one should avail it?

Multiple pregnancy is high risk for the health of the mother & infant. Women with known illness which are contraindications for multiple pregnancy such as uterine abnormality, hypertensive etc are benefitted with SET. The risk is to infants is largely due to preterm birth & also due to congenital anomalies increased in twins.

Currently with blastocyst culture, Preimplantation genetic screening, embryo freezing technology, extended culture system single embryo transfer can be encouraged without compromising on the result or pregnancy rate. Electivesingle embryo transferhas been proved to be a method to avoid multiple pregnancy without decreasing overall pregnancy rates in selected couples.