When you think of toilet paper, money, closet space, or the amount of stars you’ve collected on your Starbucks app, I think we can all agree you can never have enough. The case may not be the same, though, for embryos… at least not when it comes to putting them back in your uterus. If you’re in the throes of IVF, you know that through the whole process the goal is that come time for transfer, you’ll have at least one good embryo to put back that will hopefully make a baby. You may even think that if you’ve got them, transferring two or three or more embryos is the way to go. The more embryos, the more chances of at least one taking.
However, as a patient advocate who cares passionately about both your health and your sanity, I recommend you do as much research as you can on the topic. While it may seem on the surface that the more embryos you have to transfer, the better your chances will be of achieving a pregnancy, the latest research shows that “staying single” (at least with regards to embryo transfer) may be more beneficial for you and your baby in the long run.
The technical term for this is eSET – Elective Single Embryo Transfer, and in the interest of full disclosure, other than my first round of IVF, I only ever had one embryo, so I never really was given much of a choice. I guess you could say I didn’t have that first ‘e’ on my eSET. Mine was more like iaygSET (as in “It’s All You Got Single Embryo Transfer”).
If you’ve been doing this for a while, you’ll know that this (meaning eSET, not iaygSET) is just one of many acronyms that can help you in your trying to conceive (TTC) journey.
Since I’m not a doctor nor have I played one on TV, it’s important to look to the experts’ opinions on eSET. (Here’s where some more of the acronyms come in.) The Society of Assisted Reproductive Technology (SART) and the American Society for Reproductive Medicine (ASRM) issued joint recommendations for the number of embryos to transfer, which heavily support eSET in the majority of cases. As an educated and empowered patient, you can play an active role in your treatment journey by brushing up on these recommendations and the reasoning behind them, so you can discuss your options with your doctor. There are many factors to consider (age, diagnosis, etc.), and together, you can decide if this is something right for you, based on your situation and your family building goals.
So, why is everyone so pro-lone embryo transfer these days? If you transfer more than one embryo, your chances of having twins are higher. Now on the surface, that may seem cute. After struggling for so long, you may enjoy the notion of matching outfits and double-wide strollers. Maybe you’re even a fan of the twins in the movie, The Shining (for whatever reason). However, with twins come health concerns for both mom and babies. It means a potentially high-risk pregnancy for you that could include preterm labor/delivery, preeclampsia, gestational diabetes, or placental abruption. According to the American Pregnancy Association, almost 60% of twins are delivered preterm, while 90% of triplets are preterm, which means a NICU stay for your babies.
Even the American College of Obstetricians and Gynecologists (ACOG) agrees that, “studies demonstrate eSET achieves high rates of pregnancy, while simultaneously contributing to a drastic reduction in multifetal pregnancy.”
Plus, when you consider modern technology, such as preimplantation genetic screening (PGS), eSET may make even more sense. PGS looks inside the cells of your embryos to see which ones have a healthy genetic makeup associated with better chances of success. When you transfer a single embryo that has been PGS-tested, you have greater confidence that it is a healthy embryo with a higher likelihood of leading to a baby. If you’re looking to avoid the health risks of a possible twin or triplet pregnancy, PGS is one way to help increase the chance of your eSET being successful.
Infertility treatment (and affording it) is already an emotional rollercoaster. When you’re going through IVF, options like eSET (and PGS) can help make any additional variables a bit more controllable.
Again, these are all things to read up on and talk over with your doctor. Every single patient (like every single embryo) is different and should be treated as such. No treatment protocol should be cookie cutter, and what might be right for one patient may not be right for you. If nothing else, your doctor will be so impressed with your eSET, PGS, ART, ASRM, IVF acronym knowledge that he or she will say OMG!