Tobias Tamara, Sharara Fady I, Franasiak Jason M, Heiser Patrick W, Pinckney-Clark Emily
Seattle Reproductive Medicine, 1505 Westlake Ave North, Suite 400, Seattle, WA 98109 USA.
Virginia Center for Reproductive Medicine, 11150 Sunset Hills Rd, Suite #100, Reston, VA 20190 USA.
Fertil Res Pract. 2016 Aug 15;2:1. doi: 10.1186/s40738-016-0024-7. eCollection 2016.
The transfer of multiple embryos after in vitro fertilization (IVF) increases the risk of twins and higher-order births. Multiple births are associated with significant health risks and maternal and neonatal complications, as well as physical, emotional, and financial stresses that can strain families and increase the incidence of depression and anxiety disorders in parents. Elective single embryo transfer (eSET) is among the most effective methods to reduce the risk of multiple births with IVF.
Current societal guidelines recommend eSET for patients <35 years of age with a good prognosis, yet even this approach is not widely applied. Many patients and clinicians have been reluctant to adopt eSET due to studies reporting higher live birth rates with the transfer of two or more embryos rather than eSET. Additional barriers to eSET include risk of treatment dropout after embryo transfer failure, patient preference for twins, a lack of knowledge about the risks and complications associated with multiple births, and the high costs of multiple IVF cycles. This review provides a comprehensive summary of strategies to increase the rate of eSET, including personalized counseling, access to educational information regarding the risks of multiple pregnancies and births, financial incentives, and tools to help predict the chances of IVF success. The use of comprehensive chromosomal screening to improve embryo selection has been shown to improve eSET outcomes and may increase acceptance of eSET.
eSET is an effective method for reducing multiple pregnancies resulting from IVF. Although several factors may impede the adoption of eSET, there are a number of strategies and tools that may encourage the more widespread adoption of eSET in clinical practice.
体外受精（IVF）后移植多个胚胎会增加双胞胎及多胎妊娠的风险。多胎妊娠会带来重大的健康风险以及母婴并发症，还会导致身体、情感和经济压力，这些压力会给家庭带来负担，并增加父母患抑郁症和焦虑症的几率。选择性单胚胎移植（eSET）是降低IVF多胎妊娠风险最有效的方法之一。
目前的社会指南建议，对于预后良好的35岁以下患者采用eSET，但即便如此，这种方法也未得到广泛应用。由于一些研究报告称移植两个或更多胚胎的活产率高于eSET，许多患者和临床医生一直不愿采用eSET。eSET的其他障碍包括胚胎移植失败后治疗中断的风险、患者对双胞胎的偏好、对多胎妊娠相关风险和并发症缺乏了解，以及多次IVF周期的高昂费用。本综述全面总结了提高eSET使用率的策略，包括个性化咨询、获取有关多胎妊娠和分娩风险的教育信息、经济激励措施，以及帮助预测IVF成功几率的工具。使用全面染色体筛查来改善胚胎选择已被证明可改善eSET的效果，并可能提高对eSET的接受度。
eSET是降低IVF多胎妊娠的有效方法。尽管有几个因素可能阻碍eSET的采用，但有许多策略和工具可能会鼓励在临床实践中更广泛地采用eSET。
