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Thursday, July 7, 2016

Elective Single embryo transfer ( eSET ) - is it for me ?

The answer to this question depends on a number of factors :
1. Your age
If you are of young maternal age , the chance that more than one of your transferred embryos being genetically normal increases. Hence , it is wise to opt for single embryo transfer ( SET ). If you are less than 35 years of age , with good ovarian reserve and good quality embryos , you must consider transferring only one embryo.
2. Your ovarian reserve ( the number of embryos obtained in a particular IVF cycle )
If you get many eggs and embryos in your IVF cycle , it is better to grow them to blastocysts and do a SET.
3. Having good looking embryos
If the embryos that were created are of high grade , then doing eSET can be beneficial, provided , you are of young maternal age with good ovarian reserve.
4. Blastocyst transfer
If 40 % of your embryos develop into blastocysts , it shows that they are following a normal growth pattern. In such cases , elective SET can be beneficial.
5. Your clinic's success rate
If your clinic has high success rate for women of your age , then it is important to listen to your doctor's suggestion regarding how many embryos to transfer. You have high chance of having multiples if you transfer more than one embryo in a clinic which has high success rate.
6. When using donor eggs and embryos
Women who donate eggs are usually of young maternal age , so , the chance that many of the obtained embryos are genetically normal increases. Donor embryos are mostly got from couples who have completed their families using the same cohort of embryos. This is a sign that the remaining embryos may be good enough , too. And moreover , majority of the time , only couples who are of young maternal age will have ample embryos to donate  . So , when using donor eggs and embryos , it is good to go with single embryo transfer.
7. When using embryos which are tested for genetic competency
When using embryos which are tested using advanced genetic testing techniques ( for example , embryos tested using NGS ( next generation sequencing,  where all 23 pairs of chromosomes are screened )  , SET must be preferred.
In short , if you are of young maternal age ( ideally , below 35 years ), with good ovarian reserve ; if 40% of your obtained embryos grow to blastocysts and are of good grades allowing you to select the best ; if you use embryos which are tested for chromosomal normalcy ,  and if you are with a clinic which has high success rate , or , if you are using donor eggs and embryos , you must opt for SET - this will greatly reduce your chance of having multiples. 
Remember , a successful IVF cycle is not about getting a positive pregnancy test. Only when you take home a healthy baby ( healthy babies )  healthily , your goal has been achieved. Multiple pregnancies can be  disastrous , many a time.  Having premies in hand is heart - wrenching and losing healthy babies can break your heart. The chance of something going wrong in multiple pregnancies is several times higher when compared to singleton pregnancy. So , aim for eSET whenever possible - aim for a healthy IVF pregnancy.

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