Single Embryo Transfer - Information for Patients and Partners - Leicester Fertility Centre
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Single Embryo Transfer Information for Patients and Partners Date of Issue: 19/06/2018 Doc 404 Issue 09 1 of 10 Approved by Jane Blower Review date: 30/06/2021
What is this leaflet about and who is it for? This leaflet is produced for couples undergoing in vitro fertilisation (IVF), intracytoplasmic sperm injection (ICSI) or frozen embryo transfer (FET) to provide guidance on the safest number of embryos to transfer to the uterus to reduce the risk of multiple pregnancy. Why are there so many twins from assisted conception treatment? 23.6% of pregnancies from assisted conception are twins1 compared to only 1.5% of naturally conceived pregnancies, mainly due to 2 embryos being replaced (non-identical twins). Why are multiple pregnancies a problem? Multiple pregnancies are the single biggest risk to the health of children conceived by IVF, ICSI or FET as many more twins are unwell when they are born than singleton babies and a minority of twins may suffer health and developmental problems for many years. There are also greater risks to the mother’s health in a multiple pregnancy. What is ‘single embryo transfer’ (SET)? SET is where a single embryo is replaced into the uterus following fertilisation. At the planning appointment the clinician or nurse specialist will advise you of the risks of multiple pregnancies and of Leicester Fertility Centre’s single embryo transfer policy and patient selection criteria. You will both need to sign a consent form relating to your treatment. Patients should be aware that even when only one embryo is replaced, it is still possible for a multiple pregnancy to occur as an embryo can occasionally divide to create identical twins. Indeed, the risk of monozygotic (identical twins) is at least 2 fold higher after IVF compared to natural conception with an average of 2%. The risk is particularly higher after blastocyst (day 5 or 6 embryo) transfer. Who has been involved in looking at this issue? The HFEA in conjunction with the general public, fertility patients and healthcare practitioners including doctors, embryologists, specialist Date of Issue: 19/06/2018 Doc 404 Issue 09 2 of 10 Approved by Jane Blower Review date: 30/06/2021
nurses and counsellors held a consultation. The HFEA’s report in 2007,
“The Best Possible Start to Life” (available at www.hfea.gov.uk),
summarises the feedback received. The consensus was that the aim
should be for the healthiest outcome for mother and child and that the
right of children to have the best start in life is paramount - those born
from assisted conception should not be disadvantaged compared to
those born naturally.
Although the HFEA have not banned the transfer of 2 embryos, they
have indicated that clinics must reduce the proportion of multiple
pregnancies to a maximum of 10%.
Potential risks of multiple pregnancies
For further information on the possible risks associated with multiple
pregnancies, please read in conjunction with the Human Fertilisation
and Embryology Authority (HFEA) patient information leaflet, ‘Multiple
pregnancies and births: considering the risks’. The best possible
outcome for fertility treatment is a healthy singleton pregnancy.
What are the risks of multiple pregnancies?
Babies:
• 7 times higher risk of neonatal death (shortly after birth),
• 4 times higher risk of perinatal death (stillborn),
• 4 times higher risk of cerebral palsy (brain damage which impairs
control of muscle movements,
• 2 times higher risk of disability e.g. learning disability, language
delay, attention/ behavioural problem,
• Over 50% are born prematurely (under 37 weeks) at low birth
weight - linked to higher risk of adult disease,
• 10 times higher risk of admittance to neonatal special care unit
for breathing/ feeding problems,
• Higher rate of miscarriage.
Mother:
• Higher risk of complications including:
• 4-20 times higher risk of hypertension (high blood pressure),
Date of Issue: 19/06/2018 Doc 404 Issue 09 3 of 10
Approved by Jane Blower Review date: 30/06/2021• 3 times higher risk of pre-eclampsia (hypertensive disorder
affecting mother and child),
• 2-3 times higher risk of pregnancy-related diabetes,
• Needing hospitalisation for last weeks of pregnancy,
• Needing a Caesarian section / induced labour / instruments to aid
delivery,
• Haemorrhage (severe bleeding),
• Twice the risk of death for the mother (although still rare).
Parents:
• Higher incidence of depression coping with more than one baby,
• Higher rates of marital problems and divorce,
• Greater financial considerations
Evidence confirming there is no benefit to having 2
embryos replaced
UK legal limit is 2 (3 if over 40 years of age). Almost all multiple twin
pregnancies from assisted conception treatment are caused when 2
embryos are transferred and both the embryos implant into the womb
(non-identical twins). In these patients it therefore follows that if only
one of those embryos had been replaced, they would still have become
pregnant but with only one baby. In these patients there is no need to
put back 2 embryos as it does not increase their chances of becoming
pregnant, it only increases the risk of multiple pregnancy. Multiple
pregnancies increase the dangers to both mother and children and in
these cases are entirely avoidable. Data from European countries such
as Sweden that have been routinely replacing one embryo shows us
that this does not jeopardise patients’ chances of success if targeted at
those patients with the highest chance of becoming pregnant. The
multiple pregnancy rate dropped to around 5% but the overall
pregnancy rate stayed virtually the same.
Leicester Fertility Centre SET policy
Our aim is not to reduce patients’ chances of conceiving, but to reduce
the number of patients who are conceiving with multiple embryos as
there are significant and serious risks associated with multiple
Date of Issue: 19/06/2018 Doc 404 Issue 09 4 of 10
Approved by Jane Blower Review date: 30/06/2021pregnancies. The overwhelming evidence both from national studies undertaken by the HFEA and by analysis of our own pregnancy data, show that patients most at risk of multiple pregnancies are younger patients with good quality embryos. For these patients, having one embryo replaced does not lower the chances of success, but rather means they are more likely to have a healthy singleton pregnancy rather than a potentially risky twin pregnancy. As embryo quality is not known until the day of transfer, the final decision may sometimes be deferred until then. Therefore patients fitting the criteria below will have one fresh embryo replaced to reduce the chances of a multiple pregnancy: All patients undergoing their first IVF or ICSI cycles who are 35 years of age or less with at least 2 good quality embryos or one good quality blastocyst stage embryo; All patients with medical history which increases the risks associated with multiple pregnancy will also be advised to have only one embryo replaced. These conditions include, but are not limited to: Uterine abnormalities; Recurrent miscarriage; Prior mid trimester (after 12 weeks) miscarriage Prior preterm labour / stillbirth / neonatal death; Diabetes; Hypertension / history of pre-eclampsia; Inflammatory bowel disease; Any chronic medical condition. Date of Issue: 19/06/2018 Doc 404 Issue 09 5 of 10 Approved by Jane Blower Review date: 30/06/2021
Clinical Commissioning Group (CCG) policies for SET Patients should be aware that for NHS funded treatment, your CCG may only fund SET for fresh and frozen embryo transfers. The decision to have one or two embryos replaced in a fresh or frozen cycle will depend on patient age and embryo quality. Any queries regarding these policies should be addressed directly to the relevant CCG. Making the decision We appreciate that this is a stressful time, that there are strong emotional and financial pressures on patients undergoing fertility treatment and that the overwhelming desire is to maximise the chances of having a family. However the common idea of twins being an “instant family” and a good outcome to treatment needs to be challenged, as the reality can sometimes be very different. Everyone involved in fertility treatment needs to put the welfare of potential children first, giving them the best chance to be born healthy and full- term singleton babies. By providing this information, we hope that patients can consider carefully the risks involved with multiple pregnancies when deciding the number of embryos they wish to have transferred. We realise this may not be an easy choice so if you have any questions, please ask a member of staff who will be happy to help you. 1HFEA register data All other statistics taken from the “Best Possible Start to Life” - HFEA, 2007. Available at: www.hfea.gov.uk. What follow up care is available? Should you wish to access any supportive counselling during your fertility treatment you may contact the unit to arrange an appointment with the counsellor. (0116) 2585922 Date of Issue: 19/06/2018 Doc 404 Issue 09 6 of 10 Approved by Jane Blower Review date: 30/06/2021
Our commitment to patients We are constantly striving to improve our services to patients and we will welcome your comments or suggestions for improvement. Leicester Fertility Centre Contact Details Tel: 0116 2585922 E-mail: enquiries@leicesterfertilitycentre.org.uk Fax: 0116 2587688 Website: www.leicesterfertilitycentre.org.uk Useful addresses: Human Fertilisation and Embryology Authority www.hfea.gov.uk NICE guidelines: www.nice.org.uk NHS - Response line: 0870 155 5455 NHS - Smoking Helpline: www.givingupsmoking.co.uk / 0116 295 4141 Infertility Network UK www.infertilitynetworkuk.com / 0800 0087464 National Gamete Donation Trust www.ngdt.co.uk / 0845 2269193 Date of Issue: 19/06/2018 Doc 404 Issue 09 7 of 10 Approved by Jane Blower Review date: 30/06/2021
Do you feel that you are at risk of verbal or physical abuse? If so, you may find the following numbers useful: Domestic Violence Helpline: United against violence & abuse (UAVA) 0808 802 0028 This information was correct at the time of printing. While the Trust makes every reasonable effort to keep its information leaflets up to date, very recent changes may not be reflected in the guidance and you should discuss this with the clinical staff at the time of your appointment. Date of Issue: 19/06/2018 Doc 404 Issue 09 8 of 10 Approved by Jane Blower Review date: 30/06/2021
Questions If you have any questions write them down here to remind you what to ask when you speak to your consultant. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Date of Issue: 19/06/2018 Doc 404 Issue 09 9 of 10 Approved by Jane Blower Review date: 30/06/2021
Today’s research is tomorrow’s care
We all benefit from research. Leicester’s Hospitals is a
research active Trust so you may find that research is
happening when you visit the hospital or your clinic.
If you are interested in finding out how you can become
involved in a clinical trial or to find out more about taking
part in research, please speak to your clinician or GP.
Date of Issue: 19/06/2018 Doc 404 Issue 09 10 of 10
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