Embryo Transfer Policy
To achieve a balance between reducing multiple births and maximising a woman’s chance of having a healthy baby, all clinics including Midland Fertility, adhere to a ‘Multiple Birth Minimisation Policy’ or an ‘Embryo Transfer and SET Policy’. The aim is to help couples achieve their dream of having a healthy baby and this is more likely with a singleton pregnancy rather than twins or triplets.
What is the SET policy?
The policy means that most women will have a single embryo transfer IF she has at least one top grade embryo available (assessed on the day of embryo transfer by a Midland Fertility embryologist). The SET policy will be discussed in detail by the Midland Fertility nurse or doctor with each woman who fits the following criteria:
- she is less than 40 years old
- she is undergoing her first or second embryo transfer
- OR it is her first blastocyst transfer, irrespective of previous D3 transfers
- OR she has a history of multiple pregnancy (independent of her age)
- OR there are special risks to her by having a multiple pregnancy
- OR she is receiving donated eggs or using a surrogate
- OR if in a previous treatment cycle all of the transferred embryos implanted, ie 1 fetal heart shown on scan following 1 embryo transferred or 2 fetal hearts from 2 embryos
Other factors may be taken into account and the risks will be discussed with each patient.
For the specific group of women outlined above, transferring more than one embryo DOES NOT improve the chance of a pregnancy, only increases the risks. A double embryo transfer will only be offered to a patient if Midland Fertility considers that the chance of pregnancy will be significantly reduced with a single embryo transfer, for instance if the embryos are not top grade, but must also fall into the following HFEA rules:
- no more than two embryos may be transferred to a woman of less than 40 years of age, with no exceptions
- no more than three embryos may be transferred to a woman aged 40+ if she is using her own eggs
- no more than two embryos may be transferred to a recipient of donated eggs
Why has Midland Fertility implemented the SET policy?
The risks of any pregnancy are higher in a multiple pregnancy which can have serious, even fatal consequences for both the mother and the babies. Multiple birth is still the single biggest risk to the health and welfare of babies born after IVF/ICSI (see ‘What are the risks?’ below).
Research from the UK and other countries that use single embryo transfer shows that success rates per egg collection do not fall when single embryo transfer is used, particularly when a future frozen embryo transfer may be available from the same treatment cycle.
Who will have a single embryo transfer?
Women aged 40 years or older can have more than one embryo transferred. Women younger than 40 years who have had two previous failed cycles, or where the embryos are not graded as top quality, can also be offered a double embryo transfer.
Midland Fertility will carefully balance the chance to conceive against the risk of having a multiple pregnancy, based on the woman’s medical history and the quality of her embryos.
What are the risks of multiple pregnancy and birth?
– Main risks to mothers
In addition to the risk of miscarriage, the risks to a mother from multiple pregnancy and multiple birth range from mild to potentially life-threatening.
– Risks during pregnancy
- the risk of both early and late miscarriage is higher for mothers of twins and triplets than for mothers of singleton pregnancies
- 20% of mothers carrying twins suffer from high blood pressure, compared to only 1–5% of mothers of singletons
- pre-eclampsia affects 30% of twin pregnancies compared to 2–10% of singleton pregnancies and has potentially serious risks for both mothers and their babies
- the likelihood of a woman who is pregnant with twins developing gestational diabetes is 12% compared to only 4% for a mother with a singleton pregnancy. Although the risks to the mother are fairly mild, gestational diabetes can increase the risk of death to the unborn child or newborn baby
– Risks during or after birth
Childbirth in the UK is very safe. However, during birth, mothers of twins are more likely to require intervention, and are more likely to experience serious problems and to die than mothers of singletons:
- Caesarean section is very common among twin births because complications are more likely with twins (eg one or both babies are breech position)
- the risks of a range of other problems such as haemorrhage, diabetes in pregnancy and anaemia are also higher in twin births
- multiple births also carry the risk that, after the baby is born, the new mother will be at greater risk of stress and depression
Even less serious problems may result in the mother spending longer periods in hospital than would normally be necessary. She may have to be hospitalised for the last weeks of her pregnancy and the birth may have to be induced early.
– Risks to the baby
The health risks for twins and triplets are greatly increased compared to those for singletons, mostly because multiples tend to be born prematurely and underweight.
– Premature birth: the facts
Many twins and triplets are born prematurely:
- singleton babies are usually carried for about 40 weeks and tend to have normal birth weights
- at least half of twins are born before 37 weeks and with low birth weights, increasing their risk of serious health problems and death. Many are born before 35 weeks, when they often need neo-natal care. Their birth weight is around 800–1000g (1.8-2.2lbs) less than singletons.
- over 90% of triplets are born before 37 weeks and many are born so early that they have a greater risk of long-lasting, serious health problems or may die soon after birth
– What are the problems of premature births?
Prematurity can cause many problems and may even result in the death of the baby. Problems caused by prematurity range from those that, although serious, affect only the early stages of the child’s life, to those that have a devastating and lifelong impact.
– Early stage problems
- 40–60% of IVF twins need to be transferred to the intensive care unit when they are born. Only 20% of IVF singleton babies need the same level of specialised care
- 8% of twins need help with their breathing and 6% suffer from respiratory distress syndrome compared with 1.5% and 0.8% respectively for singletons
- the overall risk of death during birth or the first year of life is higher for twins than for singletons
- the risk of death around the time of birth is three to six times higher for twins and nine times higher for triplets
– Longer term problems
Problems that may affect twins and multiples after the early stages of life include:
- a small percentage of twins have severe health problems that will affect their entire lives (eg cerebral palsy, which affects between four and six times as many twins compared to singleton babies)
- prematurity and low birth weight carry the risks of lower IQ and is linked with Attention Deficit Hyperactivity Disorder (ADHD) and long-lasting behavioural difficulties
- problems with language development are more common with twins. Twice as many twins need speech therapy compared to singletons
- according to a Japanese study, in 7.4% of twin pregnancies, at least one child had a disability, such as cerebral palsy, impaired sight, or congenital heart disease
What are the chances of a twin pregnancy if two embryos can be transferred?
As long as two embryos are replaced, there is still a 1 in 4 risk of a multiple pregnancy and subsequent multiple birth, whatever the embryo grade replaced. If a patient wants to dramatically reduce this risk, she should consent only to a single embryo transfer.
The risk of twins, and even triplets, is much higher when the embryo is at blastocyst stage of development. The potential for the embryo to implant increases, but there is also a risk of one of the blastocysts splitting to form identical twins – leading to a triplet pregnancy if two blastocysts have been transferred. This is why only a single blastocyst transfer is recommended for patients with good grades of blastocysts.
What if a patient would still prefer to have two embryos transferred?
Midland Fertility, like all other clinics in the Midlands, has implemented the SET policy to minimise the risk and maximise the safety of all patients and their potential children. Patients with concerns about the policy are welcome to talk to Midland Fertility for further clarification. Or, for more information on the UK-wide SET initiative visit the One at a Time website
Go to the Midland Fertility Patient Treatment Information page and download:
- Egg Collection and Fertilisation
- Embryo Transfer and the 2 Week Wait
- Blastocyst Transfer
- Embryo Freezing
- Frozen Embryo Transfer
- Embryo Transfer and SET Policy
- Go to One at a Time website