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Couples Decline Single Embryo Transfer Even When Offered Financial Incentives; Many Desire to Have Twins

October 16 , 2013
by: ASRM Office of Public Affairs
Published in ASRM Press Release


Boston, MA-  A prospective pilot study presented at the IFFS/ASRM Conjoint meeting in Boston,  by Fady Sharara, MD of the Virginia Center for Reproductive Medicine and George Washington University focuses on the preferences of couples who have been incentivized to transfer single embryos.

From October 2012 through September 2013, (48) couples receiving ART treatment in which the women were under the age of 38 years old participated in a program to encourage them to transfer a single embryo.  Regardless of ovarian reserve status and insurance coverage, the couples were offered free gonadotropins, free freezing for their extra blastocysts, and a year of free cryo-storage of their blastocysts if they would agree to elective single embryo transfer (eSET). 

Thirty women consented to do eSET and 24 have completed their cycles with a clinical pregnancy rate of 71% (17/24) and ongoing pregnancy rate of 58% (14/24). Eighteen couples declined to participate because they wanted to have a chance of conceiving twins- after having been counseled on the increased risks associated with twin pregnancies.

Despite being offered significant incentives to have eSET, close to 40% of all eligible couples refused it.   Of 21 couples having insurance that provided coverage for at least one more IVF cycle, five (24%) declined eSET.  Of 27 couples who self-paid, 13 declined eSET (48%).   Those who did not have eSET were not motivated by fear that their chances of becoming pregnant would be imperiled- these patients actively desired to conceive twins.  Overall, however, the incentives were effective:  the clinic’s eSET utilization rate increased from under 10% to 62.5%. 

ASRM President Linda Giudice, MD, PhD, noted,  "Patients may feel compelled by years of frustration to accelerate their family-building by increasing their chances of having a twin pregnancy. While this is understandable, it is misguided, as SET and a resulting singleton pregnancy are considerably safer for children as well as pregnant women.  As we continue to educate patients on the risks of multiple gestation, we hope that those for whom eSET is appropriate will realize that for the same reasons eSET is right for them (they are younger and have a good prognosis), they will have the opportunity to have more than one pregnancy if they want more than one baby."

O-478       Despite significant financial incentives many couples still decline elective single embryo transfers (eSets)  F I Sharara 


Representing more than 50 fertility societies from around the globe, the International Federation of Fertility Societies (IFFS) is the world’s principal international fertility organization. The IFFS was founded in 1951, and held its first congress in New York in 1953. The IFFS mission is to stimulate basic and clinical research, disseminate education and encourage superior clinical care of patients in infertility and reproductive medicine. Website: 

The American Society for Reproductive Medicine, founded in 1944, is an organization of more than 7,000 physicians, researchers, nurses, technicians and other professionals dedicated to advancing knowledge and expertise in reproductive biology.  Affiliated societies include the Society for Assisted Reproductive Technology, the Society for Male Reproduction and Urology, the Society for Reproductive Endocrinology and Infertility, the Society of Reproductive Surgeons and the Society of Reproductive Biologists and Technologists

For more information on these press releases, contact: 

J. Benjamin Younger Office of Public Affairs
409 12th Street SW, Suite 203
Washington, DC 20024-2188
Tel: (202) 863-2494/Fax: (202) 484-4039


Sean Tipton
Phone: 202-863-2494


Eleanor Nicoll (for ASRM)
Phone: 240-274-2209


Tom Parkhill (for IFFS)


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