Single Embryo Transfer

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Hans van der Slikke, MD: "It's the 23rd of October 2001, and we're at the ASRM in Florida. Next to me is Dr. Peter Hompes from the Vrije Universiteit Medical Center in Amsterdam. We've known each other for a long time and we both work in the same clinic. Welcome, Peter."

P.G.A. Hompes, MD, PhD: "Thank you."

Hans van der Slikke, MD: "At this meeting you did a poster presentation about the factors to prevent multiple pregnancy and if possible you would select the patients suitable for a single embryo transfer."

P.G.A. Hompes, MD, PhD: "That's correct."

Hans van der Slikke, MD: "Could you tell me how you set this study up?"

P.G.A. Hompes, MD, PhD: "We started with a retrospective analysis of the last five years and that was from January of 1995 to December of 2000, and we looked over 8,862 embryo transfers in that period. We registered them and counted those who had 100% implantation and less than 100% implantation. We looked at a lot of factors such as age of the patient, secondary/primary infertility, numbers of embryos transferred, cause of infertility, quality of the embryos, and looked all those things over and compared it with the group with the 100% implantation rate and the less than 100% implantation rate."

Hans van der Slikke, MD: "How big were these two groups?"

P.G.A. Hompes, MD, PhD: "The 100% implantation rate was 419 patients and the less than 100% was 1,292 so if you put it all altogether that means that during that period we had an overall ongoing pregnancy score of 19.5%."

Hans van der Slikke, MD: "That's good, for the last five years."

P.G.A. Hompes, MD, PhD: "Yes, for the last five years."

Hans van der Slikke, MD: "And there may be a rise in this score?"

P.G.A. Hompes, MD, PhD: "Yes, absolutely, and it's ongoing."

Hans van der Slikke, MD: "What were the characteristics of this 100% pregnancy rate group?"

P.G.A. Hompes, MD, PhD: "That's what we checked out and looked at the statistically significant items - Age is one, the number of attempts is very important - it's also statistically different, the number of embryos transplanted, and the quality of the embryos. So there are four items that are very important and which had a statistical difference in our group and the rest didn't have any difference. What we then did was to make an analysis backwards, as if you already knew that. We looked at if we screened the patients of less than thirty-five years, with less than two or the same as two attempts, with two first class embryos replaced, and then made the analysis of how many patients had one-hundred percentage -- 483 had an absolutely positive pregnancy test. If you counted back, and you know from these figures that these patients would be the patient you would treat in a single embryo transfer, and you make your calculation back, then you come to a 20.7% ongoing pregnancy rate which is not statistically different from your normal and then your hyper-stimulated group."

Hans van der Slikke, MD: "This means that in this group if you would put back one embryo and use the same."

P.G.A. Hompes, MD, PhD: "In this specific group exactly the same, some are better but not different, in this group it is absolutely possible to put one back and of course that's what we are now coming to trial prospectively if we are true. So patients less than 35 years old, first attempt, more than two good quality-one embryos, and if they fit in these figures only put one back - that's the idea."

Hans van der Slikke, MD: "Is there a lot of pressure in the Netherlands from the patient to put just one embryo back like, let's say, in Sweden and Denmark?"

P.G.A. Hompes, MD, PhD: "Of course they know a lot about all the problems with multiple pregnancies, sure, and it's getting more and more. It means that a lot of patients ask you not to put more than two back but it's not a strong pressure that people say only put one back. But two, yes, that's more or less what we're doing now. On some occasions if we don't have really good quality embryos, sometimes we put three back but that's it."

Hans van der Slikke, MD: "Only if you are desperate."

P.G.A. Hompes, MD, PhD: "Exactly, that's the word but the pressure to do a single one is not so important. The patient always has the benefit of the doubt to get pregnant on the other end, and the fact is for a multiple pregnancy if it's only a twin, they'll more or less accept but of course we know all the problems it will be. But for their idea that's a risk they will take; a triple would be something completely different."

Hans van der Slikke, MD: "Thank you very much, Dr. Hompes."

P.G.A. Hompes, MD, PhD: "You're welcome."