DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20191926

Single embryo transfer and multifetal pregnancy reduction: perception and attitude of women seeking assisted reproduction in Nigeria

M. E. Aziken, Osaikhuwuomwan J. A., Iribhogbe O. I.

Abstract


Background: In-vitro fertilization (IVF) is associated with increased multiple pregnancy and its attendant complications. This study evaluates the attitude and acceptance of single embryo transfer (SET) and multifetal pregnancy reduction (MFPR) by clients assessing assisted reproduction in this region.

Methods: A cross sectional survey of patients selected for IVF was conducted. Information on demography, knowledge of IVF procedure and their perception, attitude and acceptability of multiple pregnancy as well as their knowledge, attitude and perception to single embryo transfer and multifetal pregnancy reduction were extracted for statistical analysis.

Results: Seventy-three women participated in the study. The mean age was 39 years and mean duration of infertility was 8.6 years. Only 3 (4.1%) respondents agreed to have SET as the overwhelming majority (70) 95.9% preferred 2 or more and they felt the more number of embryo transferred the better the chances of achieving pregnancy. Similarly most respondents, 38.4% (28) did not accept MFPR. Most respondents considered age (63%) and duration of infertility (78.1%) as major influencing factor for rejecting SET. Over 75% of respondents said they will still accept multiple embryos transferred despite knowledge of the possible complications.

Conclusions: While most infertile women in our sub region appear to recognize the risks with multiple pregnancy, they are less interested in SET or MFPR because they perceive more embryos transferred as a means to maximize treatment outcome. Government funding, client education and a blastocyst transfer protocol may improve acceptability as well as overall preference for less number of embryos transferred in our environment.


Keywords


Embryo transfer, Infertility, In-vitro fertilization, Multifetal pregnancy reduction, Multiple pregnancy, Single embryo transfer

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References


Wang J, Sauer MV. In vitro fertilization (IVF): a review of 3 decades of clinical innovation and technological advancement. Ther Clin Risk Manag. 2006;2:355-364.

Audibert C, Glass D. A global perspective on assisted reproductive technology fertility treatment: an 8-country fertility specialist survey. Reprod Biol Endocrinol. 2015;13:133.

Mills MS, Eddowes HA, Cahill DJ. A prospective controlled study of in-vitro fertilization, gamete intra-fallopian transfer and intrauterine insemination combined with superovulation. Hum Reprod. 1992;7:490-4.

Connolly MP, Hoorens S, Chambers GM. The cost and consequences of assisted reproductive technology: an economic perspective. Hum Reprod Update. 2010;16(6):603-13.

Bhatti T, Baibergenova A. A comparison of the cost-effectiveness of in vitro fertilization strategies and stimulated intrauterine insemination in a canadian health economic model. Obstet Gynaecol Can. 2008;30(5):411-20.

Okohue JE, Onuh SO, Ikimalo JI, Wada I. Patients’ preference for number of embryos transferred during IVF/ICSI: A Nigerian experience. Niger J Clin Pract. 2010;13:294-7.

Elster N. Less is More: The Risks of Multiple Births. Fertility and Sterility. 2000;74(4):617-23.

Mansour RT, Aboughlar MA, serour GI, Amin YM. Multifetal pregnancy reduction: modification of the technique and analysis of the outcome. Fertile Steril. 1999;71:380-4.

Blondel B, Kogan MD, Alexander GR. The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: an international study. Am J Pub Heath. 2002;92(8):1323-30.

Hobbins JC. Selective reduction: a perinatal necessity? N Eng J Med. 1988; 318:1062-3.

Fujii S, Fukui A, Yamaguchi E. Reducing multiple pregnancies by restricting the number of embryos transferred to two at the first embryo transfer attempt. Hum. Reprod. 1998;13,3550-4.

De Sutter P, Van der Elst J, Coetsier T, Dhont M. Single embryo transfer and multiple pregnancy rate reduction in IVF/ICSI: a 5-year appraisal. Reprod Biomed Online. 2003;6:464-9.

Henman M, Catt JW, Wood T. Elective transfer of single fresh blastocysts and later transfer of cryostored blastocysts reduces the twin pregnancy rate and can improve the in vitro fertilization live birth rate in younger women. Fertil Steril. 2005;84:1620-7.

Tiitinen A, Halttunen M, Härkki P, Vuoristo P, Hydén-Granskog C. Elective single embryo transfer: the value of cryopreservation. Hum Reprod. 2001;16:1140-4.

Ryan GL, Zhang SH, Dokras A. The desire of infertile patients for multiple births. Fertil Steril. 2004;81:500-4.

Child T, Henderson AM, Tan SL. The desire for multiple pregnancy in male and female infertility patients. Hum Reprod. 2004;19:558-61.

Lynch L, Berkowitz RL, Chitkara U. First trimester transabdominal multifetal pregnancy reduction: a report of 85 cases. Obstet Gynecol. 1990;75:735-8.

Yovel L, Yaron Y, Amit A. Embryo reduction in multifetal pregnancies using saline injection: comparison between the transvaginal and transabdominal approach. Hum Reprod. 1992;7:1173-5.

Iberico G, Navaro H, Blasco L, Simon C, Pellicer A and Remohi J. Embryo reduction of multifetal pregnancies following assisted reproduction treatment: a modification of the transvaginal ultrasound guided technique. Hum Reprod. 2000;15(10): 2228-33.

Kissin DM, Kulkarni AD, Mneimneh A, Warner L, Boulet SL, Crawford S, et al. Embryo transfer practices and multiple births resulting from assisted reproductive technology: an opportunity for prevention. Fertil Steril. 2015;103(4):954-61.

Twisk M, van der Veen F, Repping S, Heineman MJ, Korevaar JC, Bossuyt PM. Preferences of subfertile women regarding elective single embryo transfer: additional in vitro fertilization cycles are acceptable, lower pregnancy rates are not. Fertil Steril. 2007;88(4):1006-9.

Velez MP, Connolly MP, Kadoch IJ, Phillips S, Bissonnette F. Universal coverage of IVF pays off. Hum Reprod. 2014;29(6):1313-9.

Chambers GM, Illingworth PJ, Sullivan EA. Assisted reproductive technology: public funding and the voluntary shift to single embryo transfer in Australia. Med J Aust. 2011;195(10):594-8.

Jones GM, Trounson AO, Lolatgis N, Wood C. Factors affecting the success of human blastocsyt development and pregnancy following in vitro fertilization and embryo transfer. Fert Steril. 1998:70(6):1022-9.

Swain JE, Carrell D, Cobo A, Meseguer M, Carmen R, Smith GD. Optimizing the culture environment and embryo manipulation to help maintain embryo developmental potential. Fertil Steril. 2016;105(3):571-87.

Van Peperstraten A, Nelen W, Grol R, Zielhuis G, Adang E, Stalmeier P, et al. The effect of a multifaceted empowerment strategy on decision making about the number of embryos transferred in in vitro fertilisation: randomised controlled trial. BMJ. 2010;341:c2501.