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Demographic characteristics associated with elective single embryo transfer in IVF: who chooses just one?


Younger patient age has been found in previous IVF studies to be associated both with desire for twins and the choice of single embryo transfer; we sought to examine this and other demographic and geographic parameters in relation to elective single embryo transfer (eSET).


Descriptive analysis of online survey results from a cross-sectional sample of U.S. community women.


An online survey, advertised through RESOLVE (the National Infertility Association) was conducted over 5 weeks in 2014. Interested participants were screened for gender and cycle eligibility and gave consent by acknowledging an online privacy statement. Inclusion criteria were age < 40 and the completion of at least one IVF cycle with embryo transfer. Participants were asked to identify their age, race, income, highest education completed, and insurance coverage in the survey. The outcome of interest was the election of single embryo transfer (eSET, defined as multiple embryos available for transfer but electing a single embryo transfer) versus multiple embryo transfer (MET) in the first IVF cycle. We examined geographic characteristics by US Census region and by state IVF access quartile, as previously published.1 All variables, including age and income, were categorical, and X2 was used to compare proportions among groups.


Of 888 participants, 587 met age and cycle inclusion criteria. Participants who chose eSET tended to be younger than those choosing MET, with 25% of participants under 29 choosing eSET, compared to 12% of those aged 35-39 (p=0.014). Education level, race, income, and insurance coverage for infertility did not differ between eSET and MET groups. There was no association between eSET or MET with regard to accessibility to IVF in the participant’s state. When comparing patterns of eSET and MET according to US Census region, patients from the Midwest were significantly more likely to choose MET over eSET (91% for the Midwest vs an average of 80% for other census regions, p=0.003).


Even in patients <40 years old, younger age may be associated with electing to transfer a single embryo in a first IVF cycle. Reassuringly, other non-modifiable demographic characteristics such as education, race, ncome and insurance status may not be as vital as once thought in the decision-making around embryo transfer number. Patients and providers in the Midwest US census region may particularly benefit from increased education about the risks of MET.

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