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Regional differences in elective single embryo transfer: is location everything?


Previous studies suggested significant regional differences in access to United States IVF centers(1), and some suggested that limited access is associated with patient decisions regarding number of embryos to transfer. Our objective was to investigate whether attitudes regarding elective single embryo transfer (eSET) and multifetal reduction are associated with geographic region.


Retrospective descriptive analysis of cross-sectional online survey.


An anonymous survey regarding eSET preferences and experiences was distributed through social media over a five-week span in 2014. This study focused on survey participants who completed at least one IVF cycle with embryo(s) transferred or who were planning to undergo IVF. Participants were grouped into US census regions (West, Midwest, South, and Northeast). Outcome variables included preference for single embryo transfer (defined as transferring one embryo when multiple were available) vs. multiple embryo transfer (MET), and potential likelihood of undergoing multifetal reduction if advised by a provider. Bivariate analyses were performed using chi-squared for comparison of proportions among groups. Significant associations (p<.05) were included in a subsequent logistic regression analysis.


759 of 888 participants met inclusion criteria. The largest percentage of survey participants (36%) came from the South, with 26%, 21% and 17% percent from the Midwest, Northeast and West respectively. When compared to the Midwestern participants, participants in the South (OR 1.96[1.14-3.38]), West (OR 2.74[1.47-5.1]) and Northeast (OR 1.96[1.07-3.61]) were significantly more likely to express a preference for eSET. Participants in the Northeast would be more likely to consider multifetal reduction (OR 1.86[1.18-2.95]) when compared to the Midwestern participants. There were no differences between the Midwest, South, and West with regard to the question of multifetal reduction.


Patients in the Midwest may be the least likely to elect eSET when compared with the other 3 US census regions. This may be due to sociocultural differences or to relative rurality and limited IVF access, making it more difficult for patients to travel for multiple IVF cycles. Targeted educational efforts may be particularly useful in this region. At the same time, patients in the Midwest may be less likely to consider multifetal reduction, at least in comparison to those in the Northeast. This may also be a result of sociocultural/religious differences or to a relative lack of education regarding the risks of multiples, and it represents another opportunity for targeted education in this region.

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