1 Department of Obstetrics and Gynaecology, Helsinki University Central Hospital and 2 STAKES National Research and Development Centre for Welfare and Health, Helsinki, Finland
3 To whom correspondence should be addressed at: Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, PO Box 140, 00029 HUS, Finland. Email: aila.tiitinen{at}hus.fi
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Abstract |
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Key words: assisted reproduction technologies/cryopreservation/eSET/standard of success
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Introduction |
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The value of cryopreservation in eSET programmes |
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The outcome in FET cycles can be improved, and SET in frozenthawed cycles also has to be considered. During the years of our recent study, the amount of SETs in frozenthawed cycles increased from 28 to 66% and the implantation and pregnancy rates improved, from 13.5 to 30.0% and from 20.3 to 36.9%, respectively (Hyden-Granskog and Tiitinen, 2004). During the same period, multiple delivery rates have decreased from 21.8 to 7.9%. We want to suggest that when defining the standard of success in an ART programme, the quality of cryopreservation methods should be covered.
The contribution of embryo cryopreservation following IVF/ICSI provides further possibilities of pregnancy in addition to transfer in the fresh cycle. The contribution of cryopreservation to pregnancy has been reported to increase the baby take-home rate by 5.2% (Kahn et al., 1993) to 11% (Wang et al., 1994
) or even 19% (Bergh et al., 1995
). We analysed in a follow-up study all ETs carried out at our clinic during 19981999 (Tiitinen et al., 2001
). Following eSET (127 cases), the pregnancy per ET was 38.6% and after double embryo transfer (DET) it was 40.0%. The contribution of embryo cryopreservation in eSET cycles resulted in the cumulative delivery rate of 52.8% per oocyte retrieval after fresh and frozen transfers. After increasing the proportion of eSET cycles yearly, we still have deliveries in >50% of eSET cycles (Hyden-Granskog and Tiitinen, 2004
).
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Implementation of eSET in Finland |
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There are examples of increased use of eSET which have resulted in a reduction of multiple pregnancy rates. The twin pregnancy and twin delivery rates have decreased below 10% (Tiitinen et al., 2003; Söderström-Anttila et al., 2003
; Martikainen et al., 2004
), while the pregnancy and delivery rates have remained nearly unchanged. In the infertility clinic of Helsinki University Central, the number of eSETs increased from 11 to 60% during 19972003, and during this time the clinical pregnancy rate per ET was quite stable at 34.1% (range 30.339.8%). The multiple pregnancy rate decreased from 25% to
7%, while the mean number of embryos per ET decreased from 1.8 to 1.2 in 2003.
The number of fresh IVF/ICSI cycles in Finland has stabilized at 4500 cycles per year. According to Finnish IVF statistics, the proportion of SETs has increased since 1997, being near to 40% in 2002 (Figure 1). The effect of the increasing use of eSET can already be seen with the decrease in the proportion of multiple deliveries after ART in Finland (Figure 1).
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Conclusions |
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Our experience confirms the significance of eSET as a method to reduce the proportion of multiple pregnancies resulting from ART. The increased use of eSET can already be seen to be reducing the number of twin deliveries following ART in Finland and as a reduction of the proportion of multiple births in the Finnish Medical Birth Register (Figure 2).
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References |
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ESHRE (2004) The European IVF-monitoring programme (EIM), for the European Society of Human Reproduction and Embryology (ESHRE). Assisted reproductive technology in Europe, 2000. Results generated from European registers by ESHRE. Hum Reprod 19, 490503.
Gerris J, De Sutter P, De Neuborg D, Van Royen E, Vander Elst J, Mangelschots K, Vercruyssen M, Kok P, Eleseviers M, Annemans L, Pauwels P and Dhont M (2004) A real-life prospective health economic study of elective single embryo transfer versus two-embryo transfer in first IVF/ICSI cycles. Hum Reprod 19, 917923.
Hyden-Granskog C and Tiitinen A (2004) Single embryo transfer in clinical practice. Hum Fertil, in press.
Kahn J, von During V, Sunde A et al. (1993) The efficacy and efficiency of an in-vitro fertilization programme including embryo cryopreservation: a cohort study. Hum Reprod 8, 247252.[Abstract]
Land JA and Evers JLH (2004) What is the most relevant standard of success in assisted reproduction? Defining outcome in ART: a Gordian knot of safety, efficacy and quality. Hum Reprod 19, 10461048.
Martikainen H, Orava M, Lakkakorpi J and Tuomivaara L (2004) Day 2 single embryo transfer in clinical practice: better outcome in ICSI cycles. Hum Reprod 19, 13641366.
Martikainen H, Tiitinen A, Tomás C, Tapanainen J, Orava M, Tuomivaara L, Vilska S, Hyden-Granskog C, Hovatta O and the Finnish ET Study Group (2001) One versus two-embryo transfer after IVF and ICSI: a randomized study. Hum Reprod 16, 19001903.
Min JK, Breheny SA, MacLachlan and Healy DL (2004) What is the most relevant standard of success in assisted reproduction? The singleton, term gestation, live birth per cycle initiated: the BESST endpoint for assisted reproduction. Hum Reprod 19, 37.
Pinborg A, Loft A, Ziebe S and Nyboe Andersen A (2004) What is the most relevant standard of success in assisted reproduction? Is there a single parameter of excellence? Hum Reprod 19, 10521054.
STAKES (2004) Finnish IVF statistics 2002 and preliminary data for 2003. National Research and Development Centre for Welfare and Health, accessible at http://www.stakes.info/files/pdf/Tilastotiedotteet/Tt09_04.pdf.
Söderström-Anttila V, Vilska S, Mäkinen S, Foudila T and Suikkari AM (2003) Elective single embryo transfer yields good delivery rates in oocyte donation. Hum Reprod 18, 18531863.
Tiitinen A, Halttunen M, Härkki P, Vuoristo P and Hyden-Granskog C (2001) Elective single embryo transfer. The value of cryopreservation. Hum Reprod 16, 11401144.
Tiitinen A, Unkila-Kallio L, Halttunen M and Hyden-Granskog C (2003) Impact of elective single embryo transfer on the twin pregnancy rate. Hum Reprod 18, 4491453.
Wang XJ, Ledger W, Payne D, Jeffrey R and Matthews CD (1994) The contribution of embryo cryopreservation to in-vitro fertilization/gamete intra-fallopian transfer: 8 years experience. Hum Reprod 9, 103109.[Abstract]
Submitted on June 18, 2004; accepted on July 12, 2004.