Specialists’ Attitude toward Appropriate Number of Transferable Embryos in Assisted Reproductive Technology in Iran

Behjati Ardakani, Zohreh; Momeniha, Malihe Zaman; Azedi, Fereshteh; Kamali, Kourosh; Akhondi, Mohammad Mehdi

Specialists’ Attitude toward Appropriate Number of Transferable Embryos in Assisted Reproductive Technology in Iran

Authors

Zohreh Behjati Ardakani ¹

Malihe Zaman Momeniha ²

Fereshteh Azedi ³

Kourosh Kamali ⁴

Mohammad Mehdi Akhondi ¹

¹ Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran

² Avicenna Infertility Clinic, Avicenna Research Institute (ACECR), Tehran, Iran

³ Nanobiotechnology Research Center, Avicenna Research Institute (ACECR), Tehran, Iran

⁴ Monoclonal Antibody Research Center, Avicenna Research Institute (ACECR), Tehran, Iran

Abstract

Background: In recent years, the high likelihood of the implantation of transferred embryos has led to an increase in the number of multiple pregnancies and consequently an increased risk of complications in fetuses and mothers. Since the aim of infertility treatment is the birth of a healthy child while preserving the mother’s health, therefore, attempts should be made to avoid multiple pregnancies as much as possible besides maintaining the women’s chance of pregnancy by transferring an appropriate number of embryos. Methods: The population under study consisted of specialists (gynecologists and embryologists) who worked in ART clinics across the country and had attended an infertility congress in Tehran in 2008. The devised questionnaire enquired about the infertility specialists’ attitude towards the appropriate number of transferable embryos. The questions were designed on a Likert scale of strongly agree, agree, indif-ferent, disagree and strongly disagree. The scores of the questionnaire ranged from 0–60 which were later scaled up to 100 for ease of data analysis. Accordingly, scores below 50 were considered as “negative”, 50−75 “moderate” and greater than 75 as “positive”. Results: Overall, 9.9% of the specialists gained a score less than 50 (negative view), 67.3% between 50−75 (moderate) and 22.8% greater than 75 (positive view). Conclusion: The infertility specialists in Iran are relatively reluctant to transfer a high number of embryos for infertility treatments.

Keywords

Assisted Reproductive Techniques

Complications

embryo

Multiple pregnancies

U.S. Department of Health and Human Services Centers for Disease Control and Prevention. Assisted Reproductive Technology Success Rates. Atlanta: Centers for Disease Control and Prevention (CDC); 2006 Ombelet W, Campo R. Affordable IVF for developing countries. Reprod Biomed Online. 2007;15 (3):257-65.

Wang YA, Healy D, Black D, Sullivan EA. Age specific success rate for women undertaking their first assisted reproduction technology treatment using their own oocytes in Australia, 2002-2005. Hum Reprod. 2008;23(7):1633-8.

Stern JE, Cedars MI, Jain T, Klein NA, Beaird CM, Grainger DA, et al. Assisted reproductive technology practice patterns and the impact of embryo transfer guidelines in the United States. Fertil Steril. 2007;88(2):275-82.

Human Fertilization Embryology Authority [Internet]. London: HFEA; Multiple births and single embryo transfer review; 2009 April 7 [cited 2011 Oct 10]; [about 1 screen]. Available from: http:// www.hfea.gov.uk/530.html

Helmerhorst FM, Perquin DA, Donker D, Keirse MJ. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004;328(7434):261.

Koudstaal J, Braat DD, Bruinse HW, Naaktgeboren N, Vermeiden JP, Visser GH. Obstetric outcome of singleton pregnancies after IVF: a matched control study in four Dutch university hospitals. Hum Reprod. 2000;15(8):1819-25

Pinborg A. IVF/ICSI twin pregnancies: risks and prevention. Hum Reprod Update. 2005;11(6):575-93.

Lukassen HG, Schönbeck Y, Adang EM, Braat DD, Zielhuis GA, Kremer JA. Cost analysis of singleton versus twin pregnancies after in vitro fertilization. Fertil Steril. 2004;81(5):1240-6.

Sundby J. Infertility in the Gambia: traditional and modern health care. Patient Educ Couns. 1997;31 (1):29-37.

Pinborg A, Loft A, Schmidt L, Andersen AN. Attitudes of IVF/ICSI-twin mothers towards twins and single embryo transfer. Hum Reprod. 2003;18(3): 621-7.

Ahmadi SM, Akhondi MA, Behjati Ardekani Z. Embryo reduction in multiple pregnancies. J Reprod Infertil. 2005;6(4):441-9.

Koivurova S, Hartikainen AL, Gissler M, Hemminki E, Klemetti R, Järvelin MR. Health care costs resulting from IVF: prenatal and neonatal periods. Hum Reprod. 2004;19(12):2798-805.

van Peperstraten AM, Hermens RP, Nelen WL, Stalmeier PF, Scheffer GJ, Grol RP, et al. Perceived barriers to elective single embryo transfer among IVF professionals: a national survey. Hum Reprod. 2008;23(12):2718-23.

Berin I, Engmann LL, Benadiva CA, Schmidt DW, Nulsen JC, Maier DB. Transfer of two versus three embryos in women less than 40 years old undergoing frozen transfer cycles. Fertil Steril. 2010;93 (2):355-9.

Lee TH, Chen CD, Tsai YY, Chang LJ, Ho HN, Yang YS. Embryo quality is more important for younger women whereas age is more important for older women with regard to in vitro fertilization outcome and multiple pregnancy. Fertil Steril. 2006;86(1):64-9.

Berkowitz RL, Lynch L, Stone J, Alvarez M, Berkowitz RL, Lynch L, et al. The current status of multifetal pregnancy reduction. Am J Obstet Gynecol. 1996;174(4):1265-72.