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IVF study shows no benefit in transfer of three embryos

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The number of embryos transferred during in vitro fertilization has been a controversial topic for many years because multiple births are linked to much higher rates of medical problems for both mothers and babies as well as huge healthcare costs.

A study published Wednesday, one the largest analyses on the issue, concluded that doctors can consider transferring two embryos in some women but that there is no justification for transferring three or more embryos in any patient.

Several countries have already enacted legislation to bar transfers of two or more embryos -- or more than one embryo among women who have a good chance of pregnancy. In the United States, reproductive health leaders have also voiced support for transfers of only one or two embryos depending on the woman’s prognosis. However, the guidelines are voluntary. And although the popularity of multiple-embryo transfers has fallen, as recently as a few years ago, 40% of IVF treatment cycles in the U.S. involved transfer of at least three embryos, according to the authors of the new study.

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The study, appearing online in the journal Lancet, analyzes 124,148 IVF cycles in the United Kingdom, comparing the number of embryos transferred to patient age and other characteristics and rates of live births.

Not surprisingly, the live birth rate was greater in both women younger than 40 and women 40 and older when two embryos were transferred compared with one. However, the transfer of three embryos resulted in a lower live birth rate in the younger women compared with transferring two. And, among women 40 and older, the transfer of three embryos resulted in a live birth rate similar to two-embryo transfers.

The study confirmed that the risk of preterm birth was much higher when three embryos were transferred.

“A clear implication of our study, therefore, is that transfer of three embryos should no longer be supported in women of any age,” the authors wrote.

U.S. doctors, patients and policy-makers should take special note of the findings, Dr. Liv Bente Romundstad, a reproductive health specialist at St. Olav’s University Hospital in Norway, said in a commentary accompanying the study.

“Preterm deliveries that result from multiple pregnancies after assisted conception add a substantial financial burden to healthcare; in the USA, the annual cost is estimated to be around $1 billion,” she wrote.

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