The majority of patients receiving in vitro fertilization (IVF) treatment at University of Iowa Hospitals and Clinics support the hospital's policy of transferring a single embryo over transferring multiple embryos at once, according to a recent survey.
Ninety-four percent of the 262 patients surveyed supported the policy, which allows the transfer of just one embryo at a time for patients with the best prognosis, and 95 percent of patients said they had the right amount of input in their IVF treatment. A slightly smaller number -- 87 percent -- indicated they had the right amount of input into the number of embryos that were transferred. Six percent of the initial 262 respondents indicated they were "not at all supportive" of the program.
"We ended up being very encouraged by the results," said Ginny Ryan, MD, assistant professor of obstetrics and gynecology and director of the Pediatric and Adolescent Gynecology Clinic. "Most people said they had the right amount of say."
The 2004 policy states that women under age 38 with the best prognosis receive just one embryo per treatment, Ryan said. She told a Canadian audience of reproductive-medicine specialists earlier this month that since the policy was implemented the number of treatments has remained about the same and the pregnancy rates have increased, but the number of multiple pregnancies has dropped from 34.8 percent to 17.5 percent.
The policy of single embryo transfer included an enhanced educational component outlining the risks of twins for mothers and infants, Ryan said.
She said doctors and administrators at UI Hospitals and Clinics implemented the policy after studying the high success rate among IVF patients and the increased risks that come with multiple births -- including greater risk of a child born with cerebral palsy and higher instances of premature births.
"We started this project wondering whether people really desired to have twins and would they still desire to have twins if they knew the risks involved," Ryan said. "If you educate these patients then they will improve their knowledge about twin risks and can then decide if they truly desire twins."
Though the support levels for a single embryo transfer were initially high, that support dipped in a follow-up survey among those with unsuccessful embryo transfers. Of the 38 women whose transfers did not result in pregnancy and who responded to both surveys, nearly half of them – 47 percent – reported a lower level of support.
Ryan said that while the survey results weren't surprising they did reinforce the need to educate patients; the highest levels of support were found in patients who were concerned about the risks of twins, as well as those who had extra embryos stored in the freezer and those who were happiest with the amount of input they had.
The policy change has helped increase the hospital's success rate as well as decrease the multiples rate, thereby improving the safety for patients, Ryan said.
"Our pregnancy rates continue to be among the top in the country, and our twin rates have gone down," she said. "It was important to us to be able to talk to our patients and get their feedback."