Decreasing Financial Burden Of IVF May Encourage Single Embryo Transfers, Reduce Multiple Births

Dmitry Kissin, MD Health scientist CDC Division of Reproductive Interview with:
Dmitry Kissin, MD
Health scientist
CDC Division of Reproductive Health

Medical Research: What is the background for this study?

Dr. Kissin: Due to the frequent transfer of more than one embryo during assisted reproductive technology (ART) treatments, such as in vitro fertilization (IVF), many ART-conceived children are born as multiples (twins, triplets and higher order). Multiple births, even twins, carry increased risk for both mothers and children. In the U.S., the practice guidelines published by the American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) provide recommendations on how many embryos to transfer in order to balance safety with the effectiveness of assisted reproductive technology. In an effort to reduce multiple births and associated complications, it is important to evaluate embryo transfer practices that contribute to these outcomes.

Medical Research: What are the main findings?

Dr. Kissin: Using data from the CDC’s National ART Surveillance System (NASS), we found that the majority of ART-related multiple births in the U.S. resulted from assisted reproductive technology cycles practiced in accordance with ASRM/SART guidelines and involved the transfer of two embryos. Almost half of ART-related multiple births resulted from transferring two fresh blastocysts (embryos cultured for 5/6 days) to favorable- or average-prognosis patients less than 35 years and donor-egg recipients, or two frozen/thawed embryos to patients less than 35 years.

Medical Research: What should clinicians and patients take away from your report?

Dr. Kissin: Clinicians practicing IVF know that the decision on the number of embryos to transfer is always a balance between trying to maximize the chance of pregnancy and minimize the chance of multiple birth. The substantial reduction of assisted reproductive technology-related multiple (both twin and triplet or higher order) births in the U.S. could be achieved by single embryo transfers among young patients or recipients of donor eggs.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Kissin: One of the major barriers to widespread implementation of single embryo transfer in the U.S. is the high out-of-pocket cost of assisted reproductive technology, often not covered by health insurance. Some countries have been successful in achieving marked reductions in multiple births when they removed financial pressures for infertility patients by covering assisted reproductive technology in exchange for mandatory single embryo transfer in the best prognosis groups. Future research on whether such approach will work in the United States is needed and requires coordinated efforts by multiple stakeholders, as outlined in CDC’s “National Public Health Action Plan for the Detection, Prevention and Management of Infertility”.


Fertil Steril. 2015 Apr;103(4):954-61. doi: 10.1016/j.fertnstert.2014.12.127. Epub 2015 Jan 27.

Embryo transfer practices and multiple births resulting from assisted reproductive technology: an opportunity for prevention.

Kissin DM1, Kulkarni AD2, Mneimneh A2, Warner L2, Boulet SL2, Crawford S2, Jamieson DJ2; National ART Surveillance System (NASS) group.

[wysija_form id=”1″] Interview with: Dmitry Kissin, MD (2015). Decreasing Financial Burden Of IVF May Encourage Single Embryo Transfers, Reduce Multiple Births