Encouraging Single Embryo Transfer During In-Vitro Fertilization to Reduce Complications from Iatrogenic Multiple Births

Tufts Health Plan understands that the decision to seek fertility services may be a difficult, sensitive and highly emotional one for patients, their families and partners. Although multiple births from these interventions may be viewed by some patients as desirable, published data on the serious maternal, fetal and childhood risks of complications resulting from these “iatrogenic“ multiple births indicate that this quality of care issue needs to be addressed in a productive yet sensitive way.

There is clear published evidence that multiple births are associated with the following (not all-inclusive) adverse outcomes:

  • Increased risk of perinatal complications and death
  • Increased risk of death by age one by seven-fold for twins and 20-fold for triplets
  • Increased risk of preterm birth, associated complications and prolonged NICU care
  • Increased risk of intrauterine growth abnormalities resulting in complications and death
  • Increased risk of brain and spinal development abnormalities, with risk of cerebral palsy increased four-fold in twins and 18-fold in triplets
  • Increased risk of Cesarean section delivery and complications of pregnancy

Tufts Health Plan and its participating Fertility Centers have developed a Collaborative Statement on Single Embryo Transfer and have also worked together to develop a multi-pronged effort to reduce iatrogenic multiple births and their associated complications by increasing the use of single embryo transfer during IVF in good candidates.

Based on published scientific literature, as well as the guidelines from the Practice Committees of the Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine, Tufts Health Plan revised its Medical Necessity Guidelines for Infertility Services with regard to single embryo transfer. Those changes were announced in the February 2015 issue of Provider Update and were effective on April 1, 2015.

Tufts Health Plan and its participating Fertility Centers continue to work collaboratively to develop a communication plan for patients, members and providers, including shared decision-making tools to support the conversation between physicians and their patients regarding the benefits of undergoing single embryo transfer.

We are hopeful that providers will support this collaborative effort by discussing single embryo transfer with their patients and making early referrals to a reproductive endocrinologist when appropriate. This will help to improve the quality outcomes for patients and their children through the reduction of multiple-gestation pregnancies and the risks associated with multiple births.