In-vitro fertilization (IVF) is a delicate balance between guaranteeing success that at least one of the embryos will develop and minimizing the risk of multiple birth. The recent birth of octoplets in the US has very dramatically raised awareness of the risk associated with multiple births and the variability in how IVF is performed, even with the existence of guidelines.
This story reports on a newer procedure, elective single-embryo transfer (eSET), in which only one embryo is implanted at a time. This procedure eliminates the risk of multiple births while appearing to have favorable pregnancy rates.
The story did a good job describing the costs, and alternatives. It adequately quantifies the pregnancy rate and multiple birth rate in women who get eSET and standard IVF. It quotes multiple sources who provide valuable perspective.
The story could have been improved by describing the availability of eSET. Clearly IVF is available, but it is not clear if elective single-embryo transfer (eSET) is widely available. Furthermore, the story could have provided more information on the evidence to support eSET. Although the story mentions a recent study, it does not describe whether this study provides strong evidence to support the procedure or not.
Finally, the story should have clarified that eSET is not a new method but rather a name for the active choice to transfer a single embryo in a women who could have been eligible for transfer of more than one. Elective single-embryo transfer is theoretically available to all women at facilities that provide embryo transfer at the stage of development known as the blastocyst stage. Readers may have benefitted from knowing the option can be discussed with any infertility care team.
The story describes the cost of treatment and conveys that insurance coverage is highly variable.
The story describes the pregnancy rate and percentage of pregnancies with multiples in women who received eSET and those who transferred two embryos.
Multiple gestation, prematurity, and bedrest are noted.
The story does not adequately describe the strength of the available evidence to support eSET. Although the story mentions a recent study, it does not describe whether this study provides strong evidence to support the procedure or not. The current study is not a randomized trial and therefore does not provide definitive proof that outcomes are comparable.
The story is clear on who would be a good candidate for eSET. The story quotes the ASRM guidelines, based on the woman’s age and quality of her embryos. The story also does not overplay the emotional or "tragic" aspects of infertility as news coverage of this topic often does.
The story quotes multiple sources.
The story mentions implantation of multiple embryos as the alternative to eSET and does a good job introducing cost trade-offs associated with those options.
The story is not clear on the fact that transferring a single embryo is always available. By labeling the procedure elective single-embryo transfer (eSET), the story creates the illusion that this is something special being offered by certain institutions.
The story is misleading in describing eSET as novel. Single embryo transfer has always been an option (thought in the past perhaps advised against because of cost implications).
Families have been asking for religious/moral reasons for some time to transfer single embryos. It has always been an option (though at times advised against because of cost and before techniques of embryo preservation because of embryo sacrifice). But in the last 5 to 10 years the option is available to anyone though perhaps not systematically introduced because of the pressures the article notes to have good pregnancy and live birth rates in the national registry for one’s program.
In this case their experts may have mislead them.
Because the story quotes multiple experts, the reader can assume the story did not rely on a press release as the sole source of information.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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