Currently Quebec and very soon Ontario are the only provinces in Canada that have funding coverage for In Vitro Fertilization (IVF) treatment. An important pre-requisite for IVF Fertility funding is Single Embryo Transfer (SET) to minimize multiple pregnancies, including twins but a trade-off is a lower pregnancy rate compared to double embryo transfer (DET).
However, it has been reported that in women under 36 the combined pregnancy rates resulting from an unsuccessful “fresh” SET followed by a “frozen-thawed” SET approach those from a “fresh” double embryo transfer (DET)—but with no or low twin pregnancies in the former. The challenge is that in about 17% of the cycles, there may not be embryos for cryopreservation even among these young women. In addition, SET may not be appropriate for older women because of suboptimal embryo quality which may not be apparent on microscopic assessment.
Irrespective of provincial funding for infertility treatment, SET should be encouraged on its own merit for safe mother and child outcomes.
The following are some prerequisites for SET:
- Women under 36 years going through a first In Vitro Fertilization (IVF) cycle or with no previous failed IVF cycles
- Surplus embryos for freezing
- Quality of embryos, particularly development of an embryo to Day 5 after fertilization (“Blastocyst”)
- High risk patients irrespective of age where avoiding multiple pregnancy is paramount, e.g., uterine anomalies