Is a Single Embryo Transfer (SET) Right for Me?

The decision of whether or not to undergo a single embryo transfer (SET) during in-vitro fertilization (IVF) is a deeply personal one, fraught with complex considerations. While multiple embryo transfers (MET) were once the standard, the shift towards SET has gained significant traction due to its reduced risk of multiple pregnancies, a major complication associated with IVF. This article aims to guide you through the factors to consider when deciding if SET is the right path for you.

What is a Single Embryo Transfer (SET)?

In SET, only one viable embryo is transferred to the uterus during an IVF cycle. This contrasts with MET, where multiple embryos are transferred simultaneously. The goal of SET is to increase the chances of a healthy singleton pregnancy while minimizing the risks associated with multiples.

What are the Advantages of SET?

• Reduced risk of multiples: This is the most significant advantage. Multiple pregnancies, a common complication of IVF, carry substantially increased risks of premature birth, low birth weight, developmental delays, and maternal complications like gestational diabetes and preeclampsia. SET dramatically reduces these risks.

• Improved pregnancy rates (in some cases): While it might seem counterintuitive, studies show that in certain patient populations, SET can lead to comparable or even higher live birth rates than MET in the long run. This is because focusing resources on one healthy embryo often yields better implantation and gestation outcomes.

• Reduced risk of pregnancy loss: Although not always definitively proven, some research suggests that SET can slightly lower the overall risk of miscarriage.

• Simplified pregnancy management: A singleton pregnancy is generally easier to manage than a multiple pregnancy, reducing the need for extensive monitoring and interventions.

What are the Disadvantages of SET?

• Lower chance of immediate pregnancy: The immediate chance of pregnancy in a single cycle is statistically lower with SET compared to MET. This is the primary reason many couples hesitate.

• Increased number of cycles needed: Because of the lower chance of success per cycle, you might require more IVF cycles to achieve a pregnancy using SET, leading to increased costs and emotional stress.

• Emotional toll: The uncertainty of waiting for another cycle after a failed SET attempt can be emotionally draining.

Who is a good candidate for SET?

The ideal candidate for SET is generally a patient with:

• Good quality embryos: The embryo needs to be of high quality to maximize the chances of successful implantation. This is usually assessed through morphological grading and potentially genetic testing (PGT-A).

• A history of successful implantations: If previous IVF attempts have resulted in successful implantations, SET is more likely to be successful.

• A strong uterine lining: A healthy and receptive uterine lining is crucial for embryo implantation.

• Younger age: Younger women tend to have better embryo quality and higher chances of successful implantation.

What are the considerations before deciding on SET?

Before choosing SET, carefully weigh the pros and cons with your fertility specialist. Key factors to discuss include:

• Your age: Older women may benefit less from SET due to decreased egg quality.

• Your AMH levels (Anti-Müllerian hormone): This hormone reflects ovarian reserve. Low AMH levels may suggest fewer viable eggs.

• Embryo quality: A thorough evaluation of your embryos is essential.

• Your overall health: Underlying health conditions could affect pregnancy outcomes.

• Your emotional capacity: SET requires patience and resilience, particularly if multiple cycles are needed.

• Your financial resources: Multiple IVF cycles can be expensive.

What about frozen embryo transfers?

SET is also applicable to frozen embryo transfers (FET). The same considerations apply, but the freezing and thawing process might slightly affect embryo viability.

How do I choose between SET and MET?

The decision should be made in close consultation with your reproductive endocrinologist or fertility specialist. They will consider your individual circumstances and medical history to provide personalized recommendations that align with your goals and preferences. Don't hesitate to ask questions and express your concerns. A thorough understanding of the risks and benefits is crucial for making an informed decision.

This information is intended for educational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional for any health concerns or before making any decisions related to your health or treatment.