Deep Dive

Multiple Embryo Transfer In America

There are risks and benefits to transferring multiple embryos per transfer but one thing is undeniable: we do more of it in America than almost any other developed country. While countries like Japan, Sweden, Finland and Australia have virtually eliminated multiple-embryo transfer, in the U.S. it still comprises 70% of our IVF procedures.

Since the data establishes younger patients, and patients with PGS-tested embryos are better candidates for single-embryo transfer, you’d imagine few, if any, still have multiple embryos transferred, right? As you can see from the data below, that is not the case.

This is a clear source of frustration for both the CDC and ASRM. While the percentage of multiple-embryo transfers is dropping, many feel it is not happening fast enough. Here are some thoughts on why that may be.

Clinicians Shape Decisions With Non-Standardized Information


The prevailing wisdom is that since U.S. patients are the customers and can shop around, they are the ones making this decision and thus to understand the broader issue, we need to focus on patient motivations. Patient perspectives are important, and we will get to those in a moment, but we cannot ignore the role doctors play in this process.

Here is what our own survey work found. First, the majority of patients believe their doctor has an equal say in this process. Second, doctors often make a recommendation and that guidance is followed.

So what are doctors telling patients? A wide variety of things. For instance, 39% of patients were not educated on the risks of multiple-embryo transfer to the offspring. What patients are told correlates with treatment decisions. Patients who are more educated on the risks of multi-embryo transfer were more likely to elect for single-embryo transfer. Those better educated on the benefits of multiple-embryo transfer were more likely to go that route. What doctors are telling patients, and recommending, clearly influences our rate of multiple-embryo transfer in this the country.

Clinicians Feel Pressure To Push Success Rates With Too Little Disclosure On Embryo Transfer


Patients care about outcomes and want to be at the clinic with the best success rates. Multiple-embryo transfers improve success rates because they increase the likelihood any given transfer will deliver a baby. Comparing success rates for clinics who do a lot of multiple-embryo transfer with those who are mindful of the risks, and thus do less, is an apples-to-oranges comparison when it comes to deciding which clinic is more skilled.

While the CDC and SART have tried to level-set this, most patients get their success data from the clinics, not from CDC or SART. We counted that 78% of clinics in California that market their success rates online do so like the clinic does below: with no mention of the number of embryos transferred, the frequency of multiple-embryo transfers, or twin rates.

eSET Clinic

Why does this matter? In this case you can clearly see in the chart below, this clinic does far more multiple-embryo transfers than the national average. They may be more skilled, or simply more willing to foist greater risk upon their patients. It’s hard to tell. But what has been
shown is that when clinics post higher success rates, they take market share, and so until we force clinics to report “embryos transferred” data in their promotional material, incentives will align towards more multiple-embryo transfer.

Everyone Wants To Save The Patient Money


Generally speaking, transferring multiple embryos in a single transfer delivers a baby more quickly than doing multiple, single-embryo transfers. Since each transfer costs $3,000, doing a multiple-embryo transfer may save the patient money in the near-term.

Clearly this is a factor. In our survey work, we noted fertility doctors were more likely to recommend a single-embryo transfer when the patient lived in a state with mandated IVF insurance. The implication being this patient would not pay personally for an extra transfer.

However, we don’t think this fully explains the issue of multiple-embryo transfer in the U.S.. First, as you can see in the above, 40% of patients living in mandated states are still actively guided towards multiple-embryo transfer. Second, when you look at the 2014 CDC data, it’s clear younger patients (good candidates for single-embryo transfer) living in insurance states still overwhelmingly have multiple-embryo transfers. Below is the data from Massachusetts, Illinois, New Jersey and Maryland. Conversely, a state like Delaware has no insurance mandate and only 25% of its IVF patients elect for multiple-embryo transfer. When it comes to multiple-embryo transfer, why does Illinois, a state with good reimbursement, look the rest of America and Delaware, with no reimbursement, look more like Japan? This is not just an insurance issue, in our minds.

Patients Are Divorced From Long-Term Financial Costs


As we mentioned, multiple-embryo transfer can save time and money having a baby, so it’s a tempting option. But multiple-embryo transfers lead to higher rates of multiple gestation pregnancies which are dangerous, and as you can see below, costly. In the U.S., most fertility patients don’t pay for these downstream costs, and as a result are divorced from the financial impact of a multiple-embryo transfer.

That is not the case in foreign countries, where the government pays for IVF cycles and all future medical expenses. These governments thus worry about the downstream costs of multiple-embryo transfers and overnight have practically eliminated them (Sweden in 2004, Japan in 2006).

We do have analogies in the U.S. and those would be employers like Apple, Google, Facebook, JP Morgan and Goldman Sachs. All of these business will only pay for IVF, or pay for more of it, by requiring the employee to be treated at clinics that have a track-record of single-embryo transfer. As a result, these employers claim to have employees who do far less multiple-embryo transfer. This is a good example of how a single payer & decision-maker winnows use of multiple-embryo transfer in an American construct.

Related Courses
73k

Embryo Transfer

Learn More
We cover how many embryos to transfer, medicated vs. unmedicated cycles, fresh vs. frozen, and the do's and don'ts on transfer day itself.
Featuring experts from
Columbia, NYU, +3 more
37k

PGT (PGS) Genetic Screening

Learn More
Giving you the full picture: where it helps, where it doesn’t, and how you might think about this expensive add-on based on your specific priorities.
Featuring experts from
NYU, Mount Sinai, +6 more
339k

IVF - In Vitro Fertilization

Learn More
The most complex fertility treatment, this course will help you do it right the first time.
Featuring experts from
Northwestern, Mount Sinai, +7 more
304k

IUI or "Artificial Insemination"

Learn More
Data on IUI success rates depending on who you are, what it costs, the risks, and how to decide between doing IUI and IVF.
Featuring experts from
Johns Hopkins, Northwestern, +6 more
63k

Lifestyle Choices, From Diet To Supplements

Learn More
All the data on lifestyle choices and their impact on fertility, including decisions around diet, exercise, drinking alcohol, caffeine consumption, smoking, recreational drugs, and using supplements.
Featuring experts from
Cornell, UCLA, +4 more
27k

Acupuncture

Learn More
Does acupuncture & traditional Chinese medicine really make a difference for fertility? See the data on IVF, other fertility treatments, and trying naturally with acupuncture and Chinese herbs.
15k

Endometriosis

Learn More
Breaking down all the data and information on what endometriosis is, how to best diagnose it, and what the best treatment is depending on who you are
Featuring experts from
Stanford
6k

Fertility 101

Learn More
You took sex ed, but now you need to understand fertility. Data to answer your questions about natural conception and diagnosing what might be wrong.
Featuring experts from
Stanford, Yale, +7 more
13k

ICSI

Learn More
ICSI costs $3–$5k but only improves birth rates in specific circumstances (hint: it’s not as simple as “helps with male factor”). We break down when it’s truly helpful.
Featuring experts from
Columbia, NYU, +6 more
43k

Male Factor Infertility

Learn More
Male factor infertility impacts anywhere between a third and half of a couple's difficulty in conceiving. The primary factors often end up being related to varicocele or some form of azoospermia. While a semen analysis can help characterize if there is an issue, the test can be inconsistent, difficult to interpret.
Featuring experts from
Mount Sinai, Cornell
5k

Surrogacy For Gay Dads: An Introduction

Learn More
Introducing the major decisions a gay couple or single man need to make to become fathers. We cover the costs of everyone involved, an intro to finding an egg donor & surrogate or gestational carrier, how state laws differ for gay and single dads, pros and con of twins, and finding a clinic as a gay or single man.
Featuring experts from
Cornell, Mount Sinai, +4 more
9k

The IVF Laboratory

Learn More
Lab quality determines success. This course explains how to vet a lab to give yourself the best chance of a good outcome.
Featuring experts from
Mount Sinai, NYU, +6 more
67k

Egg Freezing

Learn More
Preparing you to be a confident self-advocate as you make decisions around fertility preservation.
Featuring experts from
Mount Sinai, NYU, +3 more
Related Lessons