The Importance of Single Embryo Transfer in Modern IVF
Dr. Charles E. Miller has practiced fertility medicine for more than 35 years, witnessing firsthand how technology and standards of care have evolved. One of the most significant shifts in modern IVF is the move toward Single Embryo Transfer (SET) as the recommended best practice. In this blog, Dr. Miller explains the change and how it benefits patients today.
Background
When Dr. Miller first opened his IVF clinic in Naperville, Illinois in September 2001, the common practice was to transfer multiple embryos at one time. Two embryos would typically be transferred in hopes of increasing the chances of a successful pregnancy. Dr. Miller’s practice was successful, and the clinic soon earned the reputation of the “Twin Capital.” Because this was the standard at the time, patients going through treatment accepted it and sometimes even favored the practice, “embracing the idea of being ‘one and done’ in terms of family building” as put by Dr. Miller. However, sometimes multiple embryo transfers came with complications, or resulted in triplet pregnancies.
Hidden risks with multiple embryos transfers
In addition to the occasional triplet pregnancy, Dr. Miller noted that once per quarter, his patients would deliver prematurely. Most of the twin pregnancies would be delivered nearly at full term (36-38 weeks) but premature deliveries were usually due to cervical incompetence, where the cervix dilates too early. According to Dr. Miller, “the risk of delivery prior to 32 weeks was 2% for singleton pregnancies, 8% for twins, and 26% for triplets (i).” Even with healthy pregnancies and births, children were left with long-term health impacts like cerebral palsy, profound developmental delays, and severe sensory and motor disabilities. Other risks associated with multiples include:
- Preterm birth
- Low birth weight
- Higher rates of Neonatal Intensive Care Unit (NICU) admission
- Maternal complications
How technology changed the game
Thanks to advancements in the embryology lab, including cryopreservation techniques and having the ability to select a genetically normal embryo, via Preimplantation Genetic Testing for Aneuploidy (PGT-A), SET is the optimal method of transfer. Dr. Miller no longer performs two-embryo transfers, only SET, and has delivery rates of over 65%.
Why is SET the recommended approach?
The values of SET extend beyond its clinical outcomes. Not only is it more cost-effective with saved NICU visits, but it also reduces the emotional strain that can come with a high-risk pregnancy. Elevated stress from pregnancy with multiples is well documented, Dr. Miller citing a study in which “22% of mothers of multiples had Parenting Stress Index scores in the severe range, compared to 5% of mothers with singleton pregnancies conceived via IVF and 9% with singleton pregnancies conceived naturally (ii).” By shifting to SET, clinics and patients can experience reduced risks from multiple pregnancies and reach their family building goals more safely.
i Practice Committee of American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion. Fertil Steril. 2012 Apr;97(4):825-34.
ii. Glazebrook C, et al. Parenting stress in first-time mothers of twins and triplets conceived after in vitro fertilization. Fertil Steril. 2004 Mar;81(3):505-11.
Do's and Don'ts During the Two-Week Wait After Embryo Transfer
Transfer Day is an exciting and hopeful point on your fertility journey, but the two-week wait that follows can be a challenging period filled with stress, anxiety and impatience. To help you make the most of this crucial time, we consulted with Monika and Mel from our amazing IVF team. They shared some important do's and don'ts to help you through the two-week wait post embryo transfer.
❌Don't Google - Trust Your Medical Team for Guidance
We know it’s tempting, but one of the most common instincts during the two-week wait is to turn to Google for answers and reassurance. However, this can lead to unnecessary stress and confusion. Remember your fertility journey is unique to you and best understood by your medical team. Rely on their expertise and guidance to ease your concerns and not Dr. Google.
✅Follow Medication Instructions
Unless instructed otherwise by your doctor, make sure to continue your medication regimen. Medications like progesterone help support embryo implantation. Consistency in following your doctor's orders is key to your success.
❌Don't Take a Pregnancy Test
It's natural to be anxious and eager to confirm a positive outcome, but taking a home pregnancy test too early can be inaccurate and potentially lead to disappointment. These tests may show a negative result because it's too soon to detect the necessary hormone levels. Or, in some cases, they might show a positive result, but the pregnancy may not continue to develop as expected. Instead, wait for the blood test, which provides more accurate and reliable results.
✅ Rest on Transfer Day, but Stay Active
While it's important to take it easy on the day of the embryo transfer, this doesn't mean you need to spend the entire two weeks in bed. Light activities such as walking can actually help boost blood flow, potentially benefiting the implantation process.
❌ Don’t Have Sexual Intercourse
To support the best conditions for the embryos to implant, refrain from sexual intercourse and orgasm during the two-week wait. This helps prevent uterine contractions that may interfere with the process.
✅ Do Delay Having a Bowel Movement
After the embryo transfer, it's wise to avoid any activities that might strain the pelvic area, including pushing during a bowel movement. Wait for about 5 hours before trying to have a bowel movement.
❌ Don't Drink Alcohol
During this critical period, it's best to maintain a healthy lifestyle, including your diet. Avoiding alcohol and focusing on a well-balanced diet is essential.
✅ Try to Relax and Manage Stress and Anxiety
Stress and anxiety are natural during the two-week wait, but managing these emotions is crucial. Consider relaxation techniques such as acupuncture, yoga, journaling or simply pampering yourself. A calm mind supports your fertility journey.
Always remember to follow the specific instructions provided by your dedicated care team. They are here to support and guide you through this journey. You're not alone, and we're here for you every step of the way.
For any concerns or questions, don't hesitate to reach out to our team. We're here to provide the care and assistance you need.
Her Own View: A Patient’s Journey Through IVF- And The Results Are In...
Well... Dan and I are happy to announce, we are PREGNANT!! Dr. Miller has done it again! I took the beta test 10 days post 5 day transfer (10dp5dt), and my level was 428. To ensure you have a viable pregnancy, beta levels must double every 48 hours. I had to do a repeat blood test 13dp5dt to make sure my levels were doubling, and they were over 2600. This was exactly what we wanted to see and meant I had a viable pregnancy!
A week later, I went in for repeat blood test/ultrasound, and we saw a yolk sack and heard a heartbeat of 120 beats per minute. When the ultrasound tech was looking for the heartbeat, she had a blank face, and I was just trying to stay calm. Then I heard the heartbeat and felt such relief. I know you are thinking, “why isn’t she more excited?” I feel that after you have had losses you can never truly enjoy the moment. It’s always like “well, I hope I see a heartbeat the next time.” You only know there is a baby in there while you’re seeing it on the screen. As soon as you leave the doctor’s office, you’re anxiously awaiting the next ultrasound. But, you have to celebrate the little things so Dan and I remained cautiously optimistic…a term that perfectly describes this process.
My beta levels were also checked again and they had increased appropriately! I am experiencing pretty bad nausea (yay!), but I am trying to eat light and healthy. Thankfully, I have not experienced any bleeding, which is markedly different that my other pregnancies and makes this pregnancy feel a little different.
I am still on daily Progesterone in Oil shots (100mg), Estradiol (8mg), Lovenox 40mg, Baby Aspirin, synthetic Folic Acid and a prenatal vitamin.
I’m almost 7 weeks pregnant now, so everything is moving in the right direction. To be completely honest with you all, I am still hesitant to let myself feel completely happy due to my history of miscarriage, so I’m going to weekly therapy to help process my feelings. Every time before I go to the bathroom, I wonder if I’ll see spotting or bleeding. Fortunately, each week passes and so far we are where we need to be. My next appointment is in about a week and I will see Dr. Miller every week until I am 8 weeks at which time I will graduate to seeing my regular OB.
Dan and I hope and pray for a successful and healthy pregnancy! Wish us luck!
-Katie
Her Own View: A Patient’s Journey Through IVF- Transfer Day!
We made it!! Transfer day is finally here! I’ve spent the last few weeks prepping for the Frozen Embryo Transfer (FET). As you might have seen from the last post, preparation includes taking Progesterone in Oil (PIO) shots, Estradiol in varying dosages and other such medications. The preparation for the FET was nothing compared to the preparation for retrieval. The varying dosages can get a little tricky, but the nurses give detailed instructions so we were well-prepped for the routine. I also had to go in for bloodwork and an ultrasound to make sure my levels are good, and that the uterine lining is thick enough for the FET. Luckily, everything went according to plan, and we transferred a beautiful, hatching blastocyst this morning!
Going into the procedure, I had a lot of nervous energy, not only the day of, but the day before. I had waited SO long for this day that I was almost in disbelief that it was finally here!
This morning, I had to be at the Naperville office at 6:15AM for a 6:45AM procedure. Dan and I were taken in around 6:30AM and were both asked to put on scrubs. Dan was allowed to put his scrubs on over his clothes; however, I was asked to take off my bottoms (for obvious reasons!). The embryologist then came into the room and informed us they successfully thawed one embryo and noted that assisted hatching was not necessary since it was already hatching out of its shell! She also verified we were only transferring one. We chose to transfer only one embryo, because the possibility of having twins scares me! Also, my insurance covers IVF so I can do one transfer at a time without paying additional fees.
Once we got into the room, I was on a chair with my legs propped up (very similar to when you have your retrieval). The major difference is this time, you’re completely awake! Next, the x-ray tech came in and took some pictures of my cervix and uterus. Then Dr. Miller came in and was very jovial as usual! He said everything looked good, and proceeded to insert the catheter. This part made me feel a little crampy, but the feeling only lasted a minute so it wasn’t too bad – I would compare it to an intense pap. Then the embryologist brought our little embryo out in what looked like a really skinny straw. Dr. Miller inserted the skinny straw into the catheter, and voila, I’m pregnant (until proven otherwise)! Dan and I were able to watch everything on the x-ray screen. We couldn’t see the actual embryo since it’s microscopic, but we were able to see the air bubbles around it. It’s hard to tell in the picture below, but the embryo is the white speck in the middle of the picture. Dr. Miller reiterated that everything went as well as we could have asked for and wished us good luck!
The actual procedure only took 10 minutes and we were in the room for about 30 minutes. After I got dressed, the nurse gave us discharge instructions. I took today off from work, so I could rest and relax and will be working from home tomorrow. So far, I have stayed on the couch most of the day, but I did fold laundry and walk around a bit. I plan to take walks, but don't plan on going to the gym, because I can't have my heart rate over 140 or lift anything over 15 lbs. I was also instructed to stay on my medications until further notice. The nurse also said I might experience some bleeding. I did have some bleeding later in the morning (which is not something anyone wants to see if they are trying to get pregnant), but now, several hours later, it has mostly subsided.
Now we wait…and wait…and wait. I will take the pregnancy blood test 10 days from now. I’m excited, nervous and scared, but I think all those feelings are normal. I hope to update you all with good news in a few days. Wish us luck!
-Katie