The policy was based on female age and embryo quality. Patients were advised on the number of embryos suitable to be replaced on the basis of their individual circumstances, as depicted in figure 1.
The policy was discussed with patients at their consultation, at information evenings and presented to them in the form of posters and information booklets.
Overall compliance with the policy was good (97.7%). Patients responded well to the policy change, having been provided with detailed information from the beginning of their treatment pathway and consistently throughout their cycle. 91.3% of patients felt that the information they were provided with was helpful and 94.2% felt that their views were listened to and incorporated into their plan of care (information from patient satisfaction surveys, 169 respondents).
Overall the target for 2009 has been comfortably met and assuming continued application of this policy and patient compliance the target of <20% for 2010 will also be achievable. However, monthly fluctuations in multiple birth rates do serve to highlight that there is scope for improvements to be made.
During the last 12-18 months the results have been closely monitored. Two features were identified;
1. The high multiple birth rate for patients aged 35 years or less who had two cleavage stage embryos replaced (36.2%).
2. The high multiple birth rate for patients aged 36-38 years who had two blastocysts replaced (37.5%).
The aim for 2010 will be to transfer one good quality blastocyst in patients aged 35 or less by further increasing the use of extended culture. We now have improved confidence and success rates from blastocyst stage ET’s.
Furthermore, we have improved consistency between operators in grading and selecting embryos / blastocysts and the results from our blastocyst freezing programme are very encouraging.
Patients aged 36-38 years who have two good quality blastocyst available will be strongly advised to have one blastocyst replaced and to consider freezing any surplus blastocysts.
Over the last 18 months our policy has had to be adapted to ensure the correct patients are selected for eSET. Pregnancy rates have not been compromised. The focus for this year will be to reduce double blastocyst transfers and to capitalise on the success achieved with frozen blastocyst stage transfers to improve cumulative pregnancy rates.
Vitrification offers the promise of improved survival rates, permitting the vitrification of single blastocysts.