A single, healthy baby is the best possible outcome of fertility treatment. Despite this, some patients worry that single embryo transfer (SET) may compromise their chances of getting pregnant.
Professionals working in the fertility sector who are responsible for the safety and welfare of patients and children conceived through fertility treatment, are also responsible for advising patients who are eligible for SET that this is the best, and safest, course of treatment for them.
The following points are based on feedback gathered from UK centres at a series of ‘One at a Time’ workshops and from patient questionnaires:
Patients look to clinic staff to make informed decisions about their treatment, which is why it’s so important that all members of the multidisciplinary clinic team understands their centre’s SET policy and has a consistent approach when advising patients. Clinics which have achieved a significant reduction in their multiple birth rates have found that giving patients clear information on the risks of multiple pregnancy and consistent advice on the recommendations greatly reduces their concerns around SET.
Most patients who choose SET do so because they are advised by their clinic that this is the best course of treatment and they trust their clinic’s opinion. Take time to build relationships with patients so they have confidence in the recommendations of clinic staff.
Patients are more likely to agree to SET when information about multiple births and SET is given at the beginning of the patient’s pathway, for example at a patient information evening. This initial information should then be reinforced by clear, consistent information about SET at every stage of treatment, and by every member of the patient’s clinical team.
Allow patients to access information in a variety of formats, such as face to face with a staff member, over the phone, at information evenings, in print and online. Patients should also be encouraged to visit the One at a Time website.
The majority of patients choose SET because their clinician recommends this as the best course of treatment for them. It may be useful to focus on addressing common concerns and misconceptions that patients have about SET. Infertility Network UK and the Multiple Births Foundation have prepared two leaflets; one for healthcare professionals and the other for patients, which help to answer common concerns that patients have about SET:
It is important to emphasise to patients that SET is not a blanket policy for everyone. Reassure your patients that the experienced professional staff involved in their care will assess their case individually to determine the best course of treatment for them.
If patients are concerned their chances of having a baby may be lower with SET, reassure them that clinics across the UK have successfully lowered their multiple pregnancy rate without reducing the overall pregnancy rate. In fact, research shows that some patients can have an increased chance of conception following SET if you consider cumulative success rates of fresh and subsequent frozen cycles.
If you have good local data, which advocates SET, you may want to share this with patients for further reassurance.
The best way to advise patients about SET will be developed by individual clinics, taking into consideration non-clinical factors, such as NHS funding criteria. Therefore it is important that each clinic undertakes regular audits of its multiple births minimisation strategy and includes evaluation of how patients respond to the information they are given about SET. In this context, it is useful to read about other clinics’ experiences of implementing and reviewing their multiple births minimisation strategies.
“There must be a consistent message from all staff to ensure patients have confidence and accept single embryo transfer as the norm.”
Rachel Cutting, MBE, Principal Embryologist, Jessop Fertility
“There is no substitute for engaging the couple in regular discussion about the number of embryos to transfer. Fertility nurses are well placed for communicating the risks and benefits of eSET in appropriately selected patients throughout treatment. In addition, explanation of the evidence and information available - for individual chance of success - coupled with compliance and trust in clinic expertise and recommendations, will ensure the successful maintenance of eSET programmes, and most importantly, improve the outcome for both mother and baby.”
Val Peddie, Fertility Nurse Specialist, Aberdeen Centre for Reproductive Medicine