Why don't we perform elective single embryo transfer? A qualitative study among IVF patients and professionals

BACKGROUND Elective single embryo transfer (eSET) enables the prevention of multiple pregnancies after in vitro fertilization (IVF). However, in Europe, the multiple pregnancy rate after IVF remains stable at ∼23%, with SET occurring in 15% of all IVF cycles. In most European clinics, the decision for the number of embryos transferred is established through a form of shared decision-making between patients and professionals. The aim of this study is to explore factors influencing this decision, in particular factors preventing eSET use. METHODS We performed explorative, semi-structured, in-depth interviews, based on two theoretical models. The interviews were performed among 19 Dutch IVF professionals and 20 patients who had just undergone IVF or were on the waiting list for IVF. The interviews were fully transcribed and two researchers independently scored the factors according to the models. RESULTS We identified a wide variety of factors, potentially influencing eSET use: 37 with the professionals and 26 among the patients. Examples of factors mentioned by both patients and professionals were: uncertainty about the eSET technique, couples' lack of knowledge about essential eSET aspects, absence of a reimbursement system which favours eSET, inadequate options to select couples suitable for eSET and inferior cryopreservation success rates. CONCLUSIONS This study demonstrates that both IVF professionals and patients identify numerous factors preventing eSET use in clinical practice. To estimate the impact of these factors identified, a quantitative confirmation and assessment of the magnitude of the effect is necessary.