Financial incentives for elective single embryo transfer (eSET)

I saw this headline the other day, “Doctor bucking trend by using one IVF embryo”, which talks about how at least one  physician is trying to make elective single embryo transfer (eSET) more appealing to patients. Dr. George Grunert with Fertility Specialists of Houston offers a “second transfer free” if first single embryo transfer doesn’t result in a pregnancy. He says, “If it doesn’t work, if you’re one of the 50 percent of people who doesn’t get pregnant, we’ll transfer that second embryo for free, and we’ll give you that second chance for pregnancy.”

You can see his SART pregnancy data from 2009 here.  Forty-three percent of transfers to women under 35 years of age resulted in live births. In 2009, he reported only 1.9% of the transfers in his program were eSET so perhaps this data was collected before initiating an incentive program.  His reported implantation rate (pregnancy rate per embryo transferred) was 30.6%. With an average of 1.9 embryos transferred, the program’s twin rate in the under 35 years of age group was 35.4% and his triplet rate was 1.8%.  What is remarkable about this program is that it represents the respectable middle of good programs, not an exceptional top 3 in the country program, crushing the premise that you need to have 60-70% pregnancy rates before  offering eSET.

So, in spite of having average pregnancy rates and no embarrassing “multiples issue to solve”,  this physician has taken the admirable stand of offering eligible patients a financial incentive for eSET, and for this I applaud him. I appreciate his efforts to reduce the financial risk for patients so that they can more easily make the decision to try eSET. There is no obvious financial incentive for the program to offer this– it actually costs them money to provide transfers for free but it is the right thing to do.  There is tons of evidence showing that singleton pregnancies have better medical outcomes for both mother and child than pregnancies with twins or more.

I don’t know if Dr. Grunert is “bucking a trend”, so much as being a pioneer in what lies ahead for every decent program. I realize that eSET is most appropriate for the under 35 years of age group- at least with our current understanding of which embryos are most capable of implantation- but as our ability to identify good embryos increases, perhaps everyone will be eligible for eSET one day.

I looked for other programs that offer a financial incentives for eSET and found this link to Reproductive Partners Medical Group’s blog in which they apparently considered the idea in 2009 and were soliciting patient ideas. One patient suggested a 100% refund and free second fresh cycle which obviously did not gain much traction with the program’s physicians. There is surprisingly little information about programs currently offering eSET that I could find on-line.

Does your program offer incentives for eSET? Would you do eSET if your doctor offered a free frozen transfer if the first fresh transfer failed? Have you ever asked your doctor for a financial incentive to do eSET if eSET was offered to you because you met eligibility requirements? If so, I’d love to hear about your experiences and I would like to acknowledge programs offering incentives to patients to promote singleton pregnancies. I think these brave programs need to be supported. Please comment below or privately via “Contact Me” if you wish to remain anonymous.




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©2011 Fertility Lab Insider. All Rights Reserved.



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