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Deciding how many embryos to transfer: ongoing challenges and dilemmas

Despite the risks associated with twin and higher-order multiple births, and calls in many countries for single-embryo transfer as the standard of care for good-prognosis patients, providers frequently transfer additional embryos, raising critical questions as to why this is the case and what can be...

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Detalles Bibliográficos
Autor principal: Klitzman, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846681/
https://www.ncbi.nlm.nih.gov/pubmed/29541689
http://dx.doi.org/10.1016/j.rbms.2016.07.001
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author Klitzman, Robert
author_facet Klitzman, Robert
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description Despite the risks associated with twin and higher-order multiple births, and calls in many countries for single-embryo transfer as the standard of care for good-prognosis patients, providers frequently transfer additional embryos, raising critical questions as to why this is the case and what can be done about it. In-depth interviews of approximately 1 h each were conducted with 27 IVF providers (17 physicians and 10 other healthcare providers) and 10 patients. Professional guidelines often contain flexibility and ambiguities or are unenforced. Thus, both providers and patients frequently wrestle with several dilemmas. Decisions about the number of embryos to transfer emerge as dyadic, dynamic and affected by several factors (e.g., providers’ type of institution, and personal and professional experiences and perceptions of the data), leading to differences in whether, how and with what effectiveness clinicians address these issues with patients. Many clinicians feel that the evidence concerning the apparent increased risk associated with a twin birth is not ‘compelling’, and patients frequently minimize the hazards. These data, the first to explore several critical aspects of how providers and patients view and make decisions about the number of embryos to transfer, thus highlight tensions, uncertainties and challenges that providers and patients confront, and have key implications for future practice, research, policy and education.
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spelling pubmed-58466812018-03-12 Deciding how many embryos to transfer: ongoing challenges and dilemmas Klitzman, Robert Reprod Biomed Soc Online Ethics, Law and Religion Despite the risks associated with twin and higher-order multiple births, and calls in many countries for single-embryo transfer as the standard of care for good-prognosis patients, providers frequently transfer additional embryos, raising critical questions as to why this is the case and what can be done about it. In-depth interviews of approximately 1 h each were conducted with 27 IVF providers (17 physicians and 10 other healthcare providers) and 10 patients. Professional guidelines often contain flexibility and ambiguities or are unenforced. Thus, both providers and patients frequently wrestle with several dilemmas. Decisions about the number of embryos to transfer emerge as dyadic, dynamic and affected by several factors (e.g., providers’ type of institution, and personal and professional experiences and perceptions of the data), leading to differences in whether, how and with what effectiveness clinicians address these issues with patients. Many clinicians feel that the evidence concerning the apparent increased risk associated with a twin birth is not ‘compelling’, and patients frequently minimize the hazards. These data, the first to explore several critical aspects of how providers and patients view and make decisions about the number of embryos to transfer, thus highlight tensions, uncertainties and challenges that providers and patients confront, and have key implications for future practice, research, policy and education. Elsevier 2016-07-25 /pmc/articles/PMC5846681/ /pubmed/29541689 http://dx.doi.org/10.1016/j.rbms.2016.07.001 Text en © 2017 The Author http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Ethics, Law and Religion
Klitzman, Robert
Deciding how many embryos to transfer: ongoing challenges and dilemmas
title Deciding how many embryos to transfer: ongoing challenges and dilemmas
title_full Deciding how many embryos to transfer: ongoing challenges and dilemmas
title_fullStr Deciding how many embryos to transfer: ongoing challenges and dilemmas
title_full_unstemmed Deciding how many embryos to transfer: ongoing challenges and dilemmas
title_short Deciding how many embryos to transfer: ongoing challenges and dilemmas
title_sort deciding how many embryos to transfer: ongoing challenges and dilemmas
topic Ethics, Law and Religion
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846681/
https://www.ncbi.nlm.nih.gov/pubmed/29541689
http://dx.doi.org/10.1016/j.rbms.2016.07.001
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