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This chapter presents suggested options for the elimination of multiple pregnancies including selective fetal reduction, single blastocyst transfer and elective single-embryo transfer (eSET). Selective fetal reduction carries a risk of miscarriage and poses serious ethical and legal questions. Three trials comparing eSET with elective double embryo transfer (DET) were identified. All involved women who had undergone embryo transfer in a fresh in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycle. It is clear that in a selected population the cumulative outcome of eSET is comparable with that of DET while virtually eliminating multiple pregnancies. The outcome of an eSET policy can be substantially enhanced in conjunction with an efficient and reliable embryo cryopreservation programme. Twin pregnancies resulting from IVF treatment are associated with higher maternal and perinatal morbidity. More data from pragmatic trials are to demonstrate whether a policy of eSET is effective, acceptable and financially viable in other clinical settings.
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