Cover -- Half-title -- Title -- Copyright -- Contents -- Contributors -- Foreword -- Preface -- REFERENCES -- SECTION 1 Preliminaries -- Chapter 1 The risks associated with multiple pregnancies -- Introduction -- Trends in multiple births -- Zygosity and chorionicity -- Maternal morbidity and mortality -- Hypertensive disorders of pregnancy -- Obstetric hemorrhage -- Obstetric intervention -- Maternal complications in triplet, quadruplet and higher-order multiple pregnancies -- Fetal and neonatal outcome -- Mortality -- Gestational age and birth weight -- Neonatal morbidity -- Fetal abnormalities -- Special considerations -- Twin-to-twin transfusion syndrome -- Monoamniotic twins -- Long-term outcome -- Cerebral palsy -- Cognitive development and social development -- ART twins versus spontaneous twins -- Conclusions -- REFERENCES -- Chapter 2 An overview of determinants of oocyte and embryo developmental competence: specificity, accuracy and applicability in clinical IVF -- The need for non-invasive marker of developmental competence -- The use of morphological criteria in oocyte and embryo competence assessment -- Microscopically detectable determinants of competence in the mature human oocyte: imaging spindle microtubule birefringence by polarizing light microscopy -- Competence indicators at the one-cell stage -- Identification and characterization of morphodynamic activities -- Fragmentation during cleavage -- Prolongation of development to the blastocyst stage -- The intrafollicular milieu and perifollicular blood flow as determinants of developmental competence -- Metabolic and molecular approaches to assessment -- Proteomic and genomic mining for competence biomarkers -- The metabolic approach to selection -- Mitochondria and competence.

Local regulation of mitochondrial activity: mitochondrial microzonation in the oocyte and early embryo -- Is there an optimal scheme for selection? -- Can morphology retain a role in selection? -- The future of competence selection and single embryo transfers -- REFERENCES -- SECTION 2 Clinical aspects -- Chapter 3 Single embryo transfer: concepts and definitions -- Introduction: to define is to limit -- The target: the twin-prone patient -- SET (single embryo transfer) -- eSET (elective single embryo transfer) -- cSET (compulsory SET) -- mSET (medical SET) -- Absolute contraindications -- Relative contraindications -- lSET (legally enforced SET) -- The Belgian model -- Commentaries to the model -- Exceptions to the model -- SBT and eSBT -- DET and eDET (elective double or dual embryo transfer) -- TET (triple embryo transfer) -- SMET (selective multiple embryo transfer) -- The relevance of an agreed set of definitions -- What do we know? -- What do we need to know? -- What should we do? -- REFERENCES -- Chapter 4 Patient selection for single embryo transfer -- Introduction -- Randomized clinical trials -- Observational studies -- Conclusions -- REFERENCES -- Chapter 5 Perinatal outcome after single embryo transfer -- Introduction -- First-trimester bleeding -- Birth weight comparison between SET and DET -- Other obstetrical and neonatal outcome parameters -- Conclusions -- What do we know? -- What do we need to know? -- What should we do? -- REFERENCES -- Chapter 6 Single embryo transfer as a model for early conception and implantation -- Introduction -- The incipient twin -- First-trimester bleeding -- hCG levels and curves after eSET and DET -- Implantation rates after eSET and DET -- The vanishing embryo syndrome -- The vanishing twin -- Pathological considerations -- Diagnosis and frequency -- Short- and long-term outcome after a vanishing twin.

Obstetric complications -- Neurological sequelae -- Conclusions -- What do we know? -- What do we need to know? -- What do we do now? -- REFERENCES -- Chapter 7 Ovarian stimulation, blastocyst culture and preimplantation genetic screening for elective single embryo transfer -- Introduction -- Ovarian stimulation issues relevant to eSET -- Financial considerations can be relevant -- Ovarian stimulation benchmarks -- Direct harmful effects of estrogen on ovarian follicles and embryos? -- Indirect harmful effects of a high follicular estradiol response on ovarian follicles have an iatrogenic basis -- Direct harmful effects of estrogen on endometrium? -- The contribution of blastocyst culture to eSET -- The impact of embryo biopsy on eSET -- General considerations -- Impact of day 5-6 versus day 3 embryo biopsy considerations -- Is there a role for preimplantation genetic screening in assisting eSET? -- Conclusions -- What do we know? -- What do we need to know? -- What should we do? -- REFERENCES -- Chapter 8 Sequential embryo selection for single embryo transfer -- Introduction -- Gamete selection -- Fertilized oocyte scoring -- Early cleavage -- First and second mitotic cleavage -- Day 3 cleaving embryo morphology -- Blastocyst morphology and selection -- REFERENCES -- Chapter 9A Cryo-augmentation after single embryo transfer: the European experience -- Introduction -- Cryopreservation in European countries -- Contribution of cryopreservation in the 1990s -- The value of cryopreservation in eSET programs -- SET with cryopreserved embryos in non-optimal patients -- Techniques -- Optimal stimulation -- The health-economic dimension -- Conclusions -- What do we know? -- What do we need to know? -- What should we do? -- REFERENCES -- Chapter 9B Cryo-augmentation after single embryo transfer: the American experience -- Introduction.

Consequences of transferring two blastocysts -- Initial experience with single blastocyst transfer -- The effect of a comprehensive incentive program on SBT patient participation -- Optimization of blastocyst cryopreservation -- Post-thaw inner cell mass (ICM) survival -- A place for assisted hatching of frozen-thawed blastocysts? -- Day 5 and day 6 cryopreserved blastocysts -- Expectations for an optimized blastocyst cryopreservation program -- The impact of cryo-augmentation after SBT -- Conclusions -- ACKNOWLEDGEMENTS -- REFERENCES -- Chapter 10A Single embryo transfer in recipients of donated oocytes -- Introduction -- Pregnancy outcome -- Why SET in oocyte recipients? -- Outcome after SET in oocyte recipients -- Counseling -- Conclusions -- What do we know? -- What do we need to know? -- What should we do? -- REFERENCES -- Chapter 10B The impact of single embryo transfer on embryo donation -- REFERENCES -- Chapter 10C SET in unique clinical situations: single women, lesbians -- Legal aspects -- Medical aspects -- REFERENCES -- Chapter 10D Preimplantation genetic diagnosis and single embryo transfer -- Introduction -- Clinical application of PGD -- PGD and SET -- PGS and SET -- Conclusion and scope -- REFERENCES -- Chapter 11 Counseling patients for single embryo transfer -- Introduction -- The psychological context of eSET -- Factors affecting attitude and choice of eSET -- Role of counseling -- Counseling approaches for decision-making -- What do we know? -- What do we need to know? -- What should we do? -- REFERENCES -- Chapter 12 Stress-reduction techniques to reduce patient dropout rates during elective single embryo transfer -- Introduction -- Overview of eSET -- IVF dropout -- The psychological impact of IVF and its effect on treatment outcomes -- The effect of psychological interventions on pregnancy.

Are some psychosocial interventions more effective than others? -- What do we do now? -- What do we know? -- What do we need to know? -- What should we do? -- ACKNOWLEDGEMENTS -- REFERENCES -- Chapter 13 Barriers for elective single embryo transfer implementation -- Introduction -- Characteristics of eSET -- Elective SET could cause a decrease in pregnancy rate per cycle (evidence-based) -- A substantial part of twin pregnancies end up with minor or no complications (evidence-based) -- Lack of a sufficient cryopreservation program (evidence-based) -- Lack of prognostic models or selection criteria for eSET (evidence-based) -- Disadvantages of eSET are easier to recognize for couples and clinicians compared with the advantages (theory-based) -- Characteristics of the IVF professional -- Doubts about the necessity for eSET (evidence-based) -- Insufficient counseling skills (evidence-based) -- Lack of knowledge of professionals on twin risks and eSET success rates (theory-based) -- Characteristics of the couples undergoing IVF/ICSI -- Female age in the population undergoing IVF/ICSI (evidence-based) -- Considering a twin to be a successful outcome (evidence-based) -- Insufficient knowledge of patients on twin risks and eSET success rates (evidence-based) -- Couples might dread possible extra necessary cycles with eSET (theory-based) -- Ethical/religious barriers (theory-based) -- Characteristics of the context in which IVF/ICSI is performed -- Legislation for eSET or another form of compelled eSET (evidence-based) -- Reimbursement of IVF/ICSI cycles (evidence-based) -- Lack of clinical guidelines (evidence-based) -- Competition between clinics and commercial interest (theory-based) -- International differences in eSET use and the possibility to travel abroad (theory-based) -- Freedom of choice for the couples.

shared decision-making or not? (theory-based).