***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND  Twin pregnancies after IVF are still frequent and are considered high-risk pregnancies leading to high costs . Transferring one embryo can reduce the twin pregnancy rate . We compared cost-effectiveness of one fresh cycle elective single embryo transfer ( eSET ) versus one fresh cycle double embryo transfer ( DET ) in an unselected patient population . METHODS Patients starting their first IVF cycle were r and omized between eSET and DET .  Societal costs per couple were determined empirically , from hormonal stimulation up to 42 weeks after embryo transfer . An incremental cost-effectiveness ratio ( ICER ) was calculated , representing additional costs per successful pregnancy . RESULTS Successful pregnancy rates were 20.8 % for eSET and 39.6 % for DET .  Societal costs per couple were significantly lower after eSET ( 7334 euro ) compared with DET ( 10,924 euro ) . The ICER of DET compared with eSET was 19,096 euro , meaning that each additional successful pregnancy in the DET group will cost 19,096 euro extra . CONCLUSIONS One cycle eSET was less expensive , but also less effective compared to one cycle DET . It depends on the society 's willingness to pay for one extra successful pregnancy , whether one cycle DET is preferred from a cost-effectiveness point of view OBJECTIVE To identify factors that influence patient decision making concerning embryo transfer . DESIGN Prospect i ve analysis . SETTING In vitro fertilization unit at a tertiary-care , university-affiliated teaching hospital . PATIENT(S ) Seventy-nine women and 53 men who were referred consecutively for IVF treatment .  INTERVENTION(S ) Provision of risk information about complications of twin pregnancy . MAIN OUTCOME MEASURE(S ) Rated desirability of different transfer options and twin pregnancy , together with st and ardized measures of depression and infertility stress . RESULT ( S ) Women 's initial preference for two-embryo transfer ( 2ET ) was related to beliefs that the chance of pregnancy was higher with 2ET vs. elective single-embryo transfer and that the personal chance of twins was relatively likely with 2ET but was not related to a specific desire for twins . Providing risk information increased the desirability of elective single-embryo transfer and decreased the desirability of twin pregnancy among both men and women . CONCLUSION ( S ) Cautious patients , preferring transfer of fewer embryos , balance desires to maximize the chance of pregnancy with acceptance of risks associated with twins . Less-cautious patients may be motivated by beliefs about the influence of age , desires for , and likelihood of twin pregnancy . Information about risks may affect these groups differently and diverse patient motivations may require tailored information to ensure informed consent Survivors of the " vanishing " twin syndrome , which occurred in dichorionic twins only , and singletons that began as singletons , had similar mean gestational duration and birth weights , as well as similar frequencies of maternal and neonatal complications . This similarity persisted when conventional IVF and IVF plus ICSI cases were separately evaluated BACKGROUND Single embryo transfer ( SET ) after IVF/ICSI has been shown to result in an acceptable pregnancy rate in selected subjects . In our unit ,  SET  is routinely carried out among women under the age of 36 in the first or second treatment cycle when a top- quality embryo is available . In order to define further the selection criteria for SET , we have analysed the outcome of elective SET ( eSET ) , including the cumulative pregnancy rate after frozen embryo transfers , performed in the years 2000 - 2002 in the Oulu Fertility Center . METHODS During the study period , a total of 1271 transfers were performed , and in 468 cycles SET  ( 39 % of all transfers ) was carried out . Of the SET cycles , in 308 cases a top- quality embryo was transferred on day 2 and extra embryos were frozen . Of these eSET cycles , ICSI was carried out in 87 cycles ( 28 % ) . RESULTS The overall clinical pregnancy rate per transfer was 34.7 % in the eSET cycles . In the eSET ICSI cycles , the clinical pregnancy rate was significantly higher than in the corresponding IVF cycles ( 50.6 versus 28.5 % , P < 0.001 ) . The cumulative pregnancy rate per patient after fresh and frozen embryo transfers was also significantly higher after ICSI ( 71.2 versus 53.4 % , P < 0.01 ) . CONCLUSIONS A high cumulative pregnancy rate per oocyte retrieval can be achieved after eSET in daily clinical practice . The implantation rate of fresh top- quality embryos in the ICSI cycles was significantly higher than in the IVF cycles , possibly due to more successful selection of the embryo for embryo transfer on day 2 after ICSI . In addition , our data suggest that embryo quality is a more important determinant of outcome than the age of the woman BACKGROUND We analysed the difference in maternal , neonatal and total costs after single ( SET ) versus double day 3 embryo transfer ( DET ) . METHODS We performed a two-centre prospect i ve study of women in their first IVF/ICSI cycle choosing between  SET or DET . Infertility treatment data were gathered from a data base ; maternal and neonatal outcome data from a case report form ( CRF ) ; health economic data from medical acts registered in the CRF for the outpatient part and from hospital bills . SET was performed in 206/367 ( 56.1 % ) and DET in 161/367 ( 43.9 % ) women . RESULTS In all , 367 transfers yielded 186 positive pregnancy tests , 148 ongoing pregnancies and 136 live deliveries ( 50.7 , 40.3 and 37.1 % per embryo transfer ) of which 15 ( 11.0 % ) were twins . Live birth rate was 37.4 % for SET , 36.6 % for DET . Intention-to-treat analysis showed differences for : duration of pregnancy ( SET : 39.0 + /- 1.4 versus DET : 38.3 + /- 2.2 weeks ; P = 0.055 ) , percentage prematurity ( 8.5 versus 23.8 % ; P = 0.033 ) , percentage of neonates hospitalized ( 5.7 versus 17.9 % ; P = 0.121 ) and duration of neonatal hospitalization ( 6.3 + /- 2.2 versus 10.3 + /- 10.1 days ; P = 0.01 ) . Total cost after DET was higher ( SET : 4700 + /- 3239 versus DET : 8613 + /- 10 105 ; P = 0.105 ) , due to significantly higher neonatal costs ( 451 + /- 957 versus 3453 + /- 8154 ; P < 0.001 ) and not to differences in maternal costs ( 4250 + /- 2882 versus 5160 + /- 4106 ; P = 0.152 ) . CONCLUSIONS This prospect i ve health economic study shows that transfer of a single top quality embryo is equally effective as , but substantially cheaper than , double embryo transfer in women < 38 years of age in their first IVF/ICSI cycle St and ard protocol s for in-vitro fertilization ( IVF ) include transfer of two or three embryos . Not surprisingly , the rate of twin pregnancy after IVF is high ( about 24 % of all pregnancies ) . Routine transfer of one , rather than two , embryos would be expected to result in a much lower rate of twin pregnancies at the cost of a lower take-home baby rate . The aim of this study was to compare hypothetical costs to society incurred by pregnancies achieved with  IVF protocol s  based on the transfer of  one or two embryos . We compared actual ( for  two-embryo transfers ) and hypothetical ( for  one-embryo transfers )  take-home baby rates ; risks of twin pregnancies ; and costs of sick leave and hospitalization during pregnancy , deliveries , neonatal intensive care , and h and icap care after transfer of one or two embryos . The study showed that even when more treatments might be needed to achieve similar baby take-home rates after transfer of one compared with two embryos , the lower twin pregnancy rate of the former approach caused it to be more cost-efficient than the latter . In conclusion ,  IVF costs are the sum of fertilization treatment costs and the costs for health care of the pregnant women and their offspring . Considering the association of the latter costs with numbers of embryos transferred , studies of one-embryo transfer protocol s are urgently needed BACKGROUND Transfer of several  embryos  after  IVF  results in a high multiple birth rate associated with increased morbidity and high costs for the neonatal care . In a previous r and omized trial we demonstrated that a single embryo transfer ( SET ) strategy , including one fresh single embryo transfer and , if no live birth , one additional frozen-thawed SET , result ed in a live-birth rate that was not substantially lower than after double embryo transfer ( DET ) but markedly reduced the multiple birth rate . METHODS We compared costs for maternal health care and productivity losses and paediatric costs for the SET and DET strategies . In addition , maternal and paediatric outcomes between the two groups were compared . RESULTS The SET strategy result ed in lower average total costs from treatment until 6 months after delivery . There were a few more deliveries with at least one live-born child in the DET group . The incremental cost per extra delivery in the DET alternative was high , 71 940 . The rates of prematurely born and low birthweight children were significantly lower with the SET strategy . There were also markedly fewer maternal and paediatric complications in the SET group . CONCLUSIONS The SET strategy is superior to the DET strategy , when number of deliveries with at least one live-born child , incremental cost-effectiveness ratio and maternal and paediatric complications are taken into consideration . The findings do not support continuing transfers of two embryos in this group of patients Abstract Objective To compare neurological sequelae in twins born after assisted conception with singletons after assisted conception and naturally conceived twins and to assess neurological sequelae in children conceived after in vitro fertilisation ( IVF ) compared with intracytoplasmic sperm injection ( ICSI ) .  Design Controlled , national register based , cohort study . Participants Twins ( n = 3393 ) and singletons ( n = 5130 ) conceived by using assisted reproductive technologies and naturally conceived twins ( n = 10 239 ) born in Denmark between 1995 and 2000 . The children 's age at time of follow up was 2 - 7 years . Data sources Children were identified by cross linkage of the national medical birth registry and the national registry for in vitro fertilisation . Neurological and psychiatric diagnoses were retrieved from the national patients ' registry and the Danish psychiatric central registry . Main outcome measures Neurological sequelae , defined as cerebral palsy , mental retardation , severe mental developmental disturbances , and retarded psychomotor development . Further we made separate analyses on the specific cerebral palsy diagnosis . Results The crude prevalence rates per 1000 of neurological sequelae in twins and singletons after assisted conception and in naturally conceived twins were 8.8 , 8.2 , and 9.6 , and of cerebral palsy 3.2 , 2.5 , and 4.0 , respectively . In twins after assisted conception compared with control twins , the odds ratios of neurological sequelae and specifically of cerebral palsy , adjusted for child sex and year of birth , were 0.9 ( 95 % confidence interval 0.6 to 1.4 ) and 0.8 ( 0.4 to 1.6 ) , respectively . The corresponding odds ratios for twins after assisted conception compared with singletons after assisted conception were 1.1 ( 0.7 to 1.7 ) for neurological sequelae and 1.3 ( 0.6 to 2.9 ) for cerebral palsy . The odds ratio of neurological sequelae in children conceived by ICSI was 0.9 ( 0.5 to 1.7 ) ν children conceived by IVF . Conclusions Twins from assisted conception have a similar risk of neurological sequelae as their naturally conceived peers and singletons from assisted conception . Children born after ICSI have the same risk of neurological sequelae as children born after IVF BACKGROUND Elective single embryo transfer ( eSET ) in a selected group of patients ( i.e. young patients with at least one good quality embryo ) reduces the number of multiple pregnancies in an IVF programme . However , the reduced overall multiple pregnancy rate ( PR ) is still unacceptably high . Therefore , a r and omized controlled trial ( RCT ) was conducted comparing eSET and double embryo transfer ( DET ) in an unselected group of patients ( i.e. irrespective of the woman 's age or embryo quality ) . METHODS Consenting unselected patients were r and omized between eSET ( RCT -eSET ) ( n = 154 ) or DET ( RCT -DET ) ( n = 154 ) . R and omization was performed just prior to the first embryo transfer , provided that at least two 2PN zygotes were available . Non- participants received our st and ard transfer policy [ SP-eSET in a selected group of patients ( n = 100 ) , otherwise SP-DET ( n = 122 
    Output:
    
Indiscriminate application of eSET in population s with less than optimal prognosis for live birth will result in a significant reduction in effectiveness compared with DET .
In women aged 38 years and over , eSET may result in a significant reduction in live birth rate compared with DET .