data and publications by the different authors that should properly have been edited out. Nevertheless, most chapters have important take-home messages.
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Single Embryo Transfer Editors Jan Gerris / G David Adamson / Petra De Sutter / Catherine Racowsky Multiple pregnancy is the largest cause of maternal and fetal morbidity after assisted reproductive technologies (ART). In this book the views of many internationally distinguished authors have been collected, focusing on the use of elective single embryo transfer (eSET) to reduce twin and multiple pregnancy rates while trying to maintain an acceptable pregnancy and rate of delivery of healthy children. We have a long way to go to persuade ourselves, and our suitable patients, to consider eSET: as pointed out in the book, 69% of patients and nearly as many doctors, having been informed of the risks of multiple pregnancy, feel that a multiple pregnancy would be the ideal outcome for IVF. In vitro fertilisation success is defined in the book as the delivery of a healthy singleton baby. Triplet pregnancy is seen as a serious complication and twins as an acceptable but much less desirable outcome than a singleton pregnancy. The first chapter, by Ulla-Britt Wennerholm, on the risks of multiple pregnancy, gives a convincing argument in itself for eSET, outlining the significant maternal and fetal risks of twin pregnancy. Unfortunately, the author slightly confuses the issues by including monozygotic twin pregnancies in her analysis. Another chapter raises some very interesting points about the impact of loss of one conception on the remaining pregnancy. The chapter on patient selection for IVF is brilliant and suggests the best strategy for selecting patients for eSET without reducing pregnancy rates unnecessarily; the impact of semen parameters on SET is clearly outlined and important. The chapters on sequential embryo selection for SET and the optimal day for eSET present straightforward,
© 2009 Royal College of Obstetricians and Gynaecologists
Book reviews
simplified, evidence-based, scientific scoring systems for selecting the best embryos and the optimal day. The importance of cryopreservation programmes is compared by authors from Europe and the USA and reassures us that cumulative birth rates after eSET with follow-on frozen–thawed (single) embryo replacements are the same as for double embryo transfer but without the high twin rates. Nevertheless, they point out that it requires careful patient counselling, free cryopreservation and free frozen embryo transfer after eSET to be acceptable to patients. The Swedish and Dutch experiences are very good and give excellent information from one of the most quoted authors on choosing the best embryo for eSET and suggested clinical protocols; this would be essential reading for commissioners. The chapter on cost-effectiveness of SET in ART cycles is definitely one for the commissioners and the chapter on barriers for eSET is suitable for everyone. André Van Steirteghem, of course, has the last word and pulls everything together with his usual perspicacity. Throughout the book there is much repetition of data and publications by the different authors that should properly have been edited out. Nevertheless, most chapters have important take-home messages for IVF teams and I would recommend the book for all clinicians and embryologists as well as our commissioners and legislators (particularly those in Belgium, who would benefit from reading the last chapter). Reviewer Shaun Fountain FRCOG Consultant in Reproductive Medicine Salisbury Fertility Centre, Salisbury, UK Cambridge University Press, 2009 ISBN-13: 978-0521888349 Hardback, 305 pages, £55 10.1576/toag.11.3.225.27513
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