Posts Tagged ‘IVF success’

More embryos do not lead to better success rates

Tuesday, January 17th, 2012

Haven't we been saying this for a long time?

 

 

A new study of fertility treatment in found that women who get three or more embryos have no better odds of having a baby than those who get just two embryos.

They also have a greater chance of risky multiple births.

“Women who have gone through infertility treatment want the best chance of having a baby, but we need to explain that the data shows transferring more embryos doesn’t actually do that,’’ said Dr. Scott Nelson, head of reproductive and maternal medicine at the University of Glasgow, who co-authored the study published in Thursday’s issue of Lancet.

In Western Europe, where some countries pay for in-vitro fertilization, or IVF, many authorities recommend a single embryo transfer for women under 37 and a maximum of two embryos for women 37 to 40. For women over 40, three is often the limit by law.

In the United States, there are relatively lax guidelines and a lack of regulation. That country has seen a rise in multiple births, including the highly publicized case of Nadya Suleman, labeled the “octomom.’’ She had octuplets in 2009 after her doctor transferred 12 embryos. She already had six children through IVF.

Most fertility treatment in the U.S. is paid for privately which experts believe encourages the use of more embryos in the belief it will improve odds.

The American Society for Reproductive Medicine recommends single embryo transfers for women under 35, but there is no enforcement of that. For women 35 to 37, they advise two to three embryos, and three to four embryos for women ages 38 to 40.

In their study, Nelson and Debbie Lawlor, of the University of Bristol, analyzed data for all 124,000 IVF cycles in the U.K. between 2003 and 2007, resulting in more than 33,500 live births. The women were 18 to 50 and had varying histories of infertility. During IVF, eggs are fertilized with sperm in a lab dish and then put in the womb.

For women under 40 who had two embryos transferred, the live birth rate was 33 percent overall. With three embryos, that dropped to 25 percent, though researchers weren’t sure why. Nelson said it might be due to the higher risk of miscarriage in a multiple pregnancy and that miscarrying one fetus would jeopardize the entire pregnancy.

For women over 40, the live birth rate was 13 percent whether they had two or three embryos transferred.

Nelson said patients going through IVF may pressure doctors to transfer more embryos, believing it may boost their chances of having a baby and avoiding more treatment.

 

How many eggs does it take to produce an IVF success?

Monday, September 12th, 2011

The trick answer is one. But is more always better?

According to a study in the September issue of Fertility & Sterility there is an advantage to obtaining six or more mature eggs compared with five or fewer eggs. But there was no advantage to obtaining ten or more over six to nine.

We listed the misconception that "more is better" as one of the incorrect premises in our book, "Conceptions & Misconceptions."  This study supports the concept. The reason may be releated to the facts that with heavy stimulation egg quality may not be as good and the higher estrogen levels may overstimulate the endometrium, reducing the chance of implantation. These observations have led to the concept of gentler or minimal IVF cycles.

So the trends are toward less is better; less stimulation and fewer embryos transferred to reduce multiple pregnancies.

Study claims to almost double IVF success rates with office procedure

Saturday, July 9th, 2011

It sounds too good to be true. And when things sound too good to be true, they usually aren't true.

A study presented at the European Society (ESHRE) claims that performing an endometrial biopsy before an IVF cycle almost doubles the chance of an ongoing pregnancy. The Brazilian research found that performing a small biopsy of the endometrial wall before embryo implantation – resulting in a tiny scar – increased the chance of an ongoing pregnancy from 38 to 63 per cent.

Dr Fernando Prado Ferreira, who led the study at Santa Joana Maternity Hospital in São Paulo, Brazil, believes the biopsies help embryos implant better in the womb, although why this might be so is currently unclear. In the trial of 144 women whose average age was 33, 46 IVF patients were given biopsies and 98 were not. Dr Ferreira, based at the Federal University of São Paulo, said: “Having a biopsy prior to IVF treatment almost doubled the chances of pregnancy over those who did not.”

RPMG's Scientific Director, Dr. David Meldrum attended the meeting as an editor of the journal, Fertility & Sterility, and commented on the study. "This study was suggestive of a positive effect of the biopsy on the occurrence of pregnancy, but it was not designed in such a way that a firm conclusion can be drawn. Ideally a randomized study should have been done. In a case-control study like this one, it is necessary to have some evidence that the number of patients to be studied is set when the study is started. Otherwise investigators can chose a point to terminate the study when the results favor a significant effect. This effect is consistent with a similar study from Israel, and a published study has shown that an endometrial biopsy stimulates growth factors in the endometrium. Hopefully a randomized study will be carried out with the study size set before starting the study. Then an reliable conclusion can be drawn.
 

The authors should not have used the term "scarring". The endometrium would heal without scarring following such a procedure. The authors perhaps meant "healing" and the other term was used due to their native language not being English."

We have observed this effect in our patients at RPMG, but to claim that it "doubles" the chance of an ongoing pregnancy is a stretch.

 

Obesity is a factor in IVF success

Tuesday, July 5th, 2011

We have said it before and now a new study in the July 2011 edition of Obstetrics & Gynecology again confirms it: obesity has an adverse effect on the chance of IVF success.

They reviewed the records of 1,721 women undergoing their first IVF cycle with their own eggs. Women with a normal BMI were compared with women with class II obesity (BMI 35-39.9) and class III obesity (BMI >40). They found lower numbers of fertilized eggs and lower peak estrogen levels when correcting for age and numbers of eggs. Most importantly women with class III obesity had a 50% lower clinical pregnancy and live birth rate.

The message here is simple and clear: it is advisable for women to maintain a normal weight before, during and after attempting to conceive. For further information on lifestyle issues see our Lifestyle & Fertility pages.

Message for the New Year-don’t drink and….do IVF

Wednesday, December 29th, 2010

And you thought it was going to be "and drive." Well, you shouldn't do that either.

In the January 2011 issue of the journal "Obstetrics & Gynecology an article quantitates the effect of drinking alcohol on IVF success. In examining 4729 IVF cycles the authors found that women drinking at least four drinks a week had 16% less odds of a live birth than those who drank fewer than four drinks a week, When both the partners drank at least four alcoholic drinks a week, the odds of live birth were 21% lower compared with couples in which both drank fewer than four.

So in this New Year, don't drink and drive or do IVF. Seriously this is a factor over which you have control. Many factors are out of your control. Control what you can.

IVF success-does a woman’s weight matter?

Tuesday, December 21st, 2010

This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.


  You bet it does.  

893 women were analyzed for the effects of weight on IVF outcome. Compared to women with a normal BMI, women with BMI over 35 had significantly lower peak estrogen level, number of eggs retrieved, total embryos, a 60% lower birth rate, and a 29% greater incidence of immature eggs. Underweight women also had a higher incidence of egg immaturity.

 

These factors together with the marked increase of extreme prematurity in pregnancy makes a strong case that women with a BMI over 35 should reduce before being offered IVF, even by surgical means if required. These findings also may suggest that dosing of fertility drugs and hCG is inadequate in these very heavy women. It is also possible that the hCG may be injected into buttock fat where absorption may be poor rather than in the muscle where it’s intended to go.

 

The lower oocyte maturity in underweight women could be due to dietary factors.

 

For more information see our Lifestyle pages where you can link to Dr. Meldrum's website for detailed information

 

 

 For more information see our Lifestyle pages where you can link to Dr. Meldrum's website for detailed information

Does insurance coverage influence IVF success?

Tuesday, October 5th, 2010

An article in the September 2010 issue of Fertility & Sterility examines the influence of a non-medical factor, insurance coverage, on IVF outcome.

They studied 91,753 fresh, nondonor IVF cycles in the United States and compared those conducted in states with mandated insurance coverage for IVF with those in states which did not mandate coverage. Cycles conducted in nonmandated states had a significantly higher pregnancy rate (38.8% vs. 35%) and live-birth rate (32.2% vs. 29.1%) than mandated states. But nonmandated states also had a significantly higher twin rate (28.1% vs. 26%) and triplet rate (3.9% vs. 3.4%). The average number of embryos transferred was also significantly higher in nonmandated states (2.6 vs. 2.2). These findings were more pronounced in the <35 and 35–37 age groups.

The reason is apparent. When couples are paying for IVF themselves there is greater pressure to succeed in an early cycle and thus more embryos are transferred and more multiple pregnancies result. The answer is also apparent.

What do consistently high-performing in vitro fertilization programs in the U.S. do?

Saturday, September 25th, 2010

I guess that that means us.

In this article in the September 2010 issue of Fertility & Sterility, the procedures they cite as common in consistently high performing IVF programs do apply to our practice. Common clinical practices identified among these programs included testing all patients for ovarian reserve, endometrial defects, and hydrosalpinges; use of a mixed LH and FSH stimulation protocol with step-down dosing; and use of ultrasound guidance for ET. Common laboratory practices included selective use of intracytoplasmic sperm injection (ICSI), group culture of embryos in microdrops, and use of blastocyst ET in selected cases. Common laboratory features included good air quality using filtration and heated stages for oocyte and embryo work.

At RPMG we follow most of those practices. One exception which many of the other high-performing centers probably also follow is the switch to culturing embryos in 5% oxygen rather than air. That switch made a dramatic improvement in embryo quality for us.

Frankly, it's not surprising that the leading centers use many of the same best practices, many of which they learn at Dr. Meldrum's annual Santa Barbara meeting which will be in its 23rd year next July,

Obesity impairs IVF success

Monday, March 8th, 2010

One of the issues I discuss with new patients when it's pertinent is weight loss in order to improve the chance of IVF success.

The latest evidence supporting this is in an article in the February 2010 edition of Fertility & Sterility looking at the outcomes in different groups based on BMI (body mass index as kilograms per square meter). They compared lean (<20 kg/m2); normal (20–24.9 kg/m2); overweight (25–29.9 kg/m2); and obese (≥30 kg/m2) women in 6500 IVF cycles. Although there was no difference in insemination procedure, fertilization rate, day of transfer, mean number of embryos transferred and cryopreserved embryos, percentage of blastocyst transfers, or embryo quality on day 2 and 3 among groups, pregnancy and live birth rates were reduced progressively with each category of increase in BMI. In addition, the cumulative pregnancy rate after four IVF cycles was reduced as BMI increased.

This confirms other studies that being obese or even just overweight overweight has a negative effect on IVF success.