Posts Tagged ‘single embryo transfer’

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.

 

Big surprise: The incidence of twins is up

Thursday, January 5th, 2012

 

An analysis of three decades of twin births (2009 data are the most recent year included) finds large increases in twin birth rates for all age groups, among all racial and ethnic groups and in the U. S. The overall U.S. twin birth rate increased 76%, from 18.9 in 1980 to 33.2 per 1,000 births in 2009.

And for mothers age 35 and over, those twin rates have skyrocketed. Among women 35-39, rates rose by nearly 100%, and among those 40 and over, rates rose more than 200%, finds the report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

While the chance of having twins does increase with a mother's age, the report suggests that fertility treatment provides the backdrop for this baby bonus, says CDCstatistician Joyce Martin.

"We found that about one-third of the increase over three decades was attributed to older maternal age and two-thirds likely the result of fertility-enhancing therapies — both drugs and technologies like in-vitro fertilization," she says.

As for women in their 20s who had twins, Martin says a small proportion of women in that age group do receive fertility treatment.

 

The analysis finds that although the pace of these increases in twin birth rates slowed from 2005 to 2009, twins now make up 3.3% of all births, up from 1.9% in 1980. The number of twin births increased from 68,339 to more than 137,000 in each year between 2006 and 2009.

As pregnancy rates with reproductive technologies have improved, we've been working hard at Reproductive Partners over the past several years to reduce the multiple birth rate. We can do that by returning fewer embryos to the woman's uterus. In many cases it's possible to achieve IVF success by transferring one embryo in women with a favorable prognosis.


Reproductive Partners makes outreach to China

Saturday, May 28th, 2011

Two Reproductive Partners physicians have been invited to China to present the latest advances in fertility treatment and screening for genetic diseases at a major hospital in Bejing. Drs. Bill Yee and Greg Rosen  are currently lecturing on preimplantation genetic screening, molecular technology to screen for a variety of recessive genetic diseases and criteria for maximizing the success rate for elective single embryo transfer to reduce the chance of multiple pregnancy, including twins.

 

In conjunction with this outreach, the RPMG website has been translated and is now available in Mandarin Chinese. Portions of the website will shortly be translated into Japanese as Japanese-speaking staff is being added to the Redondo Beach location to better serve the Japanese-speaking community.

 

Another factor in selecting single embryo transfer (eSET)

Monday, December 27th, 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.


 There are many reasons that the use of the elective single embryo transfer (eSET) is being recommended more often when the clinical situation and embryo quality make it an appropriate choice. Primarily it's a strategy to reduce the chance of having even twins with it's inherent additional risks to a pregnancy. A presentation at the meeting brings up another reason to choose eSET.

Using CDC data, singleton births having a good outcome (as defined by term birth and weight more than 2500 grams) was better when only one fetal heart was detected in early ultrasounds. Women with a history of a prior birth also had a better outcome. This study shows an adverse effect from the so-called vanishing twin. The most likely factor for this observation is the effect on the absorbtion of the additional tissue.

Does IVF increase the chance of identical (monozygotic) twins?

Tuesday, July 20th, 2010

It does, at least according to a study in the July 2010 issue of Fertility & Sterility.

The authors surveyed 4976 clinical pregnancies from one large IVF center and found ninety-eight cases of monozygotic twins (MZTs) were diagnosed after first-trimester ultrasound evaluation (2% incidence). In naturally conceived pregnancies the incidence is about 0.25-0.5%. 

The incidence in women transfering embryos from their own eggs was 1.7% but was 3.3% with donor eggs; however, younger women (<35 years old) using their own eggs displayed a similar rate (3.1%) to women using donor eggs.

Eighty MZTs occurred after fresh day-5 transfer; only 14 followed fresh day-3 transfer (2.6% vs. 1.2%). The MZT incidence in day-3 transfers without assisted hatching was not different from those with hatching (1.3% vs. 1.1%). In addition, MZT incidence did not differ significantly whether or not ICSI was performed (2.4% vs. 2.0%). Four MZTs occurred after frozen-thawed embryo transfer (0.8% incidence).

The good news is that ninety-five percent of all placental arrangements were confirmed as having two amniotic sacs on obstetric ultrasounds, making them safer pregnancies than when both babies are in the same amniotic sac.

The take-home message is that this is a good reason for young women and those using eggs from a young donor to seriously consider elective single embryo transfer (eSET) so if a set of identical twins does occur and the other embryo implants one does not have to deal with a triplet pregnancy.

RPMG studying financial incentives for eSET

Friday, October 30th, 2009

The LA Times article mentioned in the previous post shows the non-signficant difference in success rates between single- and double embryo transfers in a study from Sweden. Most impressive is the reduction in potentially complicated multiple pregnancies by transferring one embryo which should be an incentive for appropriate couples to select this option.

But in most of the U. S., couples are faced with more than the disappointment of a small increment  in the chance of a failed cycle. In most European countries, IVF is covered by the national health service so an additional cycle is less of a financial burden. In non-mandated states in the U.S, the couple is also faced with the cost of another fresh or frozen embryo cycle.

Our success rates in good prognosis patients who would be candidates to consider an eSET, our success rates are better than reported in the Swedish study and the difference in live birth rate between the two groups should be small.

In order to encourage couples to choose the single embryo option we are studying financial incentives to reduce the impact of a possible failed cycle which may not have occurred if two embryos had been transferred.

We would like to hear what financial incentive would help you choose a single embryo transfer if the difference in success rate was not statistically significant. You can post your responses to this blog.

LA Times article promotes single embryo transfer

Friday, October 30th, 2009

An article in the October 29th edition of the Los Angeles Times, “1 in vitro embryo may be best” reports on data from the New England Journal of Medicine that shows by transferring more than one embryo doctors are increasing the odds of having twins, creating a riskier pregnancy for both mother and baby.

Increased risks of twins over a single IVF baby include a greater chance of prematurity, cerebral palsy, birth defects, developmental delays and death for the babies, and gestational diabetes, bleeding and preeclampsia for the mother.

Researchers from Sweden expanded the results from a 2004 study showed a difference of 43% live birth from two embryo transfer; 39% from a  single embryo transfer. That difference was not statistically significant. One third of the patients in the double-embryo group had twins or triplets, compared with only 1% in the single-embryo group.

At Reproductive Partners we have been encouraging single embryo blastocyst transfer in appropriate couples who have a good prognosis for success and excellent embryo quality. The biggest barrier to acceptance of this concept seems to be financial. In the U.S., most couples pay for IVF out-of-pocket, where in many European countries the procedure is covered by national health insurance. So a couple with a failed cycle not only has to deal with teh disappointment of not succeeding, they are faced with paying for another fresh or a frozen cycle.