Making IVF More Successful. What works?

A recent article in Newsweek looks at “add-ons” to the basic IVF cycle and comes to the conclusion that there is no evidence that many of them help except the endometrial “scratch”: biopsy in the cycle before the transfer.

These add-ons include blastocyst culture, where the embryo is allowed to grow in the lab for five days instead of the usual three, before being transferred to a woman’s uterus and genetic screening of embryos for possible defects so that only “healthy” ones are implanted. Testing the immune system is one of a growing number of additional services offered to couples who can’t conceive through IVF treatment alone.
Some clinics say they do it because certain antibodies can interfere with embryo implantation, but these claims are not backed by evidence.

According to a study that appeared in the BMJ at the end of November, the same is true for many other extra services—of nearly 30 fertility clinic “add-ons” reviewed, they claim that only one increased a woman’s chances of having a baby. That was an endometrial scratch, in which a small nick is made in the uterus’s lining to increase the likelihood of an embryo implanting on it. And that had good results only if a woman had been through two previous rounds of IVF. Now, even the positive value of the endometrial scratch has been questioned.

The study spent a year examining the websites of all the fertility clinics in the U.K., compiling a list of procedures each clinic offered in addition to IVF. They then reviewed evidence for the usefulness of each intervention. The researchers concluded that for 26 of the 27 routinely offered procedures, there was no conclusive evidence that they improved a couple’s chances of having a baby. Of the 276 claims made by fertility clinics on their websites, only 16 even cited scientific research backing up that claim.

What they fail to consider is how quickly one can achieve success using the “add-ons” rather than not using them. For example, a good quality embryo with normal chromosomes is probably not more likely to become a healthy pregnancy if it is transferred at the blastocyst stage or tested for chromosomes. But blastocyst and preimplantation genetic screening (PGS) does help select the embryos which are likely to succeed sooner, thus reducing the need for repeated cycles. And that’s not only helpful emotionally, but in the U.S. it’s critical financially.

The answer to this for the layperson is to find a doctor you trust and discuss frankly with this doctor how any recommended “add-ons” help that doctor achieve quicker and greater success in his/her practice.

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