This past October, reproductive endocrinologists from around the globe gathered for the annual scientific meeting of the American Society for Reproductive Medicine (ASRM). It is an opportunity for us to share experiences and learn from each other.
I had lunch with a colleague practicing IVF in Mumbai, India and was fascinated with how similar our practices felt despite the huge geographic and cultural differences. The human interactions and emotional and social issues of infertility afflict our apparently disparate populations of patients in very similar ways.
There were a few presentations during the six day conference worth noting.
Regarding ovulation induction for patients unable to ovulate on their own: Metformin, in combination with Clomid appears to be slightly more effective than Clomid alone or letrizole, which may have a lower risk of multiples. Ovarian drilling (a surgical procedure involving cauterizing small craters in the ovaries) is equally effective and was suggested for Clomid/letrizole failures.
The best presentation according to many attendees was on surgery to enhance in vitro fertilization (IVF) success. Data was presented documenting the huge benefit of eliminating hydrosalpinges (fluid filled fallopian tubes) prior to embryo transfer. It is thought that the inflammatory fluid in these tubes bathes the uterine cavity, creating a hostile environment for the embryos. It appears that salpingectomy (removal of the tubes), or tubal ligation laparoscopically or by one of the less invasive hysteroscopic procedures (such as Essure) appear to be equally effective.
Cysts of endometriosis do not affect the number or quality of a patient's embryos. Because of the risk of removing normal ovarian tissue (and thereby reducing the ovarian reserve), it is not generally recommended that patients undergo endometriosis surgery to improve IVF outcome.
Routine hysteroscopy (visualization of interior of uterus through a scope) on asymptomatic patients found abnormalities in 11 to 12 percent of cases. Removing polyps significantly improved pregnancy rates. It was recommended that patients undergo a hysteroscopy after one failed IVF, if not done sooner.
Fibroids that were partially in the uterine cavity affected pregnancy rates and should be removed. Likewise, fibroids that are intramural (in the muscle of the uterus) and distort or increase the size of the uterine cavity should be removed to increase the IVF pregnancy rate.
It was also suggested that resection of the uterine septum increases the IVF pregnancy rate.
There were several interesting presentations about IVF over the course of the week-long conference. But the one that stimulated the most conversation on the trip home was a
study from Egypt. This program injected (through a catheter placed vaginally through the cervix) 500 units of HCG into the uterine cavity just before performing the embryo transfer. They found
higher pregnancy rates in women who were injected with this "magic bullet." It inspired enough interest that I expect a year from now, we will learn if the intrauterine HCG is in fact the IVF magic bullet.
Certainly, the physicians of East Coast Fertility will endeavor to utilize the worthwhile studies presented at this year’s ASRM to continue to improve the outcomes for our patients.