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Advances in Reproductive Medicine Move Us Closer to Guaranteed Success with IVF

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January 15, 2013

The world of Assisted Reproductive Technology (ART) has come so far in the last twenty years, but many physicians on the cutting edge of the field believe the most important advances are yet to come. Fertility treatments like in vitro fertilization (IVF) and embryo freezing for next cycle use have one goal in common: 100% implantation and live birth rate with a single embryo transfer (SET). In short, fertility doctors are striving for ways to tweak a fertility treatment cycle in order to achieve successful pregnancy with little to no risks to the patient.

Gabriel Garzo, M.D., of Reproductive Partners Medical Group in Southern California, says the ideal is to have high success rates with a single embryo transfer, and the field of reproductive medicine is not far away from this goal. “If you ask me where we are going in the field, it is the highest success rate or benefit with the lowest complication and risk to the patients, which is with a single embryo transfer,” he says.

Still, the American Society for Reproductive Medicine's guidelines on embryo transfer have not changed, presumably because the goal (100% success with SET) has yet to be reached. Here are the current guidelines on embryo transfers:

  • Single embryo transfer and no more than a double embryo transfer for women under 35 or those with favorable outcomes: first IVF cycle, good embryo quality, excess embryos to freeze, or history of successful IVF cycle.
  • No more than 2 blastocysts or 3 cleavage-stage embryos for those up to the age of 40.
  • No more than 3 blastocysts or 5 cleavage-stage embryos for those over the age of 40.

“Current guidelines haven’t changed from previous guidelines, and I’m surprised. The Society’s (ASRM) objective is really to decrease the rate of high order multiples; triplets or more. Even though they encourage singleton pregnancies, there aren’t stringent criteria,” states Garzo.

But we can’t talk single embryo transfers and 100% success without discussing the methods by which fertility doctors are trying to attain that goal. Preimplantation genetic diagnosis (PGD) with single embryo transfer is just one of the ways fertility clinics can increase the odds of selecting one genetically normal embryo likely to develop into a pregnancy. Additionally, advances in embryo freezing have allowed for successful thaw, and frozen embryo transfer (FET) outcomes that make successful single embryo transfer possible. (Current research suggests even higher success rates when FET is done in a succeeding cycle to minimize the effects of fertility drugs on the uterine lining.) Garzo declares these advances have the power to change how fertility doctors think about IVF and it is the responsibility of fertility doctors to change the paradigm.

“We have to change the mentality about IVF. A lot of practices are influenced by IVF in the 1980s: 20-30% pregnancy rates, embryo freezing was just starting. Back then, they would transfer more embryos because of the risk of damaging embryos in the freezing process. All of that has changed now.” Garzo says technology has advanced so that SET and high success rates are possible and doctors have less of a reason to transfer multiple embryos.

There is a significant trend toward, and improved success rates with, single embryo transfer across the US and it is likely just a matter of time before medical guidelines reflect that. Garzo believes that when presented with the data, his patients understand that the risks of a multiple embryo transfer (and pregnancy with multiples) outweigh the benefits and that success with a single embryo transfer is very likely with current technology. Understanding how advances in fertility treatment drive us closer to the ultimate goal of IVF provides a glimpse into the future of fertility treatment.


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