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Fertility Doctor of the Month: Richard T. Scott, Jr.
Richard Scott, M.D., is a board certified reproductive endocrinologist, the clinical and scientific director of RMA of New Jersey and the director of laboratory services. He and his team will do approximately 2,400 IVF cycles this year. And they have one of the largest research programs dealing with embryos in the world. Their core laboratory looks at all aspects of embryonic development and reproductive potential of embryos, and it offers comprehensive chromosome screening (CCS), a type of preimplantation genetic screening (PGS) that offers same-day testing for abnormal numbers of chromosomes in all 24 chromosomes, with subsequent fresh embryo transfer in IVF.
FertilityAuthority is pleased to recognize Dr. Richard Scott as Fertility Doctor of the Month.
“Everything we do is geared toward reducing the burden of treatment. That’s our mantra of how we care for patients,” Dr. Scott says.
Dr. Scott's philosophy centers around the importance of time in the chances for fertility treatment success. The average patient is in treatment at his practice for four months — that’s the amount of time from the first appointment to ongoing pregnancy. “We’re not wasting money and time; of course time is the thing they can afford least. Time is what really hurts [fertility patients]. So by taking that out of the loop, we can do a lot of good things and I think it’s about to get even better.”
Dr. Scott says his fertility clinic is turning its focus toward single embryo transfer (SET) in order to reduce the risks associated with twins, triplets and higher order multiples. “The only thing we really do to make our patients lives certainly more at risk or complicated is multiples," he says. "And we’re about to take them off the table,” he says. “By getting rid of multiples, you’re really at the point where IVF is safer than Clomid." He explains that by only transferring one embryo, the fertility doctors remove 99 percent of the complications associated with assisted reproductive technology while still having pregnancy outcomes that significantly exceed the national average for all age groups. Dr. Scott anticipates that within the next six months, all IVF cycles in his practice will use SET and that other practices who aren’t already doing so will soon be following suit.
Single Embryo Transfer
There are currently six randomized trials showing that one embryo transferred has lower pregnancy rates than two embryos. And that’s true, Scott says, unless you do additional screening.
“What we’re interested in is embryonic reproductive competence, which means how you optimize whether an embryo has a chance to make a baby or not, and if so what you do,” he says. Dr. Scott explains that the average embryo in any woman can’t make a baby. So how do you know which ones to put back? “The answer to the question, of course, is you have to assess them and you have to take better care of them. We have won awards for looking at them genetically, and for looking at proteins secreted in or around the embryos. We also did the first randomized trial that showed improved pregnancy rates with PGS, and we now are just finishing a study that we’ll present at ASRM this year. I think it’s safe to say that we have now shown that by screening embryos we can now very successfully reduce the number of embryos we put back,” he says.
Day 3 vs. Day 5 Biopsies
There is no evidence to justify day 3 embryo biopsies for in vitro fertilization (IVF), Dr. Scott says. Research has proven that day 5 biopsies should be the routine. In a study led by Dr. Scott, embryo biopsy was evaluated at both day 3 and day 5. One group received the day 3 biopsy and one group received the day 5 biopsy. The results demonstrate that a day 3 biopsy decreases an embryo’s chances of developing and that day 5 biopsy is safer and does not diminish the embryo's potential to implant and develop into a healthy baby.
“We were probably the only ones in the country to do day 5 biopsy on a regular basis. Now I think there are probably 20 or 30 programs doing it," he says. "And I think that number will quadruple by next year."
Research amounts to better outcomes, fewer complications, and safer, less expensive treatment. “Less time in treatment, fewer cycles required to get pregnant - all the good things are not in the future, they’re here now,” Scott says. FertilityAuthority applauds Dr. Scott for the research he’s conducted and the protocols he’s developed and employed that enhance fertility treatment for patients around the globe.