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The Middle Years Of Reproductive Endocrinology
I entered the field of IVF in 1985 when the pregnancy rate at the Jones Institute, the most successful program in the country, was 15 percent.
IVF's Early Years
Practicing reproductive medicine during the '80s was like having a new love or beginning a new romance — all of it seemed liked a miracle, and everything was about helping patients get pregnant using this new technology and educating the world about what was now possible. This was an exciting time, and the 15 percent pregnancy rate was achieved by transferring six embryos at a time.
But our excitement was often tempered by the consequence we experienced with many high order multiple pregnancies. Unfortunately, these were often complicated and did not always end well. Aside from pregnancy and neonatal complications, many of the marriages also suffered. It was hard to balance a new family's anticipation and heartfelt joy with the sometimes painful and unforeseen consequences — babies who suffered and families that fell apart.
Sometimes beginnings are like that. They start off so bright, and then they get tempered.
The Middle Years—Safer and Not So Sexy
Thankfully, I am now in the “middle years,” of IVF which is so much more successful and no less a miracle. We can attain pregnancies in greater than 60 percent of retrievals for women under 40. These rates are accomplished while transferring one, two or, at most, three embryos at a time. Cryopreservation, or freezing embryos, has also improved our pregnancy rates per retrieval, giving us multiple opportunities to get a patient to conceive from a single IVF stimulation and retrieval.
The middle years of IVF are not like the beginnings of a romance — this is the wood chopping time. The freshness of the technology has worn off, and the focus on making the treatment affordable, accessible and safe may not seem as sexy. But it is the middle years of any pursuit — whether it is marriage, raising a child or practicing medicine — in which the gold is often mined.
A Time for Reason, Not Headlines
The middle years of my practice mean we are making an effort to encourage safer single-embryo transfer and avoid risky multiple pregnancies. We introduced a program in 2007 at East Coast Fertility for patients who transferred one embryo at a time, offering free cryopreservation, storage and frozen embryo transfers until a live baby was born.
Still, patients don’t commonly choose single-embryo transfer. They haven’t seen what I have seen — they still believe that the technology will some how fail them, that IVF won’t work. But from our experience, similar to others’, there was no significant difference in pregnancy rates between patients who chose to transfer one embryo vs. those who chose to transfer two embryos.
While there was a trend toward higher rates for the two-embryo transfer group, it was practically eliminated when frozen embryo transfers were added. These groups were age-matched with no difference except for a 40 percent twin rate and one triplet in the two-embryo transfer group, compared to the single-embryo transfer group in which no twins were created.
It is hoped that these results will encourage a higher percentage of patients with a good prognosis to transfer a single embryo, which is the safer option.
The middle years of practicing reproductive endocrinology captivate my heart. It is a time for reason — not headlines. And for me that is just perfect.