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Trends in Infertility Medicine

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a blog by David Kreiner, M.D., F.A.C.O.G., East Coast Fertility, November 10, 2010

It has been two weeks since my return from this year’s national American Society for Reproductive Medicine (ASRM) fertility meeting, which was held in Denver this year. At this meeting, breakthroughs in fertility care are announced, results of research studies are discussed, and problems and issues of the day are hammered out.

A few national trends in infertility medicine were evident throughout the meeting.

Single Embryo Transfer

Single embryo transfer is becoming commonplace and successful. In some studies, it was as reliable as double embryo transfer in obtaining a baby.

There was a noteworthy study out of the Cornell program that attempted to dispute the previously reported increase in pregnancy complications associated with IVF pregnancies. They showed in their study that when only one embryo was transferred, there was no increase in preterm birth complications.

The researchers proposed that multiple embryo transfers, perhaps with multiple implantations that spontaneously reduce to singletons, are the cause for the reported increase in IVF pregnancy complications supposedly seen in singleton pregnancies. This was yet another argument — in addition to reducing the risk to multiple pregnancies — proposed for transferring a single embryo at a time.

Questions were raised as to how to motivate patients to transfer only one embryo at a time. In addition to education, at East Coast Fertility we offer those who transfer one at time free cryopreservation, storage and frozen embryo transfers. This is being practiced currently by at least one other program, and I believe we will be hearing next year that this became a nationwide practice.

Minimal Stimulation IVF

There were several studies showing excellent success with minimal stimulation IVF. Program directors actively providing minimal stimulation IVF complained that no distinction was made in the SART reporting so that the lower pregnancy rates seen with minimal stimulation still hurt those programs’ pregnancy statistics.

Hopefully, this much less expensive, less invasive, safer alternative will be evaluated separately from full stimulation IVF, so programs that offer this service to patients are not discriminated against for doing so.

Pre Embryo Genetic Diagnosis

Perhaps the most exciting advance I heard about during the meeting was the improved pregnancy rates and diminished miscarriage rates seen with the 24 chromosome analysis pre embryo genetic diagnosis. This was being offered at the blastocyst stage to improve cost effectiveness, and reduce error and injury to the embryo.

If this holds up, then the promise of improving pregnancy rates of a single embryo transfer known to be genetically normal will become the standard of care. It will not just improve the efficiency of IVF, but perhaps make it as safe as a naturally conceived pregnancy.

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