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Embryo Selection: The Critical Factor in IVF Success
by Geoffrey Sher, M.D.
No other factor in the IVF process influences success as directly as choosing the “right” embryo for transfer to the uterus. This is due mainly to the fact that Aneuploidy, an irregular numerical chromosomal configuration of the embryo, is responsible for the majority of IVF failures. Aneuploidy generally results in either: 1) the failure of the embryo to develop to a stage capable of attaching to the uterine wall, 2) miscarriage after implantation, or 3) a chromosomal birth defect such as Down syndrome. The selection of one or more “competent” embryos for transfer is thus central to IVF success.
Unfortunately, most methods currently used to select the best embryos for transfer are relatively inconsistent – yielding on average less than a 20% pregnancy rate per embryo transferred. This fact is responsible for the tendency to transfer a large number of embryos during an IVF cycle in hopes of attaining a pregnancy. Unfortunately, this can lead to high-order multiple pregnancies which carry substantial risks to both the mother and the babies.
Methods currently used to select the best embryo(s) for transfer include:
1. Microscopic Embryo Grading
2. Blastocyst Embryo Transfer
3. Embryo sHLA-G Expression
4. PGD Using Fluorescence In-Situ Hybridization (FISH)