Embryo Transfer Numbers: Which is the Correct Choice for You?

The number of embryos that should be transferred during any single IVF cycle is subject to debate.  Some specialists advocate for elective single embryo transfer (or eSET), which signifies – as the name suggests – that women only receive one embryo implantation per IVF cycle.

Others argue that urging women with infertility to use eSET is unethical, as it reduces their pregnancy chances dramatically.  Multiple embryo transfer gives women with infertility a higher chance of conception.

Which is the correct choice?

 

  • Elective single embryo transfer

The argument for single embryo transfer is that it’s considered lower risk.  Multiple embryo transfer is associated with – you guessed it – multiple births. Although the “idea” of twins may seem ideal to couples struggling with infertility, the reality is that multiple births are risky for both mother and baby. There is a higher chance risk of prematurity, handicap and mortality. The mother has increased risk of premature birth, low birth weight, cesarean section, gestational diabetes and pre-eclampsia. As only one embryo is implanted, the couple is not at risk of multiple births.

  • Multiple embryo transfer

The argument against single embryo transfer: it’s considered unethical.

Although transplanting 4 to 5 healthy, good-quality embryos may increase the risk of multiple births in young women not challenged by infertility, the fact is that many women going through IVF do not have good-quality embryos.  As older women have lower-quality embryos, their chances of pregnancy are significantly decreased.  Even if some of the embryos do implant after IVF treatment, their chances of making it through the first trimester are low (miscarriage rates are high in older women). Is it fair for fertility specialists to reduce pregnancy chances in these women, some of whom may just have one chance at IVF treatment?

The correct choice depends on the individual patient.

In this video, Dr. Vitaly A. Kushnir M.D. from Center for Human Reproduction NYC highlights the different factors that drive the decision of embryo numbers – such as the amount of embryos available, quality of the embryos, the woman’s past medical history and  her age.

The current guidelines for embryo transfer are laid out by the American Society for Reproductive Medicine. Keeping in line with Dr. Kushnir’s comments, the ASRM criteria outlines that an important factor in deciding the amount of embryos to transfer is the woman’s age.

For the moment, fertility centers follow the criteria marked out by the American Society for Reproductive Medicine. Don’t be afraid to ask your fertility specialist about the different options available for embryo transfer numbers. Hint: a fertility center giving individualized care will take into consideration your specific case and medical history before deciding which embryo transfer number would be most suited to your treatment.

3 Things Everyone Should Know When Interpreting IVF Success Rates

Annually, infertility clinics are required to report their IVF success rates to the Centers for Disease Control (CDC), and these figures are passed on to the Society for Assisted Reproductive Technology (SART).

Both organizations caution against using this data to measure the effectiveness of treatment in fertility centers because the data can lack reliability and credibility.  In fact, some centers have even been found to manipulate data by finding loopholes in the federally mandated reporting system.

For these reasons, IVF success rates outcomes should be taken with a grain of salt. Unfortunately, people consulting prospective infertility centers continue to consider a clinic’s pregnancy success rates as one of the most important measurements of the quality and level of care that a clinic provides.

Three Things to Keep in Mind When Interpreting a Prospective Clinic’s IVF Success Rates:

1.       Beware of centers with exceptionally high success rates

Chances are these centers have patient exclusion criteria. The reason their success rates are so high is likely because they accept only straightforward infertility cases.

Such centers exclude women who present with symptoms like very high FSH levels, very low AMH levels, a very low follicle count, or simply who are of advanced maternal age (women trying to get pregnant over 40).  By excluding  these women, who have lower pregnancy chances, a fertility center can offer misleading numbers that raise their success rates above industry standards.

So remember, if you’re being treated by or are looking into a fertility center that is claiming astronomical success rates, the rates likely apply only to women with the simplest of infertility cases.

2.  Check before you make your first appointment about “cut-off” values

Before your first appointment, ask if your clinic has any specific cut-off, or exclusion criteria.

You don’t want to settle on a clinic and get started with the consultation and treatment process, only to find out that because of your infertility symptoms they cannot do anything for you.

This is especially true for women of advanced maternal age (35+), as time is of particular importance to these women when trying to get pregnant.

3.  Measure the quality of an IVF center by looking at the pregnancy success rates of its egg-donation program

Experts suggest looking at the pregnancy success rates of a center’s egg-donation program to measure the skill level of a center’s IVF techniques.

Why? Egg donor cycles aren’t affected by the center’s patient selection.

Egg donor programs recruit donors that meet certain criteria, such as being young, healthy and having an excellent ovarian reserve. Therefore, since the reproductive health of the egg donors is more or less uniform, looking at the successful pregnancy outcome rates of the egg donation program is a good way to measure the skill and expertise of an IVF center.

Get some further tips about interpreting IVF success rates in the brief video below.  Fertility specialist Dr. Norbert Gleicher from the Center of Human Reproduction, New York, explains the calculation of IVF success rates and why they vary from clinic to clinic.