What are the Challenges to Patients Choosing Elective Single Embryo Transfer?
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A multiple birth significantly increases the risk of serious health problems to the mother, fetus, and newborns
- Prospective risk of fetal death more than triples in twins vs. a singleton
- The average gestational age at delivery is 35 weeks for twins and 32 weeks for triplets vs. 39 weeks for singletons
So why do so many women choose Multiple Embryo Transfer (MET)?
It all comes down to having the right information!
Patients often make a major medical decision regarding embryo transfer without knowing the full risks of a multiple birth.
Read more about this issue here!
I’m Ready: How Do I Choose A Reproductive Endocrinologist?
If the most important thing for you and your partner is having a baby – and you’re having trouble conceiving – the next most important thing is finding the right reproductive endocrinologist (RE) to get help.
A reproductive endocrinologist is an OB-GYN who specializes in diagnosing and treating infertility in women and men. They’ll direct medical testing to first help diagnose why you may be having trouble getting pregnant. And, they’ll work with you to determine the best way to overcome the problems you may be experiencing.
Here are a few important factors to consider when choosing the reproductive endocrinologist that’s right for you.
What is Intrauterine Insemination (IUI)?
There are many different reasons why a woman may have difficulty becoming pregnant. Fortunately, advances in treating infertility have led to effective procedures that help address specific problems and unexplained infertility. Intrauterine insemination (IUI) is one such first-line treatment for many couples.
When couples have fertility issues, a complete assessment of both partners can help identify the likely obstacles. If the problems are related to sperm – such as low count or motility, or incompatibility with a woman’s cervical mucus or problems with sexual intercourse – IUI may be helpful. The procedure can be performed with the partner’s sperm, or when donor sperm is used, and it is also often a first treatment for unexplained infertility and endometriosis issues.
When, Where, and How to Start Your Fertility Journey
When a couple is eager to have a baby and isn’t getting pregnant right away, time seems to stand still. The first place to start is figuring out if there is a problem. Infertility is defined as not getting pregnant after 12 months (or more) of regular unprotected sex. Ninety percent of couples get pregnant during this timeframe.
If there is trouble conceiving, experts have recommendations on how soon to consult a fertility specialist based on a woman’s age and past reproductive history. Guidelines suggest a woman under the age of 35 should seek help after 12 months, which drops to six months for women aged 35 to 39. And women aged 40 and over should seek fertility assistance after trying to get pregnant for three months without success. If the woman has a known reproductive problem such as irregular cycles, hormone problems, history of pelvic surgery or if the man has a history of problems that might affect sperm production, then they should seek medical help right away.
From Scandal to Mainstream: The History of IVF
We often take for granted what comes before research translates to widely accepted medical practice. For in-vitro fertilization (IVF), the research and breakthroughs leading to success took substantially longer than most people realize. The history of IVF is a lesson in persistence and reward — more than five million babies have been born worldwide using IVF in the 37 years since the first assisted birth. But it wasn’t easy. http://www.eshre.eu/Guidelines-and-Legal/ART-fact-sheet.aspx
How IVF – combining sperm and egg in the lab – came to be begins in the mid-1800s when scientists first confirmed that pregnancy occurred from a combination of sperm and eggs. By 1876, early IVF treatments were tested with rabbits, and by the early 20th century major research was underway on how hormones and fertility were linked.
It Takes Two: Male Infertility
It takes two to tango – and two to make a baby. So when there are problems with getting pregnant, there are two people to consider when looking for possible causes. And even though infertility is often looked at as a “women’s issue,” every couple’s fertility assessment should include a review of the male partner.
Male infertility is more common than most people realize – approximately 15% to 25% of all infertility is due to solely to male factors. An additional 20-40% of infertility cases are related to male and female issues with sperm. Some of the reasons for male infertility are well documented and a variety of tests are available to assess potential problems. However, at least fifty percent of cases are due to unknown factors.
IVF culture media may influence sex of embryo
BioNews reported on March 23rd, “The nutrient-filled liquid used to grow embryos during IVF might affect the resulting male to female birth ratio, a study suggests. But this only seems to be true when the sperm is injected directly into the egg during fertility treatment (a technique known as ICSI).
“…Dr David Adamson, a reproductive endocrinologist and surgeon at the Advanced Reproductive Care Fertility Clinic in California, USA, told Medical Daily: ‘I don’t think it’s effective enough to say that it’s a good therapeutic intervention. This may well be true, but in the absence of information about the culture medium, it’s difficult to interpret.'”
Read more here
IVF Nutrients May Influence Gender Selection In Embyros, Reports Medical Daily
Medical Daily reported March 19th, “Chinese scientists believe that certain undisclosed nutrients given to embryos during in vitro fertilization may favor the development of male fetuses over female. The study is significant because it could possibly lead to a new technique for gender selection. However, experts are more concerned about what other changes that aren’t as obvious as sex these gender-specific nutrients may bring about.” Read more here…
Dr. Adamson writes about advanced maternal age in the Silicon Valley issue of Bay Area Parent magazine. Click here to access the article.
Embryo donation and fertility treatments
Among the choices available for couples seeking fertility treatment, embryo donation is an important option to consider. Embryo donation is much more affordable than many other fertility treatments, and its odds of success are relatively favorable. Like any medical technique, however, it comes with its own challenges.
Embryo donation is defined as giving remaining embryos resulting from in vitro fertilization to either another person or couple. These embryos are placed into the recipient woman’s uterus to facilitate pregnancy and childbirth. Similar to egg and sperm donation, the resulting child is considered the child of the birth mother, and not the child of the donor. In most cases, the embryos are donated after the woman for whom they were originally created has successfully carried one or more pregnancies to term.
Endometriosis.org reports, “With an estimated 176 million women in the world affected by the painful consequences of endometriosis, it is shameful how little commitment there is to invest in basic research so that the life altering realities of endometriosis can be prevented in the next generation of women. On International Women’s Day (#IWD2015) we’ve asked 19 health care professionals, who have dedicated their professional careers to increasing the understanding of endometriosis, to give their take on what needs to happen to care better for women with endometriosis today – and what we can do to improve their lives tomorrow.” Read more here…
From Science 2.0, Dr. Adamson writes, “Every fertility specialist seeks to design the most effective treatment strategy possible for each couple seeking to become pregnant. Treatment is usually a complex process and fertility drugs are often part of the regimen. Along with the benefits of such drugs, however, come risks such as multiple gestation or pregnancy.”
Read the whole story here…
Access to Fertility Treatment Varies Across the Globe
Wanting to have a baby is a uniquely universal desire. Yet, the way fertility is viewed and treated around the world varies considerably. From access to assisted reproductive technology (ART), to widely different costs and legal barriers, couples in different countries often face widely different attitudes and strategies on their way to the same goal.
Approximately one hundred countries use ART with 1.6 million cycles and 400,000 babies born each year for a worldwide total of nearly 5 million births, according to the International Committee Monitoring the Assisted Reproductive Technologies (ICMART).
For every country, however, a variety of complex, intertwining factors of culture and religion, economics, education, ethics and supply of specialists and facilities affects what fertility treatment is available, according to a survey by the International Federation of Fertility Societies (IFFS) This translates to relatively few fertility centers in the Middle East, South East Asia and Latin America, while Japan and India have built hundreds of new facilities to meet the global demand for cross border reproductive care (CBRC).
Single or multiple embryo transfers – a tough decision
One quickly learns that fertility medicine is a field that offers many different treatment options, and each one of them requires choices. Keeping track of these choices, as well as understanding the pros and cons, is crucial, but challenging. When a woman chooses to use in vitro fertilization (IVF), one of the biggest decisions involved is the number of embryos to transfer for potential pregnancy. Both single and multiple embryo transfers come with potential risks and advantages. More embryos are more likely to result in successful implantation, but they are also more likely to result in a multiple pregnancy, which can lead to health complications as well as increased financial burdens.
In 2013, the Society for Assisted Reproductive Technology (SART), issued guidelines for the number of embryos to be transferred based on:
- The patients’ age
- Likelihood to achieve successful implantation
- The development of the embryos (the number of days since the embryo has been fertilized in vitro.)
From Medical Daily, “How old is too old to give birth? The answer to this question would have been obvious 30 years ago, but recent advancements in fertility treatments mean that in 2015, a woman’s biological clock can be permanently put on hold. Thanks to science, a 55- or even 65-year-old woman can do what was once unthinkable: become pregnant and give birth to a healthy child. However, just because a woman of this age can physically become pregnant, is the decision to do so ethical?”
Read the rest of the article here…
From Science 2.0, Dr. Adamson writes, “I read a sad story in the news recently. A Baltimore mother died a week after giving birth to two twin sons, leaving her husband to raise the two boys on his own. As tragic as the news was, the reason that it made national headlines was that the mother was 56 years old.”
Read the whole story here…
From OBG Management
Update on fertility
Egg freezing is no longer deemed “experimental.” Here are current protocols, fertility expectations, and safety outcomes as well as ethical considerations for oocyte cryopreservation.
Read more here….
OBG Manag. 2015;27(2):32-34,36-39
Mary E. Abusief, MD and G. David Adamson, MD