RMANJ Welcomes Recently Published National Perinatal Association Position Statement on ART and Single Embryo Transfer
As leaders in the field of reproductive endocrinology, we welcome the recent position statement published by the National Perinatal Association on ART (Link below). We especially support recommendations relating to single embryo transfer as we have reported on this issue extensively and most recently with the BEST clinical trial (Forman et al.).
As the great scientist Albert Einstein noted, “We can’t solve problems by using the same kind of thinking we used when we created them…To raise new questions, new possibilities, to regard old problems from a new angle, requires creative imagination and marks real advance in science.”
Assisted reproductive technologies (ART) and in vitro fertilization (IVF) have been marked by the contributions of pioneering researchers – Howard Jones, Georgeanna Jones, Gregory Pincus, Robert Edwards, Patrick Steptoe and others who had the courage, foresight and ability to think beyond the status quo, to ask important questions, and to inspire ongoing research in efforts to improve outcomes and quality of care for hopeful parents everywhere.
IVF touches many stakeholders – patients, their offspring, healthcare providers, insurance companies, as well as employers of patients undergoing the time-consuming and invasive treatments. Each of these groups may primarily focus only on its own immediate concerns and needs, not incorporating how each step and choice along the path are intricately tied to one another. Therefore goals for safe and effective IVF treatment must be multi-dimensional in order to address the near and long-term issues faced by each group of stakeholders:
- Increase pregnancy and delivery rates
- Decrease miscarriage rates
- Eliminate multiple gestations especially higher order ones (except for rare monozygotic twins)
- Decrease time in treatment and number of cycles required to attain a delivery
- Reduce downstream obstetric and pediatric consequences of infertility care
- Improve cost-effectiveness and cost containment of healthcare expenditures
A recent national review found that fewer than 19% of embryos that were considered to be of sufficient quality to be transferred, actually implanted and progressed to delivery. Despite ongoing improvements in the spectrum of IVF procedures and technologies, success rates in the United States, as measured by live birth rates, have plateaued at approximately 40%, and double embryo transfer (DET) has continued to predominate in order to maximize live birth rates.
Unfortunately, this strategy means that the incidence of twins deriving from infertility treatments is approximately 20 times greater than that of spontaneously conceived twins. Although twins are considered one of the single most important adverse outcomes of IVF cycles that result in a viable pregnancy, one of the ongoing impediments to adopting single embryo transfer (SET) as the standard of care has been that DET reliably resulted in higher delivery rates per single fresh cycle than SET.
Today, however, synchronous transfer of a single euploid embryo provides delivery rates of 55% to 65% through maternal ages of 42, exceeding national delivery rates. These outcomes are broadly achievable now by integrating our knowledge of the entire IVF process with advanced technologies. Through these synergies, a new paradigm has emerged and it is now possible to:
- Consistently perform extended embryo culture to the blastocyst stage
- Improve safety of embryo biopsy through trophectoderm biopsy
- Enhance embryo selection process through embryonic aneuploidy screening
- Ensure synchrony between blastocyst maturation and endometrial receptivity to implantation
- Utilize dramatic improvements in cryopreservation to allow for synchronous transfer
Today, we are seeing remarkable advances in our understanding of reproductive physiology, embryonic development, and the IVF process, as well as the development of powerful and validated new genomic and culture-related tools that are ushering in an era in which clinical outcomes can improve dramatically and we can redefine success as one healthy baby at a time.
Link from NeonatologyToday.Net