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Archive for the ‘FET’ tag

The Dilemma of Excess Embryos

By Tracey Minella

January 25th, 2014 at 9:32 am

credit: wiki commons public domain

 

There is so much to focus on when beginning IVF. Insurance and financing issues. Learning about all the medications, as well as how to inject many of them. Understanding the processes of daily monitoring and blood work, of retrievals and transfers. Deciding how many embryos to transfer back and whether to cryopreserve the others.

Most people do cryopreserve the embryos which are not transferred back on a fresh IVF cycle. These frozen embryos are often thawed and used in a later cycle, either years later after a successful fresh cycle or sooner if the fresh cycle was unsuccessful.

Sometimes, especially in cases where patients only transfer back one embryo, like patients in Long Island IVF’s Single Embryo Transfer Program http://bit.ly/1jjvr3y patients may obtain enough embryos from their first fresh IVF cycle to satisfy all of their family-building needs through subsequent frozen embryo transfers. They may have one baby, then another a few years later, and then yet another…all from one retrieval. Yes, they are the lucky ones.

I remember… almost casually… signing off on the cryo consent, my primary focus being on all the matters that had an immediate effect on my first fresh cycle. I wanted to be pregnant now. I’d worry about what to do with any leftover frozen embryos… after I had all the children I wanted … later. It took a few cycles before I finally had any embryos left over to freeze, but the moment I did, I set in motion a decision more complicated and emotional than I initially imagined.

What to do with excess embryos is about as personal a decision as there is. If you don’t have too many, do you keep transferring them until they are gone? Do you donate them…full genetic siblings to your other children…to another couple? Do you donate them to research if your state allows? Do you just keep them in storage and pay the fees? Do you discard them?

I was reminded of the difficulty of this decision when I read about New Zealand’s law limiting the amount of time that embryos can remain in storage to ten years. http://bit.ly/1f7uypm . Fortunately, there is no such law in New York. It is stressful enough for patients to decide what to do with excess embryos without the government imposing an arbitrary time limit on them.

There is no single right answer. Just a right answer for you.

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If you cryopreserved embryos, are you comfortable with your initial decision on how they should be handled? Or are you undecided?

 

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Infertility Podcast Series: Journey to the Crib: Chapter 34: Fertility Treatment During This Economic Downturn

By David Kreiner MD

December 5th, 2013 at 7:57 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers the final chapter, Chapter Thirty-Four: Fertility Treatment During This Economic Downturn. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=149

Fertility Treatment During This Economic Downturn


Financial hardships have increased fertility challenges for many couples attempting to build their families.  In regions where patients do not have insurance coverage for their IVF procedures it is unlikely that they proceed with the treatment that is necessary for them to be able to complete their families.

In places that do provide coverage for IVF, such as Massachusetts, 5% of all babies born are as a result of IVF.  Elsewhere in the U.S., IVF accounts for only 1% of births suggesting that the financial cost of IVF denies access for approximately 80% of couples in need.

The problem of the cost of IVF is compounded by the fact that patients are driven to transfer multiple embryos to limit the cost and avoid additional fees from cryopreservation, embryo storage and frozen embryo transfers.  These multiple transfers increase the risks of multiple pregnancy and preterm delivery with subsequent complications to the babies from preterm birth.

We, at Long Island IVF, attempt to make IVF more accessible and safer by offering income based grants, free cryopreservation, storage and discounted frozen embryo transfers to patients electively transferring single embryos.  We have also offered free IVF cycles through best video/essay contests to a few needy patients over the past few years.

It is our sincere wish and hope that a bill that is presently in front of Congress offering a tax credit to patients going through IVF is passed thereby making IVF that much more affordable to our patients in need.

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Was this helpful in answering your questions about fertility treatment during this economic downturn? Are you aware of the pending proposed Family Act, which would offer a tax credit to infertile women wishing to undergo infertility treatment (similar to the current adoption credit for those wanting to pursue adoption)? Have you urged your legislators to support this important legislation?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

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Infertility Podcast Series: Journey to the Crib: Chapter 29: Why the Wyden Bill Does Not Support Fertility Patients

By David Kreiner MD

November 3rd, 2013 at 11:20 am

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Nine: Why the Wyden Bill Does Not Support Fertility Patients. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=138

Why “The Wyden Bill” Does Not Support Infertility Patients

 

IVF results subjected to government audit were mandated to be reported with the passage of the “Wyden bill”.   The intent of the CDC and national reproductive society (SART) was to assist infertility patients by informing them of the relative success of all IVF programs in the country. 

 

Unfortunately, what sometimes creates the best statistical results is not always in the best interest of the mother, child, family and society.  Now that prospective parents are comparing pregnancy rates between programs there is a competitive pressure on these programs to reports the best possible rates.   Sounds good…unfortunately it doesn’t always work out that way for the following reasons.

 

Patients with diminished ovarian reserve, who are older or for any number of reasons have a reduced chance for success, have a hard time convincing some programs to let them go for a retrieval.  In 2008, we reported our success, 15% with patients who stimulated with three or fewer follicles.  Sounds low and in fact many of these patients were turned away by other IVF programs in our area.  However, for those families created as a result of their IVF, these “miracle” babies are a treasure that they otherwise… if not for our program giving them their chance… would never have been born.

 

Another unfortunate circumstance of featuring live birth rate per transfer as the gold standard for comparison is that it pressures programs to transfer multiple embryos thereby increasing the number of high risk multiple pregnancies created.  This is not just a burden placed on the patient for their own medical and social reasons but these multiple pregnancies add additional financial costs that are covered by society by increasing costs of health insurance as well as the cost of raising an increased number of handicapped children.

 

William Petok, the Chair of the American Fertility Association’s Education Committee reported on the alternative Single-Embryo Transfer (SET) “Single Embryo Transfer:  Why Not Put All of Your Eggs in One Basket?”.  He stated in November 2008, that although multiple rather than single-embryo transfer for IVF is less expensive in the short run, the risk of costly complications is much greater.  Universal adaptation of SET cost patients an extra $100 million to achieve the same pregnancy rates as multiple transfers, but this approach would save a total of $1 billion in healthcare costs.

 

We have offered SET since 2006 with the incentive of free cryopreservation, storage for a year and now a three for one deal for the frozen embryo transfers within the year in an effort to drive patients to the safer SET alternative. 

 

If we are going to report pregnancy rates with IVF as is required by the Wyden Bill, let us put all programs on the same playing field by enforcing the number of embryos to be transferred and even promoting minimal stimulation IVF for good prognosis patients.  The Wyden Bill without the teeth to regulate such things as the number of embryos transferred and reporting success per embryo transfer does more harm than good.  Let us promote safer alternatives and report in terms of live birth rate per stimulation and retrieval, including frozen embryo transfers, so that there is a better understanding of the success of a cycle without increasing risks and costs from multiples.

 

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Was this helpful in answering your questions about the Wyden Bill, IVF success rates and reporting requirements, and SET?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

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Infertility Podcast Series: Journey to the Crib: Chapter 30: The Gift of Life and Its Price

By David Kreiner, MD

September 3rd, 2013 at 7:41 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty: The Gift of Life and Its Price. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=141

The Gift of Life and Its Price

 

IVF has been responsible for over 1 million babies born worldwide who otherwise without the benefit of IVF may never have been.  This gift of life comes with a steep price tag that according to a newspaper article in the New York Times in 2009 was $1 Billion per year for the cost of premature IVF babies.

 

According to the CDC reported in the same NY Times issue, thousands of premature babies would be prevented resulting in a $1.1 Billion savings if elective single embryo transfer (SET) was performed on good prognosis patients. 

 

The argument often given by a patient who wants to transfer multiple embryos is that to do SET would lessen their chances and to go for additional frozen embryo transfers is costly.

 

In fact, if one considers the combined success rate of the fresh and frozen embryo transfers that are available from a single stimulation and retrieval, the success rate is at least as high if not higher in the cases of fresh single embryo transfers. 

 

At Long Island IVF, in an effort to eliminate the financial motivation for multiple embryo transfers, we offer free cryopreservation and embryo storage for a year to our single embryo transfer patients.  In addition, we offer them three (3) frozen embryo transfers for the price of one for up to a year after their retrieval.

 

IVF offered with single embryo transfer is safer, less costly and probably the most effective fertility treatment available for good prognosis patients.                     

 

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Was this helpful in answering your questions about single embryo transfers?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

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Infertility Podcast Series: Journey to the Crib: Chapter 22: Cryopreservation of Embryos

By David Kreiner, MD

July 15th, 2013 at 11:09 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Two: Cryopreservation of Embryos. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=119

 Cryopreservation of Embryos

 In 1985, my mentors, Drs. Howard W. Jones Jr and his wife Georgeanna Seegar Jones, the two pioneers of In Vitro Fertilization (IVF) in the Western Hemisphere, proposed the potential benefits of cryopreserving embryos for future transfers.  They predicted that doing so would increase the overall success rate of IVF and make the procedure safer, more efficient and cost effective. 

One fresh IVF cycle might yield enough embryos so that in addition to performing a fresh embryo transfer in the same cycle as the stimulation and retrieval that additional embryos may be preserved for use in future cycles.  This helps to limit the exposure to certain risks confronted in a fresh cycle such as the use of injectable stimulation hormones, the egg retrieval and general anesthesia.  It also allows patients to minimize their risk for a multiple pregnancy since embryos can be divided for multiple transfers.

At Long Island IVF, we are realizing the Jones’ dream of safer, more efficient and cost- effective IVF, as well as increasing the overall success of IVF. 

Today, an estimated 25% of all assisted reproductive technology babies worldwide are now born after freezing.  Studies performed in Sweden revealed that babies born after being frozen had at least as good obstetric outcome and malformation rates as with fresh IVF.  Slow freezing of embryos has been utilized for 25 years and data concerning infant outcome appear reassuring relative to fresh IVF. 

I personally have pushed to promote the concept of removing the financial pressure to put all your eggs in one basket by eliminating the cost of cryopreservation and storage for those patients transferring a single embryo.  Furthermore, such a patient may go through three frozen embryo transfers to conceive for the price of one at our program.  We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

* * * * * * **  * * * *

Was this helpful in answering your questions about cryopreservation of embryos?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

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Infertility Podcast Series: Journey to the Crib: Chapter 22: Cryopreservation of Embryos

By David Kreiner MD

July 8th, 2013 at 8:58 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Two: Cryopreservation of Embryos. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=119

Cryopreservation of Embryos

In 1985, my mentors, Drs. Howard W. Jones Jr and his wife Georgeanna Seegar Jones, the two pioneers of In Vitro Fertilization (IVF) in the Western Hemisphere, proposed the potential benefits of cryopreserving embryos for future transfers.  They predicted that doing so would increase the overall success rate of IVF and make the procedure safer, more efficient and cost effective. 

 

One fresh IVF cycle might yield enough embryos so that in addition to performing a fresh embryo transfer in the same cycle as the stimulation and retrieval that additional embryos may be preserved for use in future cycles.  This helps to limit the exposure to certain risks confronted in a fresh cycle such as the use of injectable stimulation hormones, the egg retrieval and general anesthesia.  It also allows patients to minimize their risk for a multiple pregnancy since embryos can be divided for multiple transfers.

 

At Long Island IVF, we are realizing the Jones’ dream of safer, more efficient and cost- effective IVF, as well as increasing the overall success of IVF. 

 

Today, an estimated 25% of all assisted reproductive technology babies worldwide are now born after freezing.  Studies performed in Sweden revealed that babies born after being frozen had at least as good obstetric outcome and malformation rates as with fresh IVF.  Slow freezing of embryos has been utilized for 25 years and data concerning infant outcome appear reassuring relative to fresh IVF. 

 

I personally have pushed to promote the concept of removing the financial pressure to put all your eggs in one basket by eliminating the cost of cryopreservation and storage for those patients transferring a single embryo.  Furthermore, such a patient may go through three frozen embryo transfers to conceive for the price of one at our program.  We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

 

* * * * * * **  * * * *

Was this helpful in answering your questions about cryopreservation of embryos?

Please share your thoughts about this podcast here. And ask any questions, whih Dr. Kreiner will answer.

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Five Facts About Embryo Transfers

By Tracey Minella and David Kreiner MD

December 15th, 2011 at 4:07 pm

One is the loneliest number. Eight makes you an Octomom. But there’s more to Embryo Transfers than just those extremes.

And the standards regarding how many embryos to transfer back to a woman’s uterus have changed as the assisted reproductive technology improves and IVF success rates continue to rise.

Two decades ago, it was standard to transfer up to four embryos per fresh IVF cycle. Even more if you were older or had prior failed IVF cycles. Today, cutting edge clinics like Long Island IVF and East Coast Fertility have success rates so high that Single Embryo Transfers (SETs) are often highly encouraged. And transferring more than two embryos is generally discouraged in most cases.

So, nowadays, one is no longer the loneliest number…it’s often the luckiest number!

Below, Dr. Kreiner shares five facts about embryo transfers that curious patients need to know:

  • After a few days of development, the best appearing embryos are selected for transfer
  • The number chosen influences the pregnancy rate and the multiple pregnancy rate
  • A woman’s age and the appearance of the developing embryo have the greatest influences on pregnancy outcome
  • Embryos are placed in the uterine cavity with a thin tube
  • Excess embryos of sufficient quality that are not transferred can be frozen

After a few days of development, one or more embryos are selected for transfer to the uterine cavity.  Embryos are placed in the uterine cavity with a thin tube (catheter).  Ultrasound guidance may be used to help guide the catheter or confirm placement through the cervix and into the uterine cavity. Although the possibility of a complication from the embryo transfer is very rare, risks include infection and loss of, or damage to the embryos. 

The number of embryos transferred influences the pregnancy rate and the multiple pregnancy rate. The age of the woman and the appearance of the developing embryo have the greatest influence on pregnancy outcome and the chance for multiple pregnancy.  While it is possible, it is unusual to develop more fetuses than the number of embryos transferred. It is critical to discuss with your doctor the number to be transferred before the transfer is done.

In an effort to help curtail the problem of multiple pregnancies (see multiple pregnancies), national guidelines published in 2006 recommend limits on the number of embryos to transfer (see Tables below). These limits should not be viewed as a recommendation on the number of embryos to transfer. These limits differ depending on the developmental stage of the embryos and the quality of the embryos and take into account the patient’s personal history.  

Recommended limits on number of 2-3 day old embryos to transfer

Embryos

age <35

age 35-37

age 38-40

age >40

favorable

1 or 2

2

3

5

unfavorable

2

3

4

5

Recommended limits on number of 5-6 day old embryos to transfer

Embryo Prognosis

age <35

age 35-37

age 38-40

age >40

favorable

1

2

2

3

unfavorable

2

2

3

3

In some cases, there will be additional embryos remaining in the lab after the transfer is completed.  Depending on their pregnancy potential, it may be possible to freeze them for possible use in a subsequent cycle. 

* * * * * * * * * ** * * *

How many embryos have you had transferred at one time? What was the hardest thing about your decision on the number?

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Cryopreservation: A Look into the IVF Freezer

By Tracey Minella and David Kreiner MD

December 13th, 2011 at 2:41 pm

Remember the Good Humor man? You’d hear that sound from blocks away and bolt out the door barefoot, shrieking “STAAAPPP!” arms flailing, and being joined by the rest of the block like rats to the Pied Piper.

Remember the way the white square door with the chunky silver hinge on the back swung open and all that cold, smoky fog billowed out into the humid air?

Remember the frozen magic inside?

Well, Long Island IVF and East Coast Fertility have magic freezers, too. Full of dreams. Full of potential. Full of embryos that may one day turn out to be rugrats running after the ice cream man.

In fact, Long Island IVF’s freezer once held the frozen embryo that turned out to be Long Island’s first cryo baby! Let’s revisit an earlier post by Dr. Kreiner which lets us take a peek inside the freezer of Long Island’s first successful cryopreservation program:

In 1985, my mentors, Drs. Howard W. Jones Jr. and his wife Georgeanna Seegar Jones, the two pioneers of in-vitro fertilization in the USA and the entire western hemisphere, proposed the potential benefits of cryopreserving or freezing embryos following an IVF cycle. They predicted that cryopreserving embryos for future transfers would increase the overall success rate of IVF and make the procedure more efficient and cost effective. They also suggested that it would reduce the overall risks of IVF. For example, one fresh IVF cycle might yield many embryos which can be used in future frozen embryo transfer cycles, if necessary. This helps to limit the exposure to certain risks confronted only in a fresh IVF cycle such as the use of injectable stimulation hormones, the egg retrieval operation, and general anesthesia.

At East Coast Fertility, we are realizing the Jones’ dream of safer, more efficient and cost effective IVF. By utilizing the ability to cryopreserve embryos in 2007, 61.5% (118/192) of patients under 35 were successful in having a live birth as a result of only one egg stimulation and retrieval cycle! In addition, because of our outstanding Embryology Laboratory, we are usually able to transfer as few as 1 or 2 high quality embryos per cycle and avoid risky triplet pregnancies. In fact, since 2002, the only triplet pregnancies we have experienced have resulted from the successful implantation of two embryos, one of which goes on to split into identical twins (this is rare!). By cryopreserving embryos in certain high-risk circumstances, we are able to vastly reduce the risk of ovarian hyperstimulation syndrome requiring hospitalization. At East Coast Fertility, safety of our patients comes first. Fortunately, our success with frozen embryo transfers is equivalent to that of fresh embryo transfers, so that pregnancy rates are not compromised in the name of safety, nor are the babies.

Today, as reported in the Daily Science: “The results are good news as an increasing number of children, estimated to be 25% of assisted reproductive technology (ART) babies worldwide, are now born after freezing or vitrification” (a process similar to freezing that prevents the formation of ice crystals).

The study, led by Dr Ulla-Britt Wennerholm, an obstetrician at the Institute for Clinical Sciences, Sahlgrenska Academy (Goteborg, Sweden), reviewed the evidence from 21 controlled studies that reported on prenatal or child outcomes after freezing or vitrification.

She found that embryos that had been frozen shortly after they started to divide (early stage cleavage embryos) had a better, or at least as good, obstetric outcome (measured as preterm birth and low birth weight) as children born from fresh cycles of IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection). There were comparable malformation rates between the fresh and frozen cycles. There were limited data available for freezing of blastocysts (embryos that have developed for about five days) and for vitrification of early cleavage stage embryos, blastocysts and eggs.

Slow freezing of embryos has been used for 25 years and data concerning infant outcome seems reassuring with even higher birthweights and lower rates of preterm and low birthweights than children born after fresh IVF/ICSI. For the newly introduced technique of vitrification of blastocysts and oocytes, very limited data have been reported on obstetric and neonatal outcomes. This emphasises the urgent need for properly controlled follow-up studies of neonatal outcomes and a careful assessment of evidence currently available before these techniques are added to daily routines. In addition, long-term follow-up studies are needed for all cryopreservation techniques,’ concluded Dr Wennerholm.

The use of frozen embryos has become a common standard of care in most IVF Programs. At East Coast Fertility, [now merging with Long Island IVF], we are able to keep multiple pregnancy rates down – by only transferring one or two embryos at a time – while allowing patients to hold on to the additional embryos that they may have created during the fresh cycle. It is like creating an insurance plan for patients. We developed a unique financial incentive program using the technology of cryopreservation to encourage patients to transfer only one healthy embryo at a time.

In order to ensure the best outcome for mother and child – these special pricing plans take the burden off the patient to pay for the additional transfers and the cryopreservation process. We have eliminated the cost of cryopreservation, storage and embryo transfer for patients in the single embryo transfer program. Thus, patients no longer have that financial pressure to put all their eggs in one basket! We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

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Did you know before today that Long Island IVF is the home of Long Island’s first cryo baby?

Or that East Coast Fertility’s Director, Dr. Kreiner, and Long Island IVF’s Co-Directors, Drs. Kenigsberg and Brenner were running the show together at Long Island IVF way back then when cryo first came to Long Island…back when most of you reading this were very little kids?

Stay tuned as we bring you more interesting history about these IVF pioneers now that they’re all together again.

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IVF Today: One Baby at a Time

By Tracey Minella and David Kreiner MD

August 26th, 2011 at 12:00 am

Single embryo transfers. What a concept!

Back when I was doing IVF in the mid-90’s, transferring FOUR embryos was the norm! Sometimes even more, depending on the patient’s history! After a few failed IVFs, I did a GIFT/ET in 1994 with 4 eggs for the GIFT plus a 3ET. Technically, I could have been the “Septomom”, though prior history didn’t make that seem possible. I did get pregnant that cycle but later miscarried that twin pregnancy.

Also back then, my best friend was doing IVF at a clinic upstate. She had elected on medical advice to reduce a triplet pregnancy to a twin pregnancy, but miscarried after the selective reduction. A few years later, she got pregnant with triplets again. She did not reduce and, despite many complications, has healthy 12 year old triplets now.

It’s refreshing to see that technology at some of the finest fertility clinics now enables couples to choose single embryo transfers (SETs) and avoid the expense and potential complications a high order, high risk multiple pregnancy brings.

Dr. Kreiner of East Coast Fertility believes so strongly in the success rates and safety of SETs that his practice offers an amazing financial incentive to patients undergoing traditional IVF. Read on for details:

I entered the field of IVF in 1985 when the pregnancy rate at the Jones Institute, the most successful program in the country, was 15 percent. This rate was achieved by transferring six embryos at a time. As a consequence, we experienced many high order multiple pregnancies. Unfortunately, these were often complicated and did not always end well. Aside from pregnancy and neonatal complications, many of the marriages also suffered.

Thankfully, today IVF is so much more successful and we can attain pregnancies in greater than 60 percent of retrievals for women under 40. These rates are accomplished while transferring one, two, or at most three embryos at a time. Cryopreservation, or freezing embryos, has also improved our pregnancy rates per retrieval giving us multiple opportunities to get a patient to conceive from a single IVF stimulation and retrieval.

In an effort to encourage safer single embryo transfer and avoid risky multiple pregnancies, we introduced a program in 2007 at East Coast Fertility for patients who transferred one embryo at a time. For these patients we offered free cryopreservation, storage and frozen embryo transfers until a live baby was born.

Still, patients don’t commonly choose single embryo transfer.

From our experience, similar to others’, there was no significant difference in pregnancy rates between patients who chose to transfer one embryo vs. those who chose to transfer two embryos. There was a trend, however, towards higher rates for the two-embryo transfer group that was practically eliminated when frozen embryo transfers were added. These groups were age matched with no difference except for a 40 percent twin rate and one triplet in the two-embryo transfer group compared to the single-embryo transfer group in which no twins were created.

It is hoped that these results will encourage a higher percentage of good prognosis patients to transfer a single embryo, which is the safer option.

* * * * * * *  ** * * * * * *

Would incentives and stats like those above make you consider SET for yourself? Why or why not?

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What is an Embryo Transfer? Five Things to Know

By Tracey Minella and David Kreiner MD

April 14th, 2011 at 12:00 am


One is the loneliest number. Eight makes you an Octomom. But there’s more to Embryo Transfers than just those extremes.

And the standards regarding how many embryos to transfer back to a woman’s uterus have changed as the assisted reproductive technology improves and IVF success rates continue to rise.

Two decades ago, it was standard to transfer up to four embryos per fresh IVF cycle. Even more if you were older or had prior failed IVF cycles. Today, cutting edge clinics like East Coast Fertility have success rates so high that Single Embryo Transfers (SETs) are often highly encouraged. And transferring more than two embryos is generally discouraged in most cases.

So, nowadays, one is no longer the loneliest number…it’s often the luckiest number!

Below, Dr. Kreiner of East Coast Fertility shares five facts about embryo transfers that curious patients need to know:

  • After a few days of development, the best appearing embryos are selected for transfer
  • The number chosen influences the pregnancy rate and the multiple pregnancy rate
  • A woman’s age and the appearance of the developing embryo have the greatest influences on pregnancy outcome
  • Embryos are placed in the uterine cavity with a thin tube
  • Excess embryos of sufficient quality that are not transferred can be frozen

After a few days of development, one or more embryos are selected for transfer to the uterine cavity.  Embryos are placed in the uterine cavity with a thin tube (catheter).  Ultrasound guidance may be used to help guide the catheter or confirm placement through the cervix and into the uterine cavity. Although the possibility of a complication from the embryo transfer is very rare, risks include infection and loss of, or damage to the embryos. 

The number of embryos transferred influences the pregnancy rate and the multiple pregnancy rate. The age of the woman and the appearance of the developing embryo have the greatest influence on pregnancy outcome and the chance for multiple pregnancy.  While it is possible, it is unusual to develop more fetuses than the number of embryos transferred. It is critical to discuss with your doctor the number to be transferred before the transfer is done.

In an effort to help curtail the problem of multiple pregnancies (see multiple pregnancies), national guidelines published in 2006 recommend limits on the number of embryos to transfer (see Tables below). These limits should not be viewed as a recommendation on the number of embryos to transfer. These limits differ depending on the developmental stage of the embryos and the quality of the embryos and take into account the patient’s personal history.  

Recommended limits on number of 2-3 day old embryos to transfer

Embryos

age <35

age 35-37

age 38-40

age >40

favorable

1 or 2

2

3

5

unfavorable

2

3

4

5

Recommended limits on number of 5-6 day old embryos to transfer

Embryo Prognosis

age <35

age 35-37

age 38-40

age >40

favorable

1

2

2

3

unfavorable

2

2

3

3

In some cases, there will be additional embryos remaining in the lab after the transfer is completed.  Depending on their pregnancy potential, it may be possible to freeze them for possible use in a subsequent cycle. 

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