Infertility is frustrating and painful, but if there is a silver lining to being infertile today, it is that this field of medicine is seeing some amazing improvements resulting in more pregnancies and more healthy babies. We talked about many advancements on yesterday’s Creating a Family show with Dr. Eric Forman, Reproductive Endocrinologist at Reproductive Medicine Associates of New Jersey, and Assistant Professor, Department of Obstetrics, Gynecology & Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, in New Jersey. He was co-author of the cover story in July 2014 issue of Contemporary OBGYN Magazine, “The New IVF Paradigm”.
Four Amazing Advancements in In Vitro Fertilization (IVF)
1. Chromosomal Testing at Day 5
Back in the olden days (a couple of years ago) chromosomal testing of embryos happened at around Day 3 of culture. At that stage of development, the embryo only has 6-8 cells, so only one cell could be removed.
It is now possible to biopsy the embryo at around Day 5 (the blastocyst stage, when the embryo has 75-100 cells and you can distinguish when cells will go on to develop into a fetus and which will become the placenta. More cells means more cells can be removed during the biopsy from those that are destined to become the placenta, thus increasing the accuracy of the test results.
2. Testing All Chromosomes
Way back when, it was only possible to test for 5 to 9 of the embryo’s chromosomes for abnormalities. With the current testing methods, all 23 pairs of chromosomes. Plus, current testing results are significantly more accurate.
3. Quicker Test Results
Chromosomal test results used to take days, now they can take hours. This time reduction opens up the possibility of testing at a later developmental stage, which allows more cells to be removed without harming the embryo.
4. Better Freezing Techniques
With the current cryopreservation technique, vitrification, 97-98% of embryos can be successfully frozen and thawed. Gone are the days of significant loss when thawing.
Fly in the Ointment
These advances on the field of infertility medicine are truly spectacular. Now if only we could make it more affordable. Comprehensive Chromosomal Screening (CSS) can add $3-4,000 to an IVF cycle.
Dr. Forman said that health insurance, for those lucky few that have fertility treatment coverage, usually does not cover CSS. This makes no economic sense. CSS allows patients to transfer a single embryo with confidence that they are not impairing their chances of success. Single embryo transfer significantly reduces the risk of twins. The medical cost of twins (average of $100,000+) far exceeds the cost a singleton birth ( average $20,000). Chromosomal screening would be cost effective.
Dawn, that will be great. After the fact, I did research as well, and found that embryo splitting was more likely after assisted hatching, which in our clinic is recommended for women over 35. So I feel like for women over 35, the balance of things to improve chances of success and risk of multiples is very tricky.
I’m even happy with the little improvements – three years ago I had progesterone in oil, and now with this cycle I found it’s now progesterone in ethyl oleate, which is thinner and doesn’t hurt nearly as much! It’s hard to be in this fight for long enough to see improvements like these but at the same time I’m happy to be able to see the benefits!
Megan, I hear you–happy for the improvements, but wishing you weren’t in the fight long enough to see them.
This was a very interesting show – however, as you say, the reality of infertility treatment is that the “cutting edge” technology is not applied as long as there is no insurance coverage. I think I went in to my initial visit pretty informed (thanks to listening to your shows). I asked about genetic testing my embryos and my RE said that he thought it was too aggressive – even given my age at 37 – since I had no history of miscarriage and we could do that if I had several failed cycles. When you are already paying 15-20K you don’t want to add anything that is not necessary. I also asked about single embryo transfer and he said the probability of failure was greater than probability of multiples given my age. I think this approach would be COMPLETELY different if all of this was covered by insurance. Also as Dr. Forman mentions, the emotional aspect of infertility treatment sometimes leads to decisions that defies logic.
I am curious about rates of twinning with single embryo transfer. We transferred two embryos and both took. Except one at some point had split into 3. I did not know that embryos can split! Fortunately (or unfortunately) 2 of the 3 stopped growing but I was really surprised how many women online shared this experience – there were good number of women who have mono-di (and some momo) twins after IVF.
AnonT, yes, monozygotic (identical) twinning is 2-4 times more likely after IVF–more likely after blastocyst transfer and ICSI. I find this fascinating. I know of some interesting research on this. I’ll try to pull it together in a blog sometime.
We actually found another cost benefit to doing CCS testing — it saved us a great deal of expensive transfers that would have lead to BFNs or miscarriages. Even though I was under 30 at the time of my egg retrieval, over 50% of my blastocysts (almost all of which were very “pretty” embryos that received the best rating given by my clinic) were NOT genetically normal. Most would not have been viable pregnancies, one would not have been capable of surviving outside the womb. If we’d opted to do embryo transfers without testing, we’d have done many more transfers, each of which would have been around $5k. Our testing was a little more than that, but it saved us a lot of transfers. Plus, it was great not to have to go through those rollercoasters, too — that part was priceless. But it made good economic sense for us in a situation with a large number of embryos to chose from.
Great point.