Five embryo transfer for women over 40

It seems like studies on the optimal number of embryos to transfer are pointing in opposite directions. An earlier study showed that single embryo transfers were as good as multiple when the success rate of live births was considered. Now a study by Dr. Elizabeth Ginsburg from the Brigham and Women's Hospital Center For Reproductive Medicine, Boston shows that five embryos is the optimal number for women over 40.

The study involved 863 transfers in which 142 patients received five, 392 received fewer, and 329 received more than five embryos. It showed that when fewer than five embryos were transferred, the overall pregnancy rate was 19 percent, and the live birth rate was four percent. With five embryos, the pregnancy rate was 40 percent and the live birth rate was 23 percent. More than five embryos resulted in too high a risk of multiple births.

The earlier studies considered all ages so for younger women perhaps the single embryo transfer is viable.

Lunch hour DNA tests

A clinic in North Wales is now offering customers lunch hour DNA tests. Apparently there has been enough demand by men concerned that their children were really fathered by them that this new clinic was opened. Directors of the clinic also say that women who have undergone IVF can have DNA tests to ensure that their child actually came from their own egg.

Perhaps there is a lot of cheating going on in North Wales, and frequent mixups at the IVF centers, enough that there is a real business opportunity for this type of service.

Increasing pressure for single embryo transfers

Recent studies show that multiple embryo transfers don't significantly improve the chances of a successful pregnancy, but only increase the rate of multiple births and hence the risks and costs of delivery. That alone has lead to many IVF centers to consider making single embryo transfers standard procedure. Now, a recent article in The Scotsman reveals a study that indicates 10,000 more IVF cycles could be funded each year in the UK if multiple births could be eliminated from IVF therapy.

The study showed that a single pregnancy costs 3,313 British pounds ($5,860 USD), while twins cost 9,122 pounds ($16,120 USD) and triplets 32,354 pounds ($57,170 USD). The study calculated that savings in government-funded health costs from eliminating multiple pregnancies would enable an additional 10,124 IVF cycles.

Advances in PGD on the way

Present testing methods have the ability to detect about 150 genetic disorders in embryos. But there are approximately 6,000 disorders that can result from single gene mutations. New technology may be available soon to screen for a larger number of these defects.

To take advantage of the new technology, and to reduce the number of genetic disorders in IVF babies (reportedly as high as 40% in some countries' studies), Health Canada plans to introduce PGD as standard procedure at IVF clinics in May 2006. No reports yet on who will shoulder the extra cost of IVF.

DNA contamination during IVF

A few articles have appeared recently discussing the possibility of DNA contamination if ICSI is used during IVF. Some researchers in Spain have intentionaly injected bacteria along with sperm into mice eggs and determined that DNA from the bacteria is present in the DNA of the resulting offspring. This raises a potential concern that contamination could occur during handling of sperm or during the ICSI process that could result in foreign DNA being present in the embryos. However, researchers say there is little cause for alarm since the contamination does not manifest any characteristics. Nevertheless, there are calls for increased attention to this matter since the available data is minimal and the likelihood of contamination by bateria on the sperm donor's skin is quite high.

Where problems may arise

Problems may arise at several stages in the IVF cycle:

1. The treatment cycle may be cancelled for any of the following reasons:

• ovulation induction did not produce enough stimulation of the ovaries or less than three follicles fail to develop
• hormone levels fail to show a satisfactory rising pattern
• hormone levels fall before follicles have completely developed
• there is an excessive response (more than 15 follicles)
• ovulation occurs unexpectedly before admission to the hospital, which means it is impossible to properly time the procedure (such incidence is rare)

2. Egg pick-up may be unsuccessful and no eggs recovered.

3. Eggs are recovered but fail to fertilize.

4. Embryos are transferred to the uterus but fail to implant, resulting in a period seven to 14 days later.

5. Like natural conception, IVF can lead to:

• biochemical pregnancy (transient rise in pregnancy hormone followed by late period)
• miscarriage (needing uterine cotterage)
• ectopic pregnancy (requiring surgery)

6. Multiple pregnancy (twins, triplets, etc.) is more common with IVF than with natural conception because of the practice of transferring more than one embryo to the uterus. In general, the success rate is higher if more than one embryo is transferred. However, the maximum number of embryos transferred is normally limited to three.