It has been two weeks since my return from this year’s national fertility meeting, the ASRM (American Society for Reproductive Medicine) which was held in Denver this year. It is the time and place that breakthroughs in fertility care are announced, results of research studies are discussed, problems and issues of the day are hammered out.
A few national trends were evident throughout the meeting. Single embryo transfer is becoming common place and successful. In some studies, it was as reliable as double embryo transfer in obtaining a baby. Noteworthy, was a study out of the Cornell program which attempted to dispute the previously reported increase in pregnancy complications associated with IVF pregnancies. They showed in their study that when only one embryo was transferred there was no increase in preterm birth complications. They proposed that multiple embryo transfers perhaps with multiple implantations that spontaneously reduce to singletons are the cause for the reported increase in IVF pregnancy complications supposedly seen in singleton pregnancies. This was yet another argument in addition to reducing the risk to multiple pregnancies proposed for transferring a single embryo at a time.
Questions were raised as to how to motivate patients to transfer only one embryo at a time. In addition to education, the concept at East Coast Fertility that is to offer those who transfer one at time free cryopreservation, storage and frozen embryo transfers was being practiced currently by at least one other program. I believe we will be hearing next year that this became a nationwide practice.
There were several studies showing excellent success with minimal stimulation IVF. Program directors actively providing minimal stimulation IVF complained that no distinction was made in the SART reporting so that the lower pregnancy rates seen with minimal stimulation still hurt those programs’ pregnancy statistics. Hopefully, this much less expensive, less invasive, safer alternative will be evaluated separate from full stimulation IVF so programs that offer this service to patients are not discriminated against for doing so.
Perhaps the most exciting advance I heard about during the meeting was the improved pregnancy rates and diminished miscarriage rates seen with the 24 chromosome analysis preembryo genetic diagnosis. This was being offered at the Blastocyst stage to improve cost effectiveness and reduce error and injury to the embryo. If this holds up then the promise of improving pregnancy rates of a single embryo transfer known to be genetically normal will become the standard of care not just improving the efficiency of IVF but perhaps making it as safe as a naturally conceived pregnancy.