The increased risk of multiple births has been known for decades. In the past several years there has been a significant decline in the rate of higher order multiple births, partly, thanks to revised ASRM guidelines for the recommended number of embryos to be transferred in an IVF cycle.
Single embryo transfer is rapidly gaining grounds in most programs, especially for younger patients. However, a significant proportion of embryo transfers in the US in 2014 still involve the transfer of more than one embryo. This is more common with older patients, especially given the high rate of chromosomally abnormal embryos (which rises exponentially beyond age 40).
A second culprit is the fact that IVF is not covered by many insurance providers. The significant out-of-pocket expense of IVF drives patients to pressure their physicians to transfer two embryos (or more) to increase their chances of becoming pregnant.
The good news is that the solution is within reach and should focus on four aspects, which we have been practicing at Lenox Hill Human Reproduction and the Center for Human Reproduction at North Shore-LIJ Health System:
Having continuous dialogue with law makers and insurance providers to promote coverage for ART procedures, and especially for IVF with an emphasis on single embryo transfer.
Encouraging patients to freeze their eggs in their early 30′s when most eggs are “healthy,” which will allow for single embryo transfer later in life when they are ready to conceive (even if they are in their late 30′s or early 40′s).
Improving egg and embryo freezing techniques in the lab, which will allow all IVF centers to be able to offer single embryo transfers while saving the surplus embryos for potential future transfers.
Promoting genetic testing of embryos prior to their transfer back to the uterus – a technique called PGS (Preimplantation Genetic Screening) and transferring a single, chromosomally normal embryo (free of Down’s Syndrome and other abnormalities), thus reducing multiple birth rate with its exorbitant cost to healthcare, and increasing the chance of delivering healthy babies, one at a time.
“If you’re tired of legal thrillers written by lawyers, read this amazing medical thriller written by Dr. Avner Hershlag who not only knows his stuff, but also knows how to write. Combining a little science fiction with a lot of science fact, Hershlag takes us on a scary journey through the fields of genetics and into the near future. Misconception delves deeply into a subject no less important than the mystery of life itself.”
As part of undergoing in vitro fertilization (IVF), a woman must take hormone shots which encourage her body to ripen and release more than one egg at a time. These many eggs are then collected and used for fertilization in a laboratory setting. For women who don’t like needles, this can be a difficult, painful, and stressful experience. Luckily, this may soon change.
Currently, the IVF procedure requires 7 to 10 days of hormone injections. However, “pharmaceutical companies have produced longer acting gonadotropins that last for a week. A longer acting gonadotropin may help decrease the number of shots a patient takes during the IVF process. Studies are now under way to test for efficacy, side effects, and risks for ovarian hyperstimulation syndrome (OHSS) during IVF. The American Society of Reproductive Medicine Practice Committee states that this new preparation of gonadotropin holds promise for improving patient satisfaction while maintaining efficacy.”
This could mean that patients may need to only take one or two shots to stimulate their ovaries, rather than 7 to 10 shots. This is great news for those who don’t like needles!
Talk to your doctor about what medication is available for you; be open about what procedures you are comfortable with. Do not let a fear of needles or procedures stop you from becoming a parent.
Recent studies appear to show damaging effects of normal exposure to BPA to several reproductive areas in mice. Although there is still much we need to learn about the effects of plastics on fertility, especially in humans, I think most of us who have read about it agree that there is a reason to be concerned. As of a few years ago, I know that I and most colleagues stopped microwaving our food in plastic containers, and were sure to check our children’s bottles for the ‘no-BPA’ signs.
As the evidence accumulates and seems to be supporting the theory that BPA is toxic to ovarian function, it’s just common sense to take the simple precautions to eliminate this potential threat.
Celiac disease has been a hot topic for more than a decade. And it remains controversial. But one thing that seems to have been resolved is it’s association with infertility. A recent and large-population study has found that, in general, women with celiac disease have no more fertility issues than those without celiac disease. The interesting exclusion is woman diagnosed between the ages of 25-29.
A recent report in U.S News and World Report Healthday summarizes a study that supports the premise that antidepressive drugs used in pregnancy are not associated with any increase in the incidence of autism in the offspring, although there might be an increase in attention deficit/hyper-activity disorder in these children. While this is certainly reassuring for pregnant patients on these medications, it is an area that will require a great deal more research before all of the facts are known. Each woman must discuss the alternatives with her psychiatrist to weigh the risks vs. benefits, especially since there appear to be well-described risks to not treating the depression for both the mother and baby. Non-pharmacologic treatments need to be considered as part of the whole picture.
A New York reproductive endocrinologist says a recent Consumer Reports article cautioning pregnant women about eating tuna goes too far because women need certain nutrients found in fish.
“I think the recent Consumer Report maybe went a little bit overboard,” says Tomer Singer, MD, reproductive endocrinologist at the North Shore-LIJ Health System. “What we usually advise our patients is to have one portion of tuna a week rather than to avoid it altogether.”
While every pregnancy, no matter how it comes about, is different in some ways, there are many ways in which a typical pregnancy is different than an in vitro fertilization (IVF) pregnancy.
—You’ll have more information about your future child. Before doctors insert the embryo back in to the mother for pregnancy, the embryo is checked for any mutations or abnormalities that may have been causing your infertility in the first place.
—You have the ability to choose your baby’s gender. Because you most likely had several eggs gathered and fertilized and each resulting embryo will undergo extensive testing before being placed back in the uterus, you will know which gender each embryo is. This choice is obviously unavailable for those who conceive naturally.
—There is more early monitoring. Undergoing IVF can be an expensive procedure to attempt over and over, so doctors do several tests early in the pregnancy to make sure everything is going according to plan and your fetus is growing healthily. Most women who conceive naturally do not start seeing their OB/GYN until at least 12 weeks into their pregnancy.
—You will need progesterone treatment. Low progesterone is a very common reason many women miscarry. If you have had to resort to IVF to become pregnant, your doctor will most likely want you to take progesterone supplements. If you are tested and your progesterone levels are normal, then it is fine for these supplements to stop.
—You have a greater chance of having multiples. “Generally, mothers treated with IVF have two to four eggs inserted in order to increase the chance that a healthy pregnancy will come from the treatment. Because of the extra eggs, IVF has a greater than average chance of implanting more than one egg and producing a pregnancy that results in twins or higher order multiples.” Talk to your doctor about what you desire the outcome to be from your IVF pregnancy.
There is no reason that your IVF pregnancy should not result in a healthy child. Talk to your doctor today about your individual circumstances and what the best method is to proceed.
Vitamin D, the sunshine vitamin, nicknamed because the body makes vitamin D when exposed to sunlight, is also found in foods like eggs, milk, yogurt, tuna, salmon, cereal and orange juice.
Numerous studies have suggested that Vitamin D deficiency may lower a woman’s chances of getting pregnant through in vitro fertilization (IVF). Studies suggest that those with sufficient vitamin D levels were more likely to have better-quality embryos and were twice as likely to achieve pregnancy as compared to those with vitamin D deficiency.
Since vitamin D supplementation is an inexpensive and simple intervention with few relevant side effects, additional randomized clinical trials in this area have the potential to markedly influence the way infertility is treated.