In Vitro Fertilization

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IVF - In Vitro Fertilization

The miracle of babies born through in vitro fertilization (IVF) no longer seems so miraculous. Today¡¯s technology in IVF is advancing at a rate so rapid that it confuses those receiving treatment. There are may factors leading to, diagnosing and treating of infertility. However, I will be focusing on a more specific case scenario to evaluate.

First let¡¯s take a look at, what Is In Vitro Fertilization? Simply stated, IVF involves removing eggs from a woman, fertilizing them in the laboratory (in a culture dish, actually, not a test tube) and then transferring the fertilized eggs into the uterus a few days later. More specifically, after super ovulation with hormones to produce multiple eggs, an Embryologist places the retrieved eggs in sterile culture media along with processed sperm and keeps them at normal body temperature inside an incubator, where fertilization and early cell division take place. Then the fertilized and dividing eggs are returned to the uterus. From that point, if the fertilized eggs implant successfully and become embryos, the pregnancy progresses as it would naturally.

However, more recent controversy is not with the collection or fertilization of these eggs, but is with when they will be transferred back. Earlier IVF standards were to transfer the fertilized eggs on day post retrieval. New technology in this field has been pushing the envelope and has transferred back fertilized eggs as late as day 5-6 post retrieval. This is pushing the envelop for day six is the longest the fertilized egg can survive outside the womb for days 6-7 is when the fertilized egg will implant. On days 1-4 post retrieval the single cell has divided to a mass of 8-16. On day 5-6 post retrieval the cells are now rapidly dividing and the fertilized egg is now called a Blastocyst. Both day and day 5 transfers have discernable pros and cons and leave questions that today¡¯s technology is unable to answer. This leads me to my hypothesis success rates for day 5 transfers ¡Ý day transfers. The null hypothesis day 5 transfers day transfers.

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The importance of this study is to make an informed decision on whether the increased success rate of a 5 day transfer (5dt) justify the risk of a dramatic increase in failing of fertilized eggs in a 5dt as opposed to a dt. Pros dt Decreased number of failing fertilized eggs resulting in an increased number surviving until day of transfer. Cons dt The uterus may not be properly prepared for implantation. A womans hormonal support after embryo transfer may be inadequate. With the survival (success) rate being low more fertilized eggs are transferred resulting in an increased risk of multiples. Pros Thought to have a higher success rate than a dt. Cons 5dt The first few days in incubation outside of the body, the pre-embryos wont keep dividing at the normal rate as inside the womans reproductive tract. Days 4-6 show a dramatic increase of failing fertilized eggs leaving many couples with nothing left to transfer. To achieve pregnancy, there must be successful responses to ovulation medication, egg collection, fertilization, embryo replacement, and subsequent implantation. Failures can occur at any step along the way. For example, of thirty women who start an IVF cycle, six may have their cycle dropped because of inadequate stimulation. Of the remaining twenty-four women who undergo egg retrieval, only twenty-one may get to the point of embryo transfer, with three having eggs that didnt fertilize and divide. Of the twenty-one who have embryo transfers, only five might achieve a clinical pregnancy if the clinics pregnancy rate is 5 percent per embryo transfer. One of those five is likely to miscarry, leaving only four couples that may have a live born infant. This means the live birth rate is only 4/0 or 14 percent. So, now you can see how this is an important issue for couples in an IVF cycle¡­and all this before you add in the emotional, monetary cost and health risk factors.

00 US clinics reporting IVF transfer procedures to the Centers for Disease Control and Prevention in 1 with a total of 5,554 couples for IVF transfer procedures. With the myriad of variables in IVF I will be limiting my study to the following sample parameters women ages 0-4that have been diagnosed specifically with unexplained infertility (does not present with any physical, biological, chromosomal abnormalities, or chemical findings resulting in a diagnosis of impaired fertility) and no male factor involved. When reporting success rates, the Fertility Clinic Success Rate and Certification Act of 1 (HR477) directs the selection of a secretary of Health and Human Services to develop a model program for the certification of embryo laboratories. It also requires ART programs to provide their success rates to the Center for Disease Control (CDC) for annual publication. This law standardizes reporting procedures so that success rates reflect the actual number of pregnancies in relation to completed ART (Assisted Reproductive Technology) cycles. With the clinic¡¯s strict guidelines of reporting, protocol for the retrieval and handling of the eggs while in the culture media, I¡¯m relieved of the burden in further breaking down the reported data into clinics of similar protocol and allows me to expand my sample size immensely. This reporting protocol now keeps a clinic from basing their pregnancy success rates as the number of couples who conceived clinical pregnancies divided by the total number of couples treated, regardless of how many treatment cycles they had. With the success rates now being reported as pregnancy ratio per treatment cycle or per embryo transfer by all clinics, it is now easier (and more fair) to compare.

Data/ Calculations

Original sample was n=4457 to exclude cycles that did not progress to embryo transfer (n = 880) and cycles for which patient age was either missing (n = 7), younger than 0 years (n = 450), or older than 4 years (n = 5016) and whose original diagnosis could be explained (n=,774). The final sample included , fresh, non-donor IVF cycles. Because these cycles were limited to those that progressed to embryo transfer, this number actually represents , IVF transfer procedures.

A total number of 87 live births were reported (multiple births from 1 pregnancy were counted as 1 live birth).

A 5dt with embryos transferred, live-birth rates were 1.7% (64), for women aged 0 to 4.

A dt with embryos transferred, live-birth rates were 11.6% (74), for women aged 0 to 4.

The American Society of Reproductive Medicine has an IVF registry about individual IVF clinics and their success rates.

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