- Age and Fertility
- CDC Report on Fertility Clinic IVF Success Rates
- Chromosomal Abnormalities in Eggs
- Donor Eggs
- Egg Banking
- Egg Donation
- Egg Donation Cost
- Egg Freezing
- Egg quality
- Embryo freezing
- Embryo implantation
- Fertility Preservation
- Frozen embryo transfer
- IVF Clinic Success Rates
- IVF Cost
- IVF Poor Responders
- IVF success rates
- Low ovarian reserve
- Micro IVF
- Mild IVF
- Mini IVF
- Minimal Stimulation IVF
- Number of IVF Embryos to Transfer
- Oocyte Cryopreservation
- Ovarian Reserve
- Ovarian Reserve Tests
- Preimplantation Genetic Screening
- Single Embryo Transfer
Fertility, IVF and Egg Donation
Single embryo transfer is an up-and-coming more commonly utilized procedure in the field of in vitro fertilization in recent years. There has been a push for several years to reduce the number of multiple pregnancies by reducing the number of embryos transferred with IVF. However, the push to do elective single embryo transfer is opposed by most couples that do IVF in the US.
It is a simple problem without a simple solution:
- Single embryo transfer success rates are lower than when 2 are transferred
- Couples want a baby (or twins) ASAP, and they don’t want to pay for multiple IVF attempts
- They fear failing to become pregnant more than they fear the risks from a twin pregnancy
This dilemma is often due to the fact that the large majority of patients in the US are self-pay for all costs associated with IVF. In the US the average cost of IVF is about $10,000 (for monitoring and procedures) and about $3500 for the medications. With these high costs, couples will often push for at least two embryos for transfer – even if the female partner is young.
Guidelines from the American Society for Reproductive Medicine (ASRM) were established many years ago for the maximum number of embryos to transfer (see table below). These guidelines take into consideration the age of the female and other criteria that help predict risks for having a multiple pregnancy.
ASRM guidelines have been modified over the years – with the recommended maximum number for transfer being reduced each time. I believe that the ASRM guidelines on the maximum number of embryos for transfer are excellent.
Currently the guidelines suggest a maximum of 1 to 2 embryos to be transferred for a female partner under 35 years old if the transfer is being done on day 2 or 3 – and a maximum of one embryo to be transferred for that age group if the transfer is being done on day 5. These maximum numbers are for patients considered to have a “favorable prognosis”.
When female age is over 35, the maximum number of embryos allowed increases. Everyone knows about the Octomom mess – a situation where a physician went way overboard – with a patient that was just as far out there…
Favorable prognosis would be couples having their first IVF attempt, good embryo morphology scoring, left over embryos available for freezing, or a previous successful IVF cycle. The guidelines allow transfer of additional embryos for patients that have a less favorable prognosis.
When single embryo transfer is performed, blastocyst embryo transfer on day 5 after fertilization appears to be the best method. Embryos that have continued developing normally to the 5th day have a higher chance of implanting than do day 3 embryos (on the average).
- Learn more about blastocyst transfer and multiple pregnancies
- Learn about day 5 blastocyst embryo grading
Octomom and IVF – before June of 2008
- In June of 2008, Nadya Suleman was a single, unemployed mother of 6 children
- According to reports, she was receiving some “public assistance”
- All six of her children were reportedly conceived through in vitro fertilization
- All 6 kids were under 7 years old, including 2 year old twins
Then, she does IVF again
- In June of 2008, her IVF doctor transferred 6 frozen-thawed embryos to her uterus.
- Apparently, all six embryos survived – and 2 split into identical twins – so she ended up with eight fetuses growing in her uterus.
- Nadya declined having a fetal reduction procedure. Reduction can be done to selectively reduce the number of fetuses.
- The vast majority octuplet pregnancies would be expected to result in death of all fetuses after a severely premature birth.
- In her case the pregnancy progressed to viability. All 8 babies were born (prematurely) in January of 2009.
- This is apparently only the second living set of octuplets ever born in the United States.
Public debate rages
- Is she a fit mother?
- Should the fertility specialist have been willing to treat her at all?
- How many embryos should the doctor have transferred to her uterus?
- Should a physician that transfers that many embryos to a 33-year-old be sanctioned – or even lose his medical license?
- Why doesn’t the government pass laws to control fertility doctors?
Welcome to the
Richard Sherbahn, MD is a Board Certified Reproductive Endocrinology and Infertility specialist.
Dr. Sherbahn founded the Advanced Fertility Center of Chicago in 1997.
He will post regularly about fertility issues.
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- Advanced Fertility Center of Chicago
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