- 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
- Multiple Pregnancy
- Number of IVF Embryos to Transfer
- Oocyte Cryopreservation
- Ovarian Reserve
- Ovarian Reserve Tests
- Preimplantation Genetic Screening
- Prelude Fertility
- Single Embryo Transfer
Fertility, IVF and Egg Donation
Studies show that lifestyle factors have a profound effect on fertility. One of these critical factors is body weight.
Not only does body weight impact a woman’s ability to conceive a child naturally, a high BMI puts a woman undergoing assisted reproduction, such as in-vitro fertilization, at risk.
BMI is a measure of body size that is calculated by combining height and weight. It is often used as a health screening tool. A BMI that is out of range, either too high or too low, puts a person at risk for serious medical conditions.
A person with high BMI may experience insulin resistance, type 2 diabetes, or high blood pressure. Women with low BMI may suffer from anovulation, osteoporosis, and anemia.
High Body Weight Puts Women Undergoing IVF At Risk
Studies show that significantly overweight women are at greater risk for medical complications during treatment cycles and after conception.
- Require high doses of medication to stimulate their ovaries
- Are less responsive to treatment, which means fewer eggs upon retrieval.
- Have eggs of lesser quality, and a lower rate of fertilization.
High BMI Affects Outcome
IVF data from our laboratory indicates that increased body weight (BMI > 30 kg/m2) has a significant negative effect on IVF pregnancy success rates. Published studies have also shown a higher miscarriage rate and lower live birth rate with women that have a BMI greater than 30 kg/m2. For ongoing pregnancy, there is an increased risk of many complications with obese moms; including diabetes, hypertension, early delivery, stillbirth, birth defects and need for cesarean delivery.
A Little Weight Loss Can Make A Big Difference
A 5%–10% weight loss can improve fertility outcomes. Studies have shown that 5% weight loss results in improvement in hormone regulation, such as decrease in free testosterone, reduction in fasting insulin levels, and improved ovulation.
I am often asked by my OB/GYN physician colleagues about the BMI requirements for IVF patients. At Advanced Fertility Center of Chicago, we take an individual approach to each case; however, we follow guidelines set by the American Society for Reproductive Medicine, and impose limits to ensure the safety of our patients. At this time, we have a BMI limit to undergo egg retrieval set at 42 kg/m2. Besides the risks previously stated above, women with a higher BMI may be at increased risk of complications with the anesthesia used for the egg retrieval procedures. In an office-based setting, with IV sedation, we are conservative in who we put under anesthesia so minimize these potential risks.
Why do we recommend elective single embryo transfer?
By: Michelle Catenacci, MD
Many couples that come to us have had a long and difficult journey with their infertility. When discussing treatment options, we discuss the risk of twins or high order multiples (triplets or more) that exist with the different available fertility treatment options.
However, to many that are trying to conceive, multiples are thought of as a blessing and not a risk. “The more the better”, and, “Two for the price of one”, are common replies that we get from couples when discussing twins. It can be difficult to convey that there is more risk involved with twins compared to a singleton pregnancy and that it is safest for both mom and baby to have one baby at a time.
Recent changes in recommendations
Recently, the Society of Assisted Reproductive Technology (SART) and the American Society for Reproductive Medicine (ASRM) issued new guidelines and recommendations for the number of embryos to transfer in order to encourage physicians to increase use of elective single embryo transfer (eSET).
With an elective single embryo transfer, a single embryo is selected from a larger group of embryos to be transferred. Excess embryos can be cryopreserved for future attempts at pregnancy. In general, it is recommended that patients with a high chance for success should strongly consider having eSET. Those patients include younger women (37 and under), women with normal embryos after preimplantation genetic testing for aneuploidy (PGT-A), and women using donor eggs.
Transferring one embryo at a time will not decrease the “cumulative” pregnancy rates for that IVF cycle – when looking at overall pregnancy chances with both the fresh transfer cycle and also any subsequent frozen transfer cycles. Single embryo transfer will, however, significantly decrease the overall risk of twins. For example, at our clinic, we see approximately 65% live birth with eSET for embryos that have been screened for aneuploidy using PGS (also called PGT-A). The risk of identical twins is under 1% in this situation. If we transfer two embryos, the pregnancy rate is about 90%, but the rate of twins is 65% with a 1% risk of triplets. At AFCC we try to encourage patients to transfer just one PGT-A embryo in hopes of helping them have a healthier single pregnancy.
There are increased rates of complications with twin pregnancies. Some of these risks are for the mother herself. Maternal complications that are increased in twin or higher order multiples include preeclampsia, gestational diabetes, worsening anemia and severe nausea and vomiting in early pregnancy. There is also an increased risk of abnormal placental attachment which can cause bleeding and other complications during pregnancy or at delivery.
Women pregnant with multiples are more likely to have a cesarean section for delivery. For the babies, there are significantly increased rates of preterm labor and delivery, small for gestational age babies and growth restriction. At times delivery will occur near or just before the gestational age of possible viability leading to death or long-term complications for one or both twins. The risk of cerebral palsy in twins is more than four times higher compared to a singletons. Twin babies are also more likely to be stillborn or die in the first month after birth as compared to single babies.
Our goal is to provide safe and high-quality care to our patients. When we recommend eSET we are striving to give the best possible outcome for the patient and their unborn child. When planning to move forward with IVF or egg donation it is important to know the current practices the fertility program you are working with, and their overall success and experience with eSET. For patients that have a high chance of success, transfer of a single embryo should be seriously considered even though the initial pregnancy rate from transferring two embryos is higher than if we transfer one.
Welcome to the
Advanced Fertility Center of Chicago
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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- Embryo Screening May Improve Chances Of Successful IVF Pregnancy
- How Body Weight Impacts IVF Success
- SART and CDC Release 2016 IVF and Egg Donation Success Rate Reports
- Advanced Fertility Center of Chicago Merges with Prelude Fertility
- Benefits of Elective Single Embryo Transfer – eSET
- Chicago low cost fertility screening tests
- SART Releases 2014 IVF Success Rate Report
- Is fresh or frozen embryo transfer better for IVF?
- IVF Genetic Testing Improves Embryo Implantation
- 2013 SART IVF Success Rate Report Released
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- Advanced Fertility Center of Chicago
- American Society for Reproductive Medicine
- Center for Disease Control, CDC
- Society for Assisted Reproductive Technology, SART
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