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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
There are some in vitro fertilization clinics in the US that market aggressively for mini-IVF or micro IVF (also called mild or minimal stimulation in vitro fertilization). Some claims regarding the benefits of mini-IVF are exaggerated or completely untrue. This post clarifies some issues regarding standard vs. mini IVF.
Mild IVF (or micro, or mini IVF) seems to be slowly growing in popularity over the last few years. Is it a good fertility treatment?
- The basic concept is to do in vitro fertilization after a low level of ovarian stimulation with oral medications (possibly with some “low dose” injectables as well).
- This is in contrast to the usual method of ovarian stimulation for IVF which involves more aggressive stimulation of the ovaries with multiple injections over about 8 to 15 days.
- The standard method of stimulating is done in order to try to get about 10 or more eggs to work with for in vitro fertilization.
- The IVF cycle cost for mild IVF (including medications and everything) should be less than the total cost for standard in vitro fertilization
- However, the success rates for standard IVF are much higher
- Success rates with mild in vitro fertilization are much lower – often in the range of about 5% to 15% per attempt, depending greatly on the age of the female
Why do we try to get so many eggs for “standard” IVF?
IVF success rates are much higher with a “good” number of eggs due to the substantial drop-off that is seen in early embryo development.
The chart below shows the average number of eggs, mature eggs, fertilized embryos, “good” embryos on day 3, blastocyst embryos on day 5, etc. in three age groups of women at our clinic.
- If there are extra embryos available for freezing, we freeze on day 5 and day 6 (possible freezing shown by purple arrow going up).
As shown in the chart, in the average case there is progressive drop-off over time with in vitro fertilization. Human reproduction is not extremely efficient – if we were mice or cows we would be efficient reproducers. Alas, we are not so lucky – we are stuck being human…
- We expect drop-off in the eggs and embryos in the fertilization and development process
- Therefore, having more eggs at the beginning makes it more likely to have at least one embryo at the end that is strong enough to make a baby
- Read more about the IVF process and how it increases efficiency of human reproduction
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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