IVF Care Research Articles

The role of state-of-the-art IVF care as a marker of societal development.

Access to state-of-the-art ART can be viewed as a marker of societal development. The recent Alabama Supreme Court ruling represents a major local setback in the access to state-of-the-art ART. If this isolated local incident becomes a national trend, the USA will lose ground in this emerging area of healthcare, and its citizens will be left with substandard treatment options for the redress of infertility.

The relationship between socioeconomic status and perinatal outcomes in in vitro fertilization conceptions

ObjectiveTo evaluate whether socioeconomic status has an impact on perinatal outcomes in in-vitro-fertilization pregnancies. We hypothesize that with greater coverage there may be an alleviation of the financial burden of IVF which can facilitates application of evidence-based practices. BackgroundIn-vitro fertilization (IVF) is the most used assisted reproductive technology in the United States, with growing efficiency and demand for in-vitro fertilization. Certain states have mandated coverage that enable low-income individuals to undergo in-vitro fertilization treatment. Study DesignA retrospective population-based observational study was conducted in accordance with the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database over the six-year period from 2008 to 2014 examining 10,000 in-vitro-fertilization deliveries. Maternal outcomes of interest included preterm pre-labor rupture of membranes (PPROM), preterm birth (i.e., before 37 weeks of gestation), placental abruption, Caesarean Section (C/S), operative vaginal delivery, spontaneous vaginal delivery (SVD), maternal infection, chorioamnionitis, hysterectomy, and postpartum hemorrhage. Neonatal outcomes included small for gestational age (SGA) defined as birth weight less than tenth percentile, intrauterine fetal death (IUFD), and congenital anomalies. ResultsOur study found that socioeconomic status did not have a statistically relevant effect on perinatal outcomes in women who underwent in-vitro-fertilization to conceive after adjusting for the potential confounding effects of maternal demographic, pre-existing clinical characteristics, and comorbidities. ConclusionThe literature suggests that in states with mandated in-vitro-fertilization coverage, there are better perinatal outcomes due in part to greater utilization of best IVF practices, such as single-embryo transfers. Moreover, the quality of medical care in states with coverage is in the highest quartile in the country. Therefore, our findings of equivalent perinatal outcomes in IVF care irrelevant of socio-economic status suggests that a possibly of lack of access to quality medical care may be a factor in the health disparities usually seen in lower socioeconomic status individuals.

Patient Experience During COVID-19: How the Introduction of Telehealth has Influenced Patient Practices

Background: Melbourne underwent one of the strictest lockdowns in the world in 2020, with the swing to telehealth-based appointments, bringing into focus the effectiveness of communication between staff and patients. Due to the ongoing provision of a hybrid model of in-person and telehealth appointments, it is important to learn how this shift in delivery of service has impacted patient experiences. Aim: To examine patient experiences with telehealth appointments, and to assess any associations between self-reported personality traits and preferred communication method. Method: Data was collected from a patient satisfaction survey administered in May 2021 (N=127). The patient satisfaction survey consisted of 5-point Likert scale responses regarding specific aspects of IVF care, self-reported personality trait descriptions and qualitative responses. Frequencies and ordinal logistic regression analyses was used to examine associations between personality traits and satisfaction responses. Results: Overall 80% (N=101) of patients liked the flexibility of telehealth appointments. However 68% (N=87), while understanding the need for telehealth during COVID-19, preferred face to face communication. Exploring self-reported personality traits, patients who described themselves as assertive were more likely to prefer succinct written information, whereas patients who described themselves as anxious and/or shy preferred both verbal and written communication. Patients who described themselves as optimistic, were more likely to rate themselves as pleased with their overall experiences at Newlife IVF and felt emotionally supported during treatment. Conclusion: Despite shifting to a majority telehealth service provision, most patients reported high levels of satisfaction with communication, and have continued to actively use telehealth since the lifting of lockdown, indicating that it doesn’t introduce significant barriers to patient and clinic communication. Inadvertently, necessary change due to COVID-19 has spontaneously broadened the scope of patient centered care providing further insight into patient preferences. Further exploration into using heuristics to identify links between personality types and mode of communication is warranted.

The needs of women with fertility issues who undergo In Vitro Fertilization in Greece: health care context, contact and person-centered values. An Interpretative Phenomenological Analysis

ABSTRACT Infertility is often regarded a major tragedy in a couple’s life. Fertility treatment (In Vitro Fertilization) is often seen as a solution. The aim of this study was to explore what women who undergo fertility treatment in Greece need from medical and health-care personnel and whether these can be mapped onto Rogers’ Person-Centered theory of therapy and values. Seven women who have undertaken IVF in Greece were interviewed. Interpretative Phenomenological Analysis was used to analyze the transcripts. Three super-ordinate themes emerged, containing sub-ordinate themes: (i) Experiencing safety in relationships with the IVF team, (ii) Need for agency: acknowledging women as trusted equal partners, (iii) The need for personalized IVF care. In the context of the Greek fertility care culture, women’s needs were mapped onto Rogers’ person-centered values. It is suggested that a person-centered approach to treatment and communication can meet women’s needs during IVF procedures. The study concludes by outlining the need for person-centered training of IVF health-care professionals involved in pre-conception and birth care; this would support patient-centeredness in fertility and birth care, namely care respectful and responsive to patient values and needs. Quality, respect-based fertility and pregnancy care is important to promote future generations’ well-being.

Accounting for complexity in healthcare innovation debates: Professional views on the use of new IVF treatments.

Social scientists have long been interested in the forces and values driving healthcare innovation. The simultaneous rise of 20th century healthcare reforms, increased importance of evidence and upsurge in lay health activism have shaped modern medicine. On this backdrop, fertility care emerged in the 1970s. Recent developments reveal a contentious relationship between new fertility treatments and clinical evidence, with emerging technologies being used without conclusive evidence of effectiveness despite being sold to patients. Initial critiques of this phenomenon emphasise commercial interests as the culprit, suggesting that the problematic use of unproven treatments is mainly driven by the private sector. Here, we challenge this over-simplified view of IVF care. Drawing on a qualitative analysis of key documents and 43 in-depth professional interviews, this article identifies three main stakeholder approaches to new treatment adoption. We argue that viewpoints are anchored within three critical overarching 'modes of coordination' or core values in modern healthcare: efficiency, effectiveness and patient-centeredness. This analysis encourages a more contextualised overview of fertility care than previous literatures have afforded. The IVF case shows that an emphasis on private versus public clinic practices obscure similarities between the two along with the values motivating healthcare professionals' approaches to new treatments.

Impact of access to care and race/ethnicity on IVF care discontinuation

Research questionIs race/ethnicity or access to care, as defined by insurance coverage, distance to the clinic and zip code (postal code), associated with care discontinuation following IVF? DesignA retrospective cohort study of 878 diverse women who underwent 1571 IVF cycles from 2014 to 2018 at a Southeastern academic medical centre was performed. Women were divided into low (LAC) and high (HAC) access to care groups. HAC was defined as possessing IVF insurance coverage, living ≤25 miles from the clinic, and living in a zip code with a median income ≥$75,000. Access groups and racial/ethnic groups were compared for differences in relative risk of care discontinuation following an unsuccessful IVF cycle. ResultsWomen with HAC had a poorer IVF prognosis than the LAC group, which possibly impacted the association with care discontinuation. Distance to the clinic, but not insurance coverage or zip code, was associated with increased risk of care discontinuation. Among women ≤34 years, HAC showed some evidence of an association with an increased risk of care discontinuation (adjusted relative risk 2.5, 95% confidence interval 0.8–8.1). Despite having higher rates of insurance coverage (51.2% versus 36.5%), non-Hispanic Black women were more likely to discontinue care (58.3% versus 40.2%) and less likely to achieve a live birth (53.0% versus 68.0%) than non-Hispanic White women. ConclusionsIdentification as non-Hispanic Black, and distance to the clinic, but not insurance coverage or zip code, were associated with increased risk of care discontinuation following an unsuccessful IVF cycle. In women ≤34 years old, HAC may be associated with a higher rate of care discontinuation.

Time-lapse technology improves total cumulative live birth rate and shortens time to live birth as compared to conventional incubation system in couples undergoing ICSI.

The improvement of clinical outcome provided by time-lapse technology (TLT) in IVF over conventional incubation (CI) still remains controversial. This study aimed at evaluating whether the exclusive use of time-lapse technology (TLT) during whole IVF care improves total cumulative live birth rate (TCLBR) and shortens time to live birth (TTLB) as compared to the use of CI in couples undergoing ICSI. This retrospective cohort study was conducted in couples with male infertility undergoing their first ICSI cycle in 2014-2015 and for whom embryo culture system remained the same during their whole IVF care, i.e., TLT or CI. Couples were followed up up to 2020, including all following frozen-embryo transfers and ICSI cycles (if any). Survival analysis was used to compare clinical outcome and time-related endpoints between both groups. A total of 151 and 250 couples underwent their whole IVF care with the exclusive use of TLT and CI, respectively. Survival analysis showed that TCLBR after whole IVF care was significantly higher in TLT than in CI group (66.9 vs 56.4%, p=0.02, log-rank test). Median live birth time was significantly shorter in TLT than CI group (464 vs 596 days, p=0.01). We found that TCLBR and TTLB were significantly improved with TLT over CI in couples undergoing ICSI for male factor. This study fuels the debate on the clinical benefit of using TLT. The use of time-related endpoints adds important information for both patients and practitioners.

Streamlining follicular monitoring during controlled ovarian stimulation: a data-driven approach to efficient IVF care in the new era of social distancing.

STUDY QUESTIONWhat is the optimal follicular tracking strategy for controlled ovarian stimulation (COS) in order to minimise face-to-face interactions?SUMMARY ANSWERAs data from follicular tracking scans on Days 5, 6 or 7 of stimulation are the most useful to accurately predict trigger timing and risk of over-response, scans on these days should be prioritised if streamlined monitoring is necessary.WHAT IS KNOWN ALREADYBritish Fertility Society guidance for centres restarting ART following coronavirus disease 2019 (COVID-19) pandemic-related shutdowns recommends reducing the number of patient visits for monitoring during COS. Current evidence on optimal monitoring during ovarian stimulation is sparse, and protocols vary significantly. Small studies of simplifying IVF therapy by minimising monitoring have reported no adverse effects on outcomes, including live birth rate. There are opportunities to learn from the adaptations necessary during these extraordinary times to improve the efficiency of IVF care in the longer term.STUDY DESIGN, SIZE, DURATIONA retrospective database analysis of 9294 ultrasound scans performed during monitoring of 2322 IVF cycles undertaken by 1875 women in a single centre was performed. The primary objective was to identify when in the IVF cycle the data obtained from ultrasound are most predictive of both oocyte maturation trigger timing and an over-response to stimulation. If a reduced frequency of clinic visits is needed due to COVID-19 precautions, prioritising attendance for monitoring scans on the most predictive cycle days may be prudent.PARTICIPANTS/MATERIALS, SETTING, METHODSThe study comprised anonymised retrospective database analysis of IVF/ICSI cycles at a tertiary referral IVF centre. Machine learning models are used in combining demographic and follicular tracking data to predict cycle oocyte maturation trigger timing and over-response. The primary outcome was the day or days in cycle from which scan data yield optimal model prediction performance statistics. The model for predicting trigger day uses patient age, number of follicles at baseline scan and follicle count by size for the current scan. The model to predict over-response uses age and number of follicles of a given size.MAIN RESULTS AND THE ROLE OF CHANCEThe earliest cycle day for which our model has high accuracy to predict both trigger day and risk of over-response is stimulation Day 5. The Day 5 model to predict trigger date has a mean squared error 2.16 ± 0.12 and to predict over-response an area under the receiver operating characteristic curve 0.91 ± 0.01.LIMITATIONS, REASONS FOR CAUTIONThis is a retrospective single-centre study and the results may not be generalisable to centres using different treatment protocols. The results are derived from modelling, and further clinical validation studies will verify the accuracy of the model.WIDER IMPLICATIONS OF THE FINDINGSFollicular tracking starting at Day 5 of stimulation may help to streamline the amount of monitoring required in COS. Previous small studies have shown that minimal monitoring protocols did not adversely impact outcomes. If IVF can safely be made less onerous on the clinic’s resources and patient’s time, without compromising success, this could help to reduce burden-related treatment drop-out.STUDY FUNDING/COMPETING INTEREST(S)F.P.C. acknowledges funding from the NIHR Applied Research Collaboration Wessex. The authors declare they have no competing interests in relation to this work.TRIAL REGISTRATION NUMBERN/A.

Endometrial thickness measurements among Asherman syndrome patients prior to embryo transfer.

Is there an association between endometrial thickness (EMT) measurement and clinical pregnancy rate among Asherman syndrome (AS) patients utilizing IVF and embryo transfer (ET)? EMT measurements may not be associated with successful clinical pregnancy among AS patients undergoing IVF. Clinical pregnancy rate after IVF is significantly lower in patients with a thin endometrium, defined as a maximum EMT of <7 mm. However, AS patients often have a thin EMT measurement due to intrauterine scarring, with a paucity of data and no guidance on what EMT cutoff is appropriate when planning an ET among these patients. This is a retrospective cohort study of 45 AS patients treated at a specialized advanced hysteroscopic clinic from 1 January 2015, to 1 March 2019. Review of EMT measurements prior to a total of 90 ETs, among 45 AS patients. The impact of the maximum EMT measurement prior to ET on clinical pregnancy rate was analyzed. A total of 25/45 (55.6%) AS patients ultimately went on to have ≥1 clinical pregnancy following a mean ± SD of 2.00 ± 1.26 ET attempts. There was a total of 90 ETs among the 45 AS patients, with 29/90 (32.2%) ETs resulting in a clinical pregnancy. Younger patient age (P = 0.05) and oocyte donation (P = 0.01) were the only variables identified to be significant predictors for a positive clinical pregnancy outcome on bivariate analysis. The mean EMT measurement prior to all ETs among AS patients was 7.5 ± 1.6 mm. EMT measurement prior to ET did not predict a positive clinical pregnancy on either bivariate (P = 0.84) or multivariable analysis (odds ratio 0.91, P = 0.60). 31.8% of EMT measurements measured <7.0 mm. In this small cohort, no difference in the clinical pregnancy rate was detected when comparing ETs with EMT measurements of <7.0 mm versus ≥7.0 mm (P = 0.83). The mean EMT measurement decreased with increasing AS disease severity; 8.0 ± 1.6 mm for mild disease, 7.0 ± 1.4 mm for moderate disease and 5.4 ± 0.1 mm for severe disease. Our small sample size limits our ability to draw any definitive conclusions. In addition, patients utilized various infertility clinics. This limits our ability to evaluate the consistency of EMT measurements and the IVF care that was received. EMT measurement cutoff values should be used with caution if canceling a scheduled ET in AS patients. This study was not funded. K.I. reports personal fees from Karl Stroz and personal fees from Medtronics outside the submitted work. The other authors have no conflicts of interest. N/A.

Can affordability and access to care be enhanced by minimal stimulation IVF (MS-IVF) and single embryo transfer (SET)?

To analyze cumulative live birth/ongoing pregnancy rates and potential cost savings associated with MS-IVF and single embryo transfer (SET) in good prognosis patients. A retrospective analysis comparing outcomes and costs of MS-IVF and traditional IVF in good prognosis patients. 137 good prognosis patients (defined as age <35, AMH>2.4, AFC>10, BMI <35, with diagnoses of PCOS, stage I-II endometriosis, tubal factor, and/or mild to moderate male factor) underwent MS-IVF or traditional IVF based on patient/physician preferences. FSH/low dose hcg/antagonist protocols were utilized. MS-IVF included 5 days of clomiphene 100mg prior to initiation of 150u FSH. Traditional IVF cycles had a mean starting FSH of 244u FSH. Cycle outcomes and cost analyses of the two groups included all fresh and frozen transfers. The two groups were comparable in age, basal FSH, BMI, and mean embryos transferred, with SET in all but one fresh transfer and all but one frozen transfer. The MS-IVF group was more likely to have a fresh transfer, contributing to cost reduction. 5 MS-IVF cycles were canceled due to low response; this was not statistically significant. There were significant differences in mean total gonadotropins, oocytes retrieved, blastocysts formed, and fresh transfers. SET was utilized to decrease multiple pregnancies while resulting in delivered, ongoing, and cumulative pregnancies higher than U.S. averages (SART 2014). Ongoing fresh, FET, and cumulative pregnancy rates achieved from one stimulation cycle were not statistically different between the two groups. Overall costs were 27% less in the MS-IVF group, while a 24% cost reduction was found on a per live birth/ongoing pregnancy basis. Greater affordability should result in enhanced access to IVF care by offering lower cost MS-IVF to good prognosis patients without sacrificing success. SET can dramatically reduce downstream costs associated with multiple gestation. We propose that MS-IVF combined with SET could be an appealing aspect of fertility benefits for employers and insurers who desire greater subscriber access to affordable IVF care.Tabled 1MS-IVF and Traditional IVF Outcome and Cost ComparisonMS-IVFTraditional IVFp ValueNumber of Stimulation Cycles8354Mean Total FSH Dose (IU's)12092168p<0.01Mean Total Oocytes15.724.1p<0.01Mean Blastocysts7.511.7p<0.01Fresh Transfers/Retrieval53/78 (68%)25/54 (45%)p<0.04Ongoing Pregnancies/Fresh transfer - N (%)33/53 (62%)17/25 (68%)NSOngoing Pregnancies/Frozen Transfer - N (%)28/45 (62%)29/44 (66%)NSOngoing Cumulative Pregnancies/Stimulation Cycle - N (%)61/83 (73%)46/54 (85%)NSMean Number of Transfers to Ongoing Pregnancy1.21.3NSMean Cycle Cost/Stimulation Cycle$14,088.80$19,345.54p<0.01Mean Cost/Live Birth or Ongoing Pregnancy$15,265.91$20,131.72p<0.01 Open table in a new tab

Comprehensive chromosome screening improves embryo selection: a meta-analysis

To study whether preimplantation genetic screening with comprehensive chromosome screening (PGS-CCS) improves clinical implantation rates (IR) and sustained IR (beyond 20weeks) compared with routine care for embryo selection in IVF cycles. Meta-analysis of randomized controlled trials (RCTs) and observational studies (OSs). University-affiliated teaching hospital. Infertile couples undergoing IVF. PGS-CCS with the use of different genetic platforms performed on polar body (PB), cleavage embryo, or blastocyst following embryo biopsy. Clinical IR and sustained IR in RCTs as well as OSs comparing PGS-CCS and routine care were determined after a complete review of the literature. Pooled estimates of risk ratios (RRs) with their 95% confidence intervals (CIs) according to a fixed-effects model with the use of the Mantel-Haenszel method were calculated after the meta-analysis. Forest plots are provided for comparative purposes. Out of 763 citations identified, 29 articles met initial eligibility criteria and were further analyzed. Of these, only three RCTs and eight OSs met full inclusion criteria, allowing direct comparison of PGS-CCS and routine IVF care based on embryo morphology selection. In the RCTs, all embryo biopsies were performed on day 5-6 of embryo development. In the OSs, biopsies were performed on different stages of embryo development, including PB, day 3, or day 5-6. Meta-analysis of the RCTs (3 studies; n = 659) showed that PGS-CCS was associated with a significantly higher clinical IR, with a pooled RR of 1.29 (95% CI 1.15-1.45), as well as a significantly higher sustained IR, with a pooled RR of 1.39 (95% CI 1.21-1.60). Similar findings were shown in the OSs, where the pooled RR for clinical IR was 1.78 (95% CI 1.60-1.99; 7 studies; n = 2,993) and for sustained IR was 1.75 (95% CI 1.48-2.07; 4 studies; n = 1,124). Statistical heterogeneity (I(2)) was minimal for RCTs and substantial among OSs. PGS with the use of CCS technology increases clinical and sustained IRs, thus improving embryo selection, particularly in patients with normal ovarian reserve. Results from ongoing RCTs conducted on different patient populations (e.g., decreased ovarian reserve) and different embryo stage biopsy (e.g., PB, day 3) may further clarify the role of this technology.

“We usually Just Push for Adoption”: differences in referral for abortion, IVF, ovarian cancer, and high-risk prenatal care among Nebraska clinicians

“We usually Just Push for Adoption”: differences in referral for abortion, IVF, ovarian cancer, and high-risk prenatal care among Nebraska clinicians

Incorporation of comprehensive chromosome screening (CCS) in IVF care is associated with faster resumption of care after failed embryo transfer

Time away from fertility treatment after a pregnancy loss can have a negative impact on overall success rates. Treatment paradigms which minimize loss rates and decrease time to resumed treatment are thus optimal. This data seeks to determine if utilization of CCS impacts time to resumption of treatment after an embryo transfer fails to result in a delivery. Retrospective cohort study at a single, academic center. All first fresh or frozen embryo transfer cycles from 2010 to 2014 were evaluated. All cycles which had an embryo transfer which did not result in a delivery were included for analysis. Time away from treatment was designated by calculating the number of days between the embryo transfer and the date of next treatment cycle start. Patients were compared overall and then analyzed depending upon whether CCS was part of their treatment strategy. Student t-test and chi square were utilized where appropriate. During the study timeframe there were 1763 individual patients who met inclusion criteria. The average number of days away from treatment was 88.2 (9-700). There were 1504 patients who did not have CCS and 259 who did have CCS. Patient in the non-CCS group required a D&C in 10.8% of cases while those in the CCS group required a D&C in 7.0% of cases (p=0.106). The average time away from treatment for the group without CCS was 90.2±1.95 days and with CCS was 76.3±4.69 days (p<0.006). Time away from fertility treatment when an embryo transfer does not result in a delivery can significantly impact overall success rates. Data about time away from treatment after pregnancy loss can be helpful in patient counseling and setting expectations. The overall average time to next treatment nearly 3 months. When CCS is incorporated into the treatment paradigm, the time away from treatment after a loss is decreased. It is possible that a priori knowledge of ploidy status allows for patients and their care team to process the implications of pregnancy loss more quickly and allows swifter return to care.

Microbiome at the time of embryo transfer: next generation sequencing of the 16S ribosomal subunit

Microbiome at the time of embryo transfer: next generation sequencing of the 16S ribosomal subunit

A prospective, blinded, non-selection study to determine the predictive value of ploidy results using a novel method of targeted amplification based Next generation sequencing (NGS) for comprehensive chromosome screening (CCS)

NGS technologies are now being utilized for CCS with promises to increase throughput and decrease costs. Unfortunately, these technologies have not been validated clinically. Most concerning is the lack of data documenting the false abnormal rate, defined as the proportion of embryos labeled as aneuploid through NGS but which would have delivered a healthy infant had they not been discarded. This study utilizes a non-selection design where embryos are transferred without knowledge of the NGS CCS result to determine the predictive value of both aneuploid and euploid results. Prospective, blinded, non-selection study. Patients with normal ovarian reserve ≤ 42 years of age were recruited. Following routine IVF care, trophectoderm biopsy was performed. Embryos were subsequently selected for transfer per routine. No NGS CCS analysis was done prior to transfer. A novel targeted amplification method of NGS based CCS which does not require whole genome amplification was then performed. The outcome for each transferred embryo was compared to the NGS screening result to determine the predictive value of that result. In the case of a two embryo transfer, DNA fingerprinting was utilized to ensure that the embryo responsible for the pregnancy was identified correctly. Implantation rates were compared between embryos designated euploid, aneuploid, and for the population as a whole. 117 patients had 187 blastocysts transferred. Of the 41 embryos assigned an aneuploid karyotype, none sustained implantation yielding a predictive value of an aneuploid result of 100%. 97 of 146 embryos designated as euploid implanted and progressed to delivery yielding a predictive value for a euploid result of 66.0%. No embryo designated as euploid subsequently developed into an aneuploid gestation. Euploid embryos had a higher sustained implantation rate than the population as a whole (50.8%, p<0.0001) and those designated aneuploid (0%, p<0.0001). This study represents the first prospective clinical evaluation of the predictive values of both a euploid and an aneuploid result when using NGS based CCS. This targeted amplification NGS CCS paradigm has a high degree of precision and provides excellent predictive values for actual clinical outcomes.

Impact of blastocyst biopsy and comprehensive chromosome screening technology on preimplantation genetic screening: a systematic review of randomized controlled trials

Embryonic aneuploidy is highly prevalent in IVF cycles and contributes to decreased implantation rates, IVF cycle failure and early pregnancy loss. Preimplantation genetic screening (PGS) selects the most competent (euploid) embryos for transfer, and has been proposed to improve IVF outcomes. Use of PGS with fluorescence-in-situ hybridization technology after day 3 embryo biopsy (PGS-v1) significantly lowers live birth rates and is not recommended for use. Comprehensive chromosome screening technology, which assesses the whole chromosome complement, can be achieved using different genetic platforms. Whether PGS using comprehensive chromosome screening after blastocyst biopsy (PGS-v2) improves IVF outcomes remains to be determined. A systematic review of randomized controlled trials was conducted on PGS-v2. Three trials met full inclusion criteria, comparing PGS-v2 and routine IVF care. PGS-v2 is associated with higher clinical implantation rates, and higher ongoing pregnancy rates when the same number of embryos is transferred in both PGS and control groups. Additionally, PGS-v2 improves embryo selection in eSET practice, maintaining the same ongoing pregnancy rates between PGS and control groups, while sharply decreasing multiple pregnancy rates. These results stem from good-prognosis patients undergoing IVF. Whether these findings can be extrapolated to poor-prognosis patients with decreased ovarian reserve remains to be determined.

Evaluation of an effective multifaceted implementation strategy for elective single-embryo transfer after in vitro fertilization

What is the relationship between the rate of elective single-embryo transfer (eSET) and couples' exposure to different elements of a multifaceted implementation strategy? Additional elements in a multifaceted implementation strategy do not result in an increased eSET rate. A multifaceted eSET implementation strategy with four different elements is effective in increasing the eSET rate by 11%. It is unclear whether every strategy element contributes equally to the strategy's effectiveness. An observational study was performed among 222 subfertile couples included in a previously performed randomized controlled trial. Of the 222 subfertile couples included, 109 couples received the implementation strategy and 113 couples received standard IVF care. A multivariate regression analysis assessed the effectiveness of four different strategy elements on the decision about the number embryos to be transferred. Questionnaires evaluated the experiences of couples with the different elements. Of the couples who received the implementation strategy, almost 50% (52/109) were exposed to all the four elements of the strategy. The remaining 57 couples who received two or three elements of the strategy could be divided into two further classes of exposure. Our analysis demonstrated that additional elements do not result in an increased eSET rate. In addition to the physician's advice, couples rated a decision aid and a counselling session as more important for their decision to transfer one or two embryos, compared with a phone call and a reimbursement offer (P < 0.001). The differences in eSET rate between exposure groups failed to reach significance, probably because of the small numbers of couples in each exposure group. Adding more elements to an implementation strategy does not always result in an increased effectiveness, which is in concordance with recent literature. This in-depth evaluation of a multifaceted intervention strategy could therefore help to modify strategies, by making them more effective and less expensive.

Mitochondrial fatty acid transport enzyme deficiency—implications for in vitro fertilization

To describe the individualized clinical and embryologic care required by a patient with adult-onset carnitine palmitoyl transferase II deficiency during IVF treatment and in a subsequent pregnancy. A case study. A private fertility unit and public obstetric hospital. A patient with a rare mutation in the mitochondrial fatty acid transport enzyme, carnitine palmitoyl transferase II. The patient received (IVF) fertility treatment and pregnancy care. Pregnancy and delivery of a healthy child. This patient conceived on her first cycle of IVF and went on to deliver a healthy child. Patients with adult-onset carnitine palmitoyl transferase II deficiency can have successful pregnancy outcomes after IVF, provided clinical and embryologic care is optimized.

Day 5 blastocyst embryo transfer: time for a single embryo transfer?

OBJECTIVE: To determine if the day of transfer (cell stage, day 5 or 6 blastocyst) affects IVF pregnancy outcome and multiple birth rates.DESIGN: Retrospective chart review.MATERIALS AND METHODS: A retrospective data review for IVF (women < 37 yo) and ovum donation cycles for the year 2006 were analyzed for embryo numbers transferred, and their grade and day of transfer, to determine live birth rates and multiple birth rates. Institutional approval for this study was obtained. Multiple regression analyses were used, and the number of embryos transferred and grade were used as covariates when multiple pregnancies were considered. Three groups were considered: cell stage transfers (transfers at 72 or 96 hours) or blastocyst transfer on day 5 or 6.Table 1Comparison of Delivered Pregnancy Rates by Day of TransferDay of TransferOdds Ratio95% CI3 vs 54.501.01 20.004 vs 59.013.05 26.326 vs 57.753.18 18.87 Open table in a new tab Table 2Comparison of Multiple Birth Rates by Day of TransferDay of TransferOdds Ratio95% CI3 vs 54.720.53 41.674 vs 53.771.12 12.666 vs 54.331.57 11.90 Open table in a new tab CONCLUSIONS: The data suggests that day 5 blastocyst transfer is superior, but yields higher multiple birth rates. A randomized trial of transferring suitable day 5 blastocysts on day 5 or 6 would clarify if the day of transfer was important. Couples seeking IVF care should seek out programs that offer day 5 blastocyst transfers and should consider a single blastocyst transfer. OBJECTIVE: To determine if the day of transfer (cell stage, day 5 or 6 blastocyst) affects IVF pregnancy outcome and multiple birth rates. DESIGN: Retrospective chart review. MATERIALS AND METHODS: A retrospective data review for IVF (women < 37 yo) and ovum donation cycles for the year 2006 were analyzed for embryo numbers transferred, and their grade and day of transfer, to determine live birth rates and multiple birth rates. Institutional approval for this study was obtained. Multiple regression analyses were used, and the number of embryos transferred and grade were used as covariates when multiple pregnancies were considered. Three groups were considered: cell stage transfers (transfers at 72 or 96 hours) or blastocyst transfer on day 5 or 6. CONCLUSIONS: The data suggests that day 5 blastocyst transfer is superior, but yields higher multiple birth rates. A randomized trial of transferring suitable day 5 blastocysts on day 5 or 6 would clarify if the day of transfer was important. Couples seeking IVF care should seek out programs that offer day 5 blastocyst transfers and should consider a single blastocyst transfer.