State of the A.R.T (Advanced Reproductive Techniques) 2015

It feels great to be blogging again. I figured the best was to re-start this blog was to provide an update and summary on how these remarkable techniques have grown and developed as well as summarizing their current success and limitations. The technique of In Vitro Fertilization (IVF) has become the gold-standard of fertility treatment both for its diagnostic value as well as its high success rates compared to other treatment options. It is currently estimated that over 5,000,000 people have been born using IVF since the first reported success in 1978. In 2012 about 1% of all births in the USA —a total of 65,160 babies—were conceived and born through IVF. So let’s first consider the safety of this technology.

A recent report  summarized the safety of Assisted Reproductive Technology in the US by reviewing all of the available data from 2000 to 2011. This analysis included 1.14 million IVF cycles in order to determine the incidence of medical complications within 12 weeks of the procedure. They were looking for complications like infection, bleeding, adverse reaction to medications, anesthetic complications and Ovarian Hyperstimulation Syndrome (OHSS). OHSS was the most common complication and occurred in about 1.54% (154 times in 10,000 cycles). Even this It was rare for any complications to require hospitalization which occurred in 0.35% (35 times in 10,000 cycles). Best of all, the incidence of complications—including adverse medical reactions—declined throughout the time period analyzed.

Importantly, as the pregnancy rates have increased; ART treatment is also resulting in the birth of healthier babies. For instance a 20 year review  of cycles performed in the Scandinavian countries of Norway, Sweden, Finland and Denmark demonstrated a remarkable decline in the incidence of preterm birth or with low birth rate. They also found a similar reduction in still birth and infant mortality. The most important contributing factor to this remarkable success is that these countries have a national policy of transferring only one embryo at a time. The practice of elective single embryo transfer (ESET) is rapidly becoming the norm in the US as well. Another reassuring finding  was that the risk of Autism Spectrum Disorder (ASD) was not increased in children born through IVF; a fear that many had theorized before the data was available to review.

Finally, a recent report  on the increased use of Intracytoplasmic Sperm Injection (ICSI) as a technique to fertilize eggs was recently misinterpreted—in my opinion—rather cynically by the popular critics. ICSI was a treatment first used in 1992 to overcome severe male factor infertility. This report revealed that the use of ICSI has doubled during the last two decades even though the incidence of male factor infertility has remained steady.  Their reports suggested it was being used unnecessarily. As a clinician however I know that many couples have multiple factors contributing to their infertility challenge. Even with a normal sperm count, the sperm may not be able to penetrate the egg; either because the sperm is too weak or because the egg shell (zona) is too tough. Either way, this technique overcomes either challenge. In fact, this recent study found that the rate of “failed fertilization” was markedly reduced by the wider use of ICSI. Another important benefit of using ICSI routinely is that it makes it possible to minimize the risk of a good egg being fertilized by an abnormal sperm. The end result is that ART becomes increasingly safer and more effective and ICSI is one aspect that has contributed to that success.

If you’d like to estimate your own unique chance of a achieving a successful pregnancy through IVF, check out the following link to the Society for Assisted Reproductive Technology: https://www.sartcorsonline.com/Predictor/Patient . There you can answer a few short questions about your current situation and you’ll be given your own personalized IVF cycle prognosis using the statistics from the SART National Database (2006-2012). The results from your center may vary but this should give you an excellent reference point to have further discussions with your reproductive healthcare provider.

[r1]Link to http://jama.jamanetwork.com/article.aspx?articleid=2088842

[r2]Link to http://humrep.oxfordjournals.org/content/early/2015/01/16/humrep.deu345.abstract?sid=ab6c68c3-4f95-40cb-9b74-c9367305e75a

[r3]Link to http://jama.jamanetwork.com/article.aspx?articleid=1707721&resultClick=3

[r4]Link to http://jama.jamanetwork.com/article.aspx?articleid=2091303&resultClick=3

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