I remain concerned that when IVF doesn’t work, a patient is too often given a diagnosis of carrying high levels of Natural Killer (NK) cells in her uterus, preventing implantation. In fact, it’s far more likely to be a problem on the embryo side – often related to older eggs – and the reality of this can be tough to face.
If it was a case of “well, looking for them and treating them can’t do any harm”, the situation might be more acceptable. However the diagnostic tests for NK cells are not well validated (meaning there may be lots of false results), and the commonly used treatment of prednisone (corticosteroids) may carry higher risks to mother and fetus.
I’ve previously discussed the fact that many studies now show that vitrified (frozen) blastocyst embryos do just as well as embryos transferred fresh. In fact, there are times when a pregnancy outcome will be better when a frozen-thawed embryo is replaced into a woman’s natural ovulation cycle, than when a fresh embryo is transferred into a uterus that has been stimulated with IVF medications (ie a fresh cycle).
Endometrial biopsy (or “endometrial scratch”) is a technique that is increasingly being used as part of IVF treatment. It’s a relatively simple thing to do – it involves passing a catheter through the neck of the womb (the cervix) into the uterine cavity and taking a small sample of the inner uterine lining (called endometrium), and sending it for analysis.
Fresh is best. It sounds logical and is promoted by some clinics as the ‘gold standard’. But it is a mantra that could be stood on its head in terms of the most effective use of IVF embryos to maximise the chance of an on-going pregnancy and health baby.
The traditional practice of IVF is to transfer the ‘best looking’ embryo into the uterus immediately after a stimulated cycle.
Following the development of techniques for freezing and thawing embryos, in the 1980s, if a couple has more embryos that appear to be developing normally in the lab, they can be frozen for later use. More recently, we have seen dramatic improvements in the techniques for freezing these so-called excess embryos. In 2006, Genea was the first clinic group in Australia to introduce a new freezing method called vitrification – or snap freezing – as standard practice.
When IVF doesn’t quickly work, patients become convinced that there is something wrong with their uterus or body that leads to the “rejection” of their embryos. Of course this may be true for some women, but in fact the problem is usually one on the side of the embryo – even high grade blastocysts have up to a 50% chance of having chromosome errors that prevent implantation or lead to miscarriage. Well done studies repeatedly suggest that so-called “implantation failure” is far more likely to actually be a problem of embryos.
Sydney IVF is now longer based only in Sydney – but has a presence across Australia and across the world. And Sydney IVF is not just about IVF. Hence the announcement today that Sydney IVF is reborn as Genea – World leaders in fertility.
More details very soon – but for now, here’s some of the media response to the annoucement, which coincided with some recent new success rates:
When a couple undertakes an IVF cycle we usually attain say up to a dozen eggs and following fertilisation and culture, there might ultimately be in the region of 1 – 4 applicable embryos at the day 5 stage. At that point, our usual advice is to transfer the best blastocyst and freeze the remaining blastocysts for later use.
…or “Why genetic anomalies of embryos are more likely to be important than taking steroids”
I’ve been very lazy with my blog lately but have decided to use my recent trip to the international conference ESHRE in Stockholm to give you some feedback about current activites.
One study that caught my eye was a Danish study that looked at the outcomes of couples who had had at least three early pregnancy miscarriages and how often they will ultimately go on to have a live birth.
Reading IVF literature from around the world, I am still intrigued that in many countries it is considered appropriate to routinely transfer multple embryos in IVF cycles. This includes the view by many clinicians that twins are “acceptable”. Now twins can be very cute – but the higher rates of complications from premature delivery, developmental delay, anomalies and deaths that occur from twins compared to single pregnancies means that a couple’s chance of a healthy baby per IVF cycle is higher through single embryo transfer than it is from multiple embryo transfer.
If you are skeptical, read this article that looked at a large data set of IVF cycles across Australia and form your own opinion.
One of the commonest statements I hear about so-called natural therapies is they don’t do any harm. Many people have a degree of scepticism as to whether they do anything, but an understandable reluctance to move to high powered mainstream medicine and on the well-meant advice from friends etc, I can readily see why people take natural therapy pathways.