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.
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.
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.
One of the most interesting presentations I heard at the recent Fertility Society of Australia conference in Adelaide was not one about cutting edge science or new developments (as an aside, Sydney IVF’s technology is at the forefront of IVF practice but it’s always interesting to get other people’s views and directions). In fact the talk I found the most interesting was from Graeme Hugo, an expert on population, both Australia’s and worldwide.
…this is the title of a song by one of my favourite Australian bands Mental as Anything. This song has nothing to do with statistics (the band members went to Art School), but it’s the launchpad for a discussion of the average of something, or in statistical terms, the mean. To do this I want to make reference to the recently released report by the Austrian Institute of Health and Welfare (AIHW), which annually publishes IVF pregnancy rates for Australia and New Zealand.
Firstly, this data is very valuable. Australasia can be very proud that every IVF cycle and every successful outcome has been recorded (anonymously) in a central database since IVF began 30 years ago. I’ve never, for example, seen national data for the outcomes from naturopathy or detox diets. The data show that we have high pregnancy rates by international standards and we tend to keep problems like multiple pregnancy to a minimum. The good success rates have been maintained over successive years.
However, the results give only the mean percentage rate of all treatments.
This question was raised by someone who recently visited the blog. It raises some fundamentally important points about human fertility and the chance of conception. It strikes me that sometimes these concepts aren’t even recognised by some doctors!