Fertility treatments can be complex and often require patients to make many decisions along the way.
One of the toughest decisions for patients undergoing IVF & Donor Egg treatment is how many embryos should I transfer? This is an important decision and we understand the reasons why patients might struggle for the right answer.
The IVF process is complex and consists of several steps, including: ovulation induction, egg retrieval, fertilization of the eggs and embryo culture, embryo grading, and embryo transfer.
Listen in as Alan Martinez, MD discusses your options when considering IVF and if single embryo transfer is the right choice for you.
What You Need to Know About IVF and Single Embryo Transfer
From the Show: RSC NJ - Fertility Talk
Summary:
Air Date: 7/28/16
Duration: 10 Minutes
Transcription:
Melanie Cole (Host): If you are considering in vitro fertilization, does the thought of multiple births concern you? My guest today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and fertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. First, tell us, with in vitro fertilization, what is typically what goes on?
Dr. Alan Martinez (Guest): With in vitro fertilization, what happens is that the female patient undergoes a treatment with injectible medicines that promote an increased response of the ovaries and results in growth of a number of eggs. Those eggs, when they reach a certain size of maturity, they are removed via an oocyte retrieval or an egg retrieval. Then, in the laboratory setting using either donor’s or partner’s sperm, these eggs are then inseminated, either injected each sperm into each individual mature egg or added to a dish and allowed to naturally fertilize. Then, those embryos are grown out over a period of days, and usually either a day three or a day five transfer is done back into the uterus in attempts to conceive.
Melanie: Has there been an issue or do you hear concern from couples about multiple births?
Dr. Martinez: Absolutely. We have patients that may be concerned about multiple births because they have a problem before in a prior pregnancy where they’ve actually had twin pregnancies and there’s been negative complications from that whether they had losses or early or early births or problems related to the infant’s health when delivered. Some patients have a history of that. Others are concerned because they have other medical conditions that may make their pregnancies a little bit more of a concern when you have more than one baby or twins or triplets or higher. There are several reasons why people are concerned about it, but our patients are coming to us and they’re asking those questions.
Melanie: What can you tell them? What is single embryo transfer?
Dr. Martinez: That is when we take those group of embryos that are growing in our laboratory and, usually nowadays, we elect to transfer embryos on day five, which is where they should be at a more advanced stage which allows for better selection. That more mimics the natural time when the embryo would implant in the uterus in a normally achieved pregnancy. We take an embryo, and we grade the embryos on the day of transfer and, based upon different criteria, we decide whether the patient is eligible for transferring one high-quality embryo or more in some cases.
Melanie: Will that reduce their chance of getting pregnant? Explain some of the concerns that couples have with this.
Dr. Martinez: Well, couples that are coming to us, always want to conceive as of a year ago or yesterday. They’re always looking to conceive as fast as they can. Patients oftentimes think that transferring more embryos increases their pregnancy rates. While this is overall true, they’re surprised at the actual numbers that when you take one good, high-quality embryo, say a blastocyst embryo on day five versus one or versus two, the pregnancy rates increase a certain percentage but it’s small. However, the increases in the potential pregnancy complications, should that patient have a twin pregnancy or a higher gestation pregnancy, far greatly outweighs the chances of trying to conceive with one embryo.
Melanie: Are there certain people who are more suitable for single embryo transfer?
Dr. Martinez: Absolutely. The best scenario is when patients are under the age of 35 and they have gone through IVF and this is their first cycle or they’ve been successful through IVF before and they have an abundance or more than one high-quality embryo. So, when you can select from multiple good embryos, then we think, “Okay the better thing to do is to transfer one embryo.” Also, in some cases with IVF now, we have an option to do pre-implantation genetic screening, which is where we test the chromosomes. I've spoken about this before on your show. In this case, when we test an embryo regardless of the age of the female, when you have the normal chromosomes and the normal genetics of that embryo, you can make an argument for transferring one embryo in a patient of any age.
Melanie: So, how often can somebody do a single transfer? Would they need to do it more often if it doesn’t take?
Dr. Martinez: Well, if the pregnancy rates are a little bit lower with a single embryo transfer, then they have to go through another subsequent transfer which, if they have other high-quality embryos, they may go through what we call a frozen embryo transfer. So, from their fresh cycle, they’ve had multiple embryos that are frozen. The first one doesn’t take, and then we go ahead and we do a subsequent transfer. But, the studies have shown that if you transfer a high-quality blastocyst day five embryo, and you do a single embryo transfer, that compared to a double embryo transfer, if you proceed with a frozen transfer, if the first one is not successful, then the cumulative pregnancy rates are exactly the same. And the difference--the major difference, I always stress with my patients--is that our goal is to get you pregnant with one baby. If we have twins, sometimes that happens and we can't control that, but anything more than that, your pregnancy complications go up. So, I would rather, as a medical provider, achieve a single pregnancy with one gestation and that’s our goal.
Melanie: You mentioned the best quality embryo. What determines that?
Dr. Martinez: So, when the embryos grow out in the laboratory setting, they will declare themselves. There’s a growth curve and there’s certain thresholds that they have to meet. So, we look at how the embryo divides and we can categorize it based on its stage. It’s a very complex system but we can essentially grade an embryo--and I’m simplifying it--but we can say, “Okay, that's an A quality embryo. That’s a B because the cells don’t look as healthy; there are less of cells; there’s more granularity of the cells.” All of these very specific criteria that directly relate to the grading of these embryos. So, we can clearly know based upon how they’ve developed in the lab, their likelihood of success. In those cases, we will only transfer single embryos when we have high-quality embryos that we can select from. It’s very easy to decide that. And then, it’s just based on the patient’s age and the other testing like I talked about before.
Melanie: Does freezing that high-quality embryo, if you find a few for that particular couple, does that affect their quality at all?
Dr. Martinez: No, because the high-quality embryos with the current technology and in the right hands, in the right expertise in our laboratory setting, these embryos can be frozen very effectively, and the overall survival rate is well into the upper 90%. So, we’re talking 96%, 98% embryo survival. It’s very rare that these embryos do not survive the thaw process. Therefore, we have the option if we do a single embryo transfer and it works for the patient, then they have these other three embryos that are cryo-preserved, for instance. They can come back and start to build their family afterwards, and it’s very easy to do. So, we can achieve high pregnancy rates with good quality embryos and decrease the potential complication rates from having twin pregnancies and other kinds of pregnancies and, in many patients, this is the way to go.
Melanie: In just the last few minutes, Dr. Martinez, give your best advice to the couples listening about what you really want them to know about single embryo transfer and IVF and why they should come to the Reproductive Science Center of New Jersey for their care.
Dr. Martinez: So, the IVF process may be daunting for some but you do not have to worry. You sit down with us and, like any good quality physician, we will walk you through the process. We will teach you how to go through IVF and help you through that based upon what kind of embryos that your body gives us. Then, we can decide the best treatment options for you. In some cases, it’s the single embryo transfer. If that’s the case, we’re going to be honest with you, and we’re going to offer that to you. And we have the technology to really drive up these pregnancy rates while decreasing the pregnancy complications. That’s our whole goal. It’s to take care of you as our patient, to keep the moms healthy because that’s the first thing and then to help you grow your family. So, at the Reproductive Science Center of New Jersey, this is our motto: that we treat everyone as if they are family. Everything and every patient is analyzed, specifically meets with a provider such as myself, and we make the best individualized treatment plan for you. We both come to an agreement and we want to offer a supportive friendly environment to help you achieve pregnancy success.
Melanie: That’s such great information and so fascinating. Dr. Martinez, thank you so much for being with us today. You're listening to Fertility Talk with RSCNJ. For more information, you can go to FertilityNJ.com. That’s FertilityNJ.com. This is Melanie Cole. Thanks for much for listening.
Melanie Cole (Host): If you are considering in vitro fertilization, does the thought of multiple births concern you? My guest today is Dr. Alan Martinez. He’s a specialist in reproductive endocrinology and fertility at the Reproductive Science Center of New Jersey. Welcome to the show, Dr. Martinez. First, tell us, with in vitro fertilization, what is typically what goes on?
Dr. Alan Martinez (Guest): With in vitro fertilization, what happens is that the female patient undergoes a treatment with injectible medicines that promote an increased response of the ovaries and results in growth of a number of eggs. Those eggs, when they reach a certain size of maturity, they are removed via an oocyte retrieval or an egg retrieval. Then, in the laboratory setting using either donor’s or partner’s sperm, these eggs are then inseminated, either injected each sperm into each individual mature egg or added to a dish and allowed to naturally fertilize. Then, those embryos are grown out over a period of days, and usually either a day three or a day five transfer is done back into the uterus in attempts to conceive.
Melanie: Has there been an issue or do you hear concern from couples about multiple births?
Dr. Martinez: Absolutely. We have patients that may be concerned about multiple births because they have a problem before in a prior pregnancy where they’ve actually had twin pregnancies and there’s been negative complications from that whether they had losses or early or early births or problems related to the infant’s health when delivered. Some patients have a history of that. Others are concerned because they have other medical conditions that may make their pregnancies a little bit more of a concern when you have more than one baby or twins or triplets or higher. There are several reasons why people are concerned about it, but our patients are coming to us and they’re asking those questions.
Melanie: What can you tell them? What is single embryo transfer?
Dr. Martinez: That is when we take those group of embryos that are growing in our laboratory and, usually nowadays, we elect to transfer embryos on day five, which is where they should be at a more advanced stage which allows for better selection. That more mimics the natural time when the embryo would implant in the uterus in a normally achieved pregnancy. We take an embryo, and we grade the embryos on the day of transfer and, based upon different criteria, we decide whether the patient is eligible for transferring one high-quality embryo or more in some cases.
Melanie: Will that reduce their chance of getting pregnant? Explain some of the concerns that couples have with this.
Dr. Martinez: Well, couples that are coming to us, always want to conceive as of a year ago or yesterday. They’re always looking to conceive as fast as they can. Patients oftentimes think that transferring more embryos increases their pregnancy rates. While this is overall true, they’re surprised at the actual numbers that when you take one good, high-quality embryo, say a blastocyst embryo on day five versus one or versus two, the pregnancy rates increase a certain percentage but it’s small. However, the increases in the potential pregnancy complications, should that patient have a twin pregnancy or a higher gestation pregnancy, far greatly outweighs the chances of trying to conceive with one embryo.
Melanie: Are there certain people who are more suitable for single embryo transfer?
Dr. Martinez: Absolutely. The best scenario is when patients are under the age of 35 and they have gone through IVF and this is their first cycle or they’ve been successful through IVF before and they have an abundance or more than one high-quality embryo. So, when you can select from multiple good embryos, then we think, “Okay the better thing to do is to transfer one embryo.” Also, in some cases with IVF now, we have an option to do pre-implantation genetic screening, which is where we test the chromosomes. I've spoken about this before on your show. In this case, when we test an embryo regardless of the age of the female, when you have the normal chromosomes and the normal genetics of that embryo, you can make an argument for transferring one embryo in a patient of any age.
Melanie: So, how often can somebody do a single transfer? Would they need to do it more often if it doesn’t take?
Dr. Martinez: Well, if the pregnancy rates are a little bit lower with a single embryo transfer, then they have to go through another subsequent transfer which, if they have other high-quality embryos, they may go through what we call a frozen embryo transfer. So, from their fresh cycle, they’ve had multiple embryos that are frozen. The first one doesn’t take, and then we go ahead and we do a subsequent transfer. But, the studies have shown that if you transfer a high-quality blastocyst day five embryo, and you do a single embryo transfer, that compared to a double embryo transfer, if you proceed with a frozen transfer, if the first one is not successful, then the cumulative pregnancy rates are exactly the same. And the difference--the major difference, I always stress with my patients--is that our goal is to get you pregnant with one baby. If we have twins, sometimes that happens and we can't control that, but anything more than that, your pregnancy complications go up. So, I would rather, as a medical provider, achieve a single pregnancy with one gestation and that’s our goal.
Melanie: You mentioned the best quality embryo. What determines that?
Dr. Martinez: So, when the embryos grow out in the laboratory setting, they will declare themselves. There’s a growth curve and there’s certain thresholds that they have to meet. So, we look at how the embryo divides and we can categorize it based on its stage. It’s a very complex system but we can essentially grade an embryo--and I’m simplifying it--but we can say, “Okay, that's an A quality embryo. That’s a B because the cells don’t look as healthy; there are less of cells; there’s more granularity of the cells.” All of these very specific criteria that directly relate to the grading of these embryos. So, we can clearly know based upon how they’ve developed in the lab, their likelihood of success. In those cases, we will only transfer single embryos when we have high-quality embryos that we can select from. It’s very easy to decide that. And then, it’s just based on the patient’s age and the other testing like I talked about before.
Melanie: Does freezing that high-quality embryo, if you find a few for that particular couple, does that affect their quality at all?
Dr. Martinez: No, because the high-quality embryos with the current technology and in the right hands, in the right expertise in our laboratory setting, these embryos can be frozen very effectively, and the overall survival rate is well into the upper 90%. So, we’re talking 96%, 98% embryo survival. It’s very rare that these embryos do not survive the thaw process. Therefore, we have the option if we do a single embryo transfer and it works for the patient, then they have these other three embryos that are cryo-preserved, for instance. They can come back and start to build their family afterwards, and it’s very easy to do. So, we can achieve high pregnancy rates with good quality embryos and decrease the potential complication rates from having twin pregnancies and other kinds of pregnancies and, in many patients, this is the way to go.
Melanie: In just the last few minutes, Dr. Martinez, give your best advice to the couples listening about what you really want them to know about single embryo transfer and IVF and why they should come to the Reproductive Science Center of New Jersey for their care.
Dr. Martinez: So, the IVF process may be daunting for some but you do not have to worry. You sit down with us and, like any good quality physician, we will walk you through the process. We will teach you how to go through IVF and help you through that based upon what kind of embryos that your body gives us. Then, we can decide the best treatment options for you. In some cases, it’s the single embryo transfer. If that’s the case, we’re going to be honest with you, and we’re going to offer that to you. And we have the technology to really drive up these pregnancy rates while decreasing the pregnancy complications. That’s our whole goal. It’s to take care of you as our patient, to keep the moms healthy because that’s the first thing and then to help you grow your family. So, at the Reproductive Science Center of New Jersey, this is our motto: that we treat everyone as if they are family. Everything and every patient is analyzed, specifically meets with a provider such as myself, and we make the best individualized treatment plan for you. We both come to an agreement and we want to offer a supportive friendly environment to help you achieve pregnancy success.
Melanie: That’s such great information and so fascinating. Dr. Martinez, thank you so much for being with us today. You're listening to Fertility Talk with RSCNJ. For more information, you can go to FertilityNJ.com. That’s FertilityNJ.com. This is Melanie Cole. Thanks for much for listening.