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Drop in the Nationwide IVF Success Rate

By Francis Polansky, M.D.

For many years, the American Society for Reproductive Medicine (ASRM) has been compiling IVF treatment outcome data from US IVF centers.

As the laboratory techniques improved and new procedures were introduced to the IVF treatment, there was a steady increase in the probability of IVF live births.

For the first time, in the latest 2017 annual report, there has been a drop in the IVF success rate in all patient age groups compared with the previous year. (The annual reports have a two-year lag by the time the treatment outcomes are published.)

 

Decrease in the Nationwide Live Birth Probability from 2016 to 2017
(Most Recent Reporting)
Female Age 34 &
Younger
35 - 37 38 - 40 41 - 42 43 &
Older
  2016 2017 2016 2017 2016 2017 2016 2017 2016 2017
Live Birth Probability (%) 41 39 32 30 22 19 12 9 4 3
Decrease in the Nationwide Live Birth Probability from 2016 to 2017
(Most Recent Reporting)
Female Age 34 &
Younger
35 - 37 38 - 40 41 - 42 43 &
Older
  2016 2017 2016 2017 2016 2017 2016 2017 2016 2017
Live Birth Probability (%) 41 39 32 30 22 19 12 9 4 3

American Society for Reproductive Medicine

 

It is interesting to contemplate what could have caused such an across-all-age-groups decrease in the IVF live birth rate.

A possible, if not likely, explanation could be the widespread addition of preimplantation genetic embryo testing (PGT) to the IVF treatment. It has been known for several years that adding PGT to the IVF treatment does not improve the probability of a successful outcome, and may, in fact, be detrimental for some of the believed indications (ASRM).

Using even the latest methods, genetic analysis has been suggested to be associated with up to one-third false-positive findings resulting in discarding embryos that may have resulted in live births.

Theories proposed to explain the phenomenon include:

  • Approximately 10% of cells removed for testing yield no results
  • Chromosomal segregation errors may lead to embryo mosaicism (an embryo that contains both normal and abnormal cells) in which abnormal cell lines fail to proliferate, and the normal cell line develops into a normal offspring. If the analyzed cell were biopsied from an abnormal cell line, such embryo would be discarded.
  • Self-correction of the abnormal cell line(s). Again, if the embryo biopsy were carried out before this self-correction, such embryo would be discarded.
  • The genetic analysis itself may result in a false-positive or incorrect result.

 

This means that we must accept the reality that with PGT testing, we are discarding embryos that may have resulted in a live birth. Recent reports describe births of healthy babies after the transfer of “genetically abnormal” embryos.

The ASRM concludes that:

  • There is good evidence to recommend against the use of PGT as currently performed to improve live birth rates in patients with advanced maternal age.
  • There is good evidence to recommend against the use of PGT as currently performed to select the best embryo to transfer in good prognosis patients.

 

October 2019

 

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