Latest IVF Insights

FTS has provided below a summary of the latest Fertility Society of Australia conference abstracts (October 2017) on IVF processes & techniques to help you decide what to invest in.

Too often IVF-decision-making is guided by IVF clinics geared to making profits and encouraging the use of more expensive ovarian stimulation drugs or selling supplements for which there is no evidence of effect. The research papers below are provided to guide you, empowering you as an informed consumer

GENERAL IVF TOPICS

Freeze-All Versus Fresh Embryo Transfer In IVF/ICSI: A Randomized Clinical Trial Vuong L et al.

In infertile couples without Polycystic Ovary Syndrome undergoing IVF, a freeze-all strategy did not increase ongoing pregnancy rates.

The Relative Contribution Of Treatment And Natural Conception To Pregnancy And Live Birth In An Australian Fertility Clinic Gadalla M. et al

A report on an ongoing retrospective study on infertile couples consulting an Australian fertility clinic from January 1st 2012 to December 31st 2014. Couples were followed for up to 3 years. The primary outcome was cumulative live birth. In women <35 years, 35–39 years and ≥40 years, cumulative 36-months live birth rates were 57.9 %, 47.8 % and 22.2 %, respectively. Half of the live births were achieved after ICSI (50.9%), IVF (22.8%), IUI (3.5%), OI (1.8%) and without treatment (21.1%). Live birth rates per diagnostic category were 50% for male factor (75% ICSI), 65% for ovarian factor (77% ICSI), 33% for tubal factor infertility, 33% for endometriosis (50% ICSI) and 33% for unexplained infertility (75% ICSI, 36.8% IVF, 31.6 % spontaneously).

The study concluded that of the 50% of couples who had success within 3 years, use of ICSI rather than any other IVF techniques, was the main contributor of this success, regardless of whether the cause was male factor infertility, ovarian factor, tubal factor, endometriosis or unexplained.

RESEARCH ON STIMULATED CYCLES

How To Deal With Recurrent Implantation Failure Anno 2017? Fatemi, H

With the current tools present, the transfer of the embryo should preferably be conducted in a complete natural cycle after being chromosomally tested at a blastocyst stage, and transferred based on its chromosomal and mitochondrial status.

Ovarian Stimulation In IUI Cycles In Couples With Unexplained Subfertility: Follicle Stimulating Hormone (FSH) Or Clomiphene Citrate )? Danhof et al

In IUI-OS with adherence to strict cancellation criteria, FSH is not superior to CC to achieve ongoing pregnancies, while multiple pregnancy rates are comparable. In view of the data, we suggest to use the least expensive and least invasive stimulation agent, which is Clomiphene Citrate. A formal cost-effectiveness analysis for the ultimate interpretation of the data is planned.

Does Increasing Gonadotropin Dose For A Given AMH Level Improve The Ovarian Response? Agresta Et Al

For a given AMH level, a plateau response appeared within each AMH stratum at or below a total dose 2000-2499 IU and response did not increase with further increasing FSH dose. This large dataset has allowed detailed investigation of FSH dose-ovarian-response association, correcting for significant confounders. Many patients may be receiving greater FSH doses than required for optimal response.

Vitrified blastocysts were shown to yield the highest live delivery rates after adjusting for covariates. There was a 90% higher odds of live delivery per embryo transfer cycle for vitrified blastocysts compared with slow frozen cleavage-stage embryos.

A Comparison Of FSH Consumption In The Real-World Setting And In A Large Phase-3 Randomised Controlled Trial Fois R et al

Real-world FSH doses often exceed a dose-response plateau threshold, meaning your clinic is often prescribing much more FSH than you require

IMMUNE SUPRESSION

Immune Suppression – Not A Solution For Repeated IVF Failure Sarah A. Robertson

While in the specific circumstance of autoimmunity some women benefit from these drugs, it is incorrect to assume a ‘one-size-fits-all’ approach. In most women, suppressing the immune response is likely to cause more harm than good. Depending on female age, a significant number of oocytes appear to have chromosomal abnormalities. One of the most important causes for failure of implantation is chromosomal imbalance in the embryo.

SUPPLEMENTS TOPICS
The Effectiveness Of Micronutrient Supplementation On Sperm Quality, Embryo Development And Pregnancy Outcomes In Overweight And Obese Men Shehadeh H et al

Micronutrient supplementation increased sperm motility and standard insemination fertilization rates, improved day 4 embryo morphology and grading with further improvements in blastocyst ICM and TE quality in obese men compared to obese men not consuming micronutrient supplements

Melatonin In Assisted Reproductive Technology: The Miart Trial. A Pilot Double-Blind Randomised Placebo-Controlled Clinical Trial Fernando S et al

The use of melatonin with the intention of improving ART success rates should be discontinued until high quality evidence demonstrates its efficacy.

Nutritional Supplements And Herbal Medicines For Women With Polycystic Ovary Syndrome (Pcos); A Systematic Review And Meta-Analyses Of RCTs Arentz et al

There is no high quality evidence to support the effectiveness of nutritional supplements and herbal medicine for women with PCOS and evidence of safety is lacking. High quality trials of nutritional supplements and herbal medicines examining menstrual regulation and adverse effects in women with PCOS are needed due to women’s high prevalence of use.

Antioxidants In IVF Medium Significantly Improve Embryo Development Truong et al

Supplementation of antioxidants to the IVF medium, especially during oocyte collection and fertilization, imparts significant benefits on embryo development rate and cell numbers, plausibly through the reduction of oxidative stress.

SURROGACY

Experience Of Surrogate Mothers Montrone, M

None of the surrogates researched indicated concerns about relinquishing the baby and most surrogates (90%) continued to have sufficient regular contact with the intended parents and the baby. Most relationships of and between all the parties to the surrogacy reportedly became closer with the exception of two where the surrogate and her partner had problems, with one relationship ending; and another surrogacy where there was a relationship breakdown between the surrogate and one of the intended parents.

These findings provide evidence that post-partum surrogates and their partners are well adjusted and perceive their surrogacy in a positive light. For the few individuals experiencing heightened concerns further counselling is recommended.