Search Results for: Embryo Biopsy

Embryo Biopsy vs. PGD (Preimplantation Genetic Diagnosis) vs. PGS (Preimplantation Genetic Screening)

Infertility treatment has evolved rapidly over the last couple of years, which means   we have more tools to help our patients have healthy babies.  However, these rapid advances are sometimes difficult to comprehend –  especially when breaking down the cost. Like all IVF clinics, we rely on outside laboratories that specialize in genetic testing, utilizing either blood or cells from a developing embryo. We want to shed some light on the difference between Genetic Carrier Screening (blood tests), ICSI, Embryo Biopsy, PGS (Preimplantation Genetic Screening) and PGD (Preimplantation Genetic Diagnosis).  The following is a discussion of the specifics of what all of this means.

Genetic carrier screening is a simple blood test, drawn in our office, that can help you understand your risk of having a child with a genetic disease

When patients are in the diagnostic phase of treatment, we recommend genetic carrier screening.  Genetic carrier screening is a simple blood test, drawn in our office, that can help you understand your risk of having a child with a genetic disease. Initially, the female partner is screened and if she is not a carrier for any genetic diseases, no further testing is required. If she is a carrier, we will test the male partner. If the male partner is not a carrier, no further testing is required.

If both partners are carriers of the same genetic disease, the recommendation would be IVF/ICSI/PGD because there is a 1 in 4 chance (25%) of having a child with that disease. PGD (Preimplantation Genetic Diagnosis) of an embryo allows us to screen for a specific disease. This initial blood test is typically covered by your insurance.

If PGS or PGD is planned, then ICSI is needed. First, what is ICSI? ICSI is an acronym for intracytoplasmic sperm injection. A fancy way of saying “inject sperm into egg”. When we perform ICSI, the embryologist can isolate and inject a single sperm directly into the oocyte (egg). This ensures that only a single sperm penetrates and thus fertilizes the egg.  Because genetic material from non-fertilizing sperm can alter the nature of PGS/PGD testing, doing ICSI is absolutely necessary. Who knew the sperm who didn’t make it stayed around the egg after fertilization? Unfortunately, even when the insurance company is willing to cover the cost of IVF, individual fees for specialized procedures like ICSI and embryo biopsy may NOT be covered. Our billing team can help you understand exactly what level of coverage you have and any additional costs not covered by insurance.

What exactly is the embryo biopsy? The actual embryo biopsy is the removal of a few cells on the outer layer of the embryo that will eventually become the placenta. This is done by an embryologist in our lab using a specialized technique. The biopsied material is sent to an advanced genetic laboratory for PGS / PGD (this is the actual testing) that specializes in examining the DNA of these cells. Again, even though insurance is covering the IVF cycle, they may NOT cover the costs of performing the actual biopsies on the embryos.

So, what’s the difference between PGS and PGD???

So, what’s the difference between PGS and PGD???  PGS is the screening of the biopsied cells of an embryo to determine if the embryo has the normal number of chromosomes. It is very basic and tells us if the embryo has the normal number of chromosomes – 46,XX or 46,XY. If there are missing or added chromosomes, the embryo may be considered abnormal, and therefore not eligible for transfer back into the uterus. PGD is more specialized and can detect single gene mutations, and can help couples conceive a healthy baby even if both partners are carriers for a specific disease.

Both PGD and PGS are incredible tools that help couples conceive healthy babies. This can be such a confusing language to learn, with so many tests having almost the same initials. Don’t ever hesitate to ask us to slow down, ask us more questions, and/or ask for an explanation that makes sense to YOU! The nurses, doctors and billing team are here to answer questions that come up before, during, and even after a treatment cycle. As always, we wish you nothing but the best in your journey to a healthy baby!

 

Learn more about Embryo Biopsy.

How do you know that Dominion Fertility’s IVF lab is A+?

One of the most important keys to success in any IVF cycle is the work that happens in the lab following the egg collection and fertilization. We are fortunate to have an outstanding IVF lab that contributes to our high success rates including a stunning 41 positive pregnancy tests in 49 frozen-thawed embryo transfers (FET) in January, 2019.

Day 0: Egg Collection and Fertilization

Day 0 is the day of the egg collection. The actual egg retrieval procedure is done under light sedation in our Arlington office. In Natural Cycle IVF the vast majority of cycles result in just one mature follicle containing a mature egg. In stimulated IVF, we use fertility injections to stimulate extra follicles, usually end up with 10-18 eggs.  Some women produce very few follicles [decreased ovarian reserve] and others produce many follicles [PCOS patients]).

The eggs are fertilized on day 0.  In most of our IVF cycles this is accomplished by injecting a single sperm into each egg using a thin glass needle. This process is called Intracytoplasmic Sperm Injection or ICSI, a safe procedure first described in 1998.

 

Day 1: Fertilization Check

On day 1, our excellent team of embryologists examines every egg retrieved the previous day to check for fertilization. Eggs that fertilize normally will possess 2 distinct circles located within the interior of the egg…one of these is the genetic material (pronucleus or PN) from the egg and the other pronucleus is from the sperm. We call this normally fertilized egg a 2 PN egg.

Day 2 and 3: Cleavage Stage

The fertilized egg then starts dividing.  By day 2 it is 4 cells and by day 3 it is 6-10 cells (see 8 cell embryo below).

Day 5 and 6: Blastocyst Stage

By day 5 the embryo should now consist of hundreds of cells organized into a hollow ball or blastocyst. The outer rim of cells are called the trophectoderm and these will ultimately become the placenta while the inner cell mass cells will become the fetus.

Not all day 3 embryos will grow to a blastocyst.  In general, about 50% do reach the blastocyst stage.

Fresh or Frozen Embryo Transfer – Which is Best?

Here are some points to consider.

1.     All PGT-A cycles are freeze all cycles. Patients electing to have PGT-A to check their embryos for aneuploidy need to defer a fresh transfer since the PGT-A results are not available until about a week after the embryo biopsy that is performed on Day 5 or Day 6 of either a Stimulated IVF or a Natural Cycle IVF.

2.     All stimulated IVF cycles at Dominion are freeze all cycles. Stimulated IVF results in an endometrium (uterine lining) that may be less than ideal because of the high estrogen levels and the significant drop in estrogen levels that occurs following an egg collection. This drop in estrogen can be especially profound in stimulated IVF using Lupron trigger.

3.     Almost all Natural Cycle IVF treatments end with a fresh ET.  Natural Cycle IVF is often performed without any PGT-A and without any hormone stimulation (it is performed in a woman’s natural cycle, hence the name Natural Cycle IVF).   For most NC IVF cycles, a fresh ET is performed.

Fresh ET: How do we decide Day 3 vs Day 5 transfer

For our stimulated IVF patients, we always grow the embryos to day 5.  With our Natural Cycle IVF program, the first embryo transfer is on day 3.  If pregnancy does not occur, the next Natural Cycle IVF transfer is performed on day 5.  . Natural Cycle IVF allows us to track the egg all the way to a baby and this has allowed us as a clinic to offer some unique insight into fertilization and development that few other clinics possess. For example, most clinics discard eggs that do not show definitive signs of fertilization on day 1. In our NC IVF program we have seen these eggs with uncertain fertilization grow to blastocyst and result in healthy babies.

At Dominion Fertility we are focused on helping our patients attain a successful outcome and we remain innovative and flexible providing the widest range of treatment options.

Dominion Fertility Physicians

 

 

Dominion Fertility adopted a “freeze all” embryos approach for stimulated IVF.  This approach optimizes successful outcomes while reducing complications.

Why No Fresh Embryo Transfers?

There are two major reasons that we have adopted the universal freeze all policy for our Stimulated IVF program:

Reason#1: It’s safer for you and better for your pregnancy.

One of the most vexing problems with stimulated cycle IVF has been the risk of Ovarian Hyperstimulation Syndrome (OHSS). Freezing all the embryos from an IVF cycle and performing a frozen embryo transfer (FET) at a later date can reduce the risk and severity of OHSS.

In addition, several studies have shown that performing an embryo transfer in a stimulated cycle can lead to an increase in pregnancy related complications such as first and third trimester bleeding. During a Frozen Embryo Transfer (FET) cycle your hormone levels are more ideal leading to a better outcome for you and your baby.

Reason #2: Most patients choose Preimplantation Genetic Screening (PGS)

PGS allows us to determine which embryos are genetically normal so we can maximize pregnancy rates with elective single embryo transfer and decrease the risk of miscarriage. However, PGS results are not available for about a week following the biopsy of the blastocyst stage embryo necessitating freezing of all embryos following biopsy.

It’s good to be the youngest in the family. I keep telling my 14 year old daughter this fact but she just rolls her eyes and sighs….Seriously, as the youngest child of 3 boys I can definitely state that I was totally spoiled and got away with a lot of things that my older brothers would never had even considered possible. Not crazy dangerous things like smoking, drinking and drugs (after all I am an Eaglel Scout)…just day to day stuff that drove my brother Steve crazy. For example, in the Gordon household one of my mother’s signature dishes to serve for dinner was salmon croquettes. I loved my Mom. I miss her dearly (she passed away in 2012) and not a day goes by that I don’t think about picking up the phone and calling her just to chat….but salmon croquettes?? Bleah. Seriously, these were slimy pink patties of goo that were breaded and baked in the oven. I actually love salmon. These were not salmon. At least not that I can vouch for…I think that the fish paste came from a can. In any case, since I made it abundantly clear that I was uninterested in eating these breaded patties of pink goo, my mother did what any mother does who spoils her youngest child…she made me lamb chops. Yum yum. From that point on I no longer dreaded nights when salmon croquettes were on the menu since that meant I was getting lamp chops!

Fast forward to last night. My youngest was unimpressed with the chicken pot pie that my wife had actually made from scratch during the day. So she searched through the refrigerator and found some taco meat that was left over from her making her favorite dinner last week. Since we are now parenting through exhaustion we just threw up our hands and said fine, fine eat whatever you want. So she warmed up the taco meat and gobbled it down….only later did she note that it tasted kinda weird. It tasted weird because she had actually not put it back in the refrigerator after she last ate it and it stayed on the counter for a couple of hours. Now before you call CPS and report the Gordons for child abuse for letting their daughter contract botulism I will reassure you that she is fine this morning and no worse for the wear. Of course, I was fully prepared for food poisoning last night sleeping with one eye open awaiting the tell-tale knock on the bedroom door…or a text message from her. I think that she learned a lesson about leaving food out too long. At least I hope she did…

So what does this story have to do with infertility? Well, we are often asked by IVF patients about the choice between a day 3 and day 5 embryo transfer. Actually, back when I started practice in 1996 we were doing mainly day 2 embryo transfers. For those not clear on the concept of day 2, 3 or 5 let me step back for a second and explain. In IVF speak, day 0 is the day of the egg collection. This procedure is done under light sedation and has a low rate of complications. In Natural Cycle IVF we almost always retrieve just a single egg since the vast majority of natural cycles result in just one mature follicle with the other follicles failing to grow past 10-11 mm in size. In stimulated IVF cycles we use fertility shots to rescue the extra follicles and usually end up with 10-18 eggs (some women make very few follicles [decreased ovarian reserve] and others make a lot of follicles [PCOS patients]). On the afternoon of day 0 the egg and sperm get to meet each other (usually by injecting a single sperm in each egg – ICSI). On day 1 we expect to see evidence of normal fertilization with a 2 pn egg. The fertilized egg then starts dividing so by day 2 it is 4 cells and by day 3 it is 6-10 cells and by day 5 it is hundreds of cells organized into a hollow ball or blastocyst. Not all beautiful day 3 embryos will continue to grow to blastocyst and not all borderline looking day 3 embryos will stop growing.

So what about day 3 vs day 5. For our stim IVF patients it is easy…we always push to day 5. We stopped doing any fresh day 5 transfers and now freeze all embryos at day 5 or 6 for future use in a frozen embryo transfer (FET) cycle. There is very good support for this approach as long as a clinic has a good freezing program (which we do). Also most of our patients elect to pursue genetic testing of their embryos with preimplantation genetic screening (PGS) and this necessitates waiting to day 5 as opposed to performing embryo biopsy on day 3. Day 5 embryo biopsy is very accurate (99%) and does not seem to damage the embryo.

Natural Cycle IVF is a bit more hazy. We started the NC IVF program 10 years ago in 2007. Initially we chose to go to blast on all patients. However, after a few years we spoke with some of our European colleagues who suggested that we consider doing a day 3 transfer initially and then making the move to day 5 if a patient failed to conceive with a day 3 embryo.  We have gotten VERY good at culturing the embryos and I really believe that if an embryo fails to grow to day 5 then it was not going to produce a baby if it had been transferred on day 3. Our incubators have gotten a lot better over the years and we now know a lot more about how to feed and grow these embryos than we did back in the early days of IVF when each clinic actually produced its own culture media! Wow, what a difference a few decades make! If an embryo is not as developed as we would expect on day 3 then we also will push to day 5. Some of these will kick it into gear and turn into nice blastocysts and beautiful babies and some will stop growing altogether. Natural Cycle IVF allows us to track that single egg all the way to a baby and this has allowed us as a clinic to offer some unique insight into fertilization and development that few other clinics possess. For example, most clinics discard eggs that do not show definitive signs of fertilization on day 1. In our NC IVF program we have seen these eggs grow to blastocyst and result in healthy babies demonstrating the limits of our understanding of the precise timing of early embryo growth and development.

So we want to do whatever it takes to give our patients the success that they want from our IVF program. We remain innovative and flexible to provide a wide range of options. Rest assured, leaving your embryos in the incubator is not a problem….It is a lot better than leaving taco meat out on the counter and letting your spoiled youngest child wolf it down!

In the past, the endometrial biopsy was a routine part of the fertility evaluation, but currently it is performed mainly on patients at risk for endometrial cancer or with repeated IVF failures. An endometrial biopsy is a simple office-based procedure that is performed just before the onset of a woman’s menses. It can be done without any anesthesia and is well-tolerated by most patients with the majority reporting uterine cramping that quickly resolves.

Although an endometrial biopsy can yield information about the hormonal status of the lining and can rule out chronic infection/inflammation in the uterus, its usefulness as a fertility test is limited by the fact that abnormal biopsies are obtained in more than one-third of women with proven fertility.Therefore, the finding of an abnormal endometrial biopsy in fertility patients is of uncertain benefit. Most reproductive endocrinologists prefer simply to have their patients take extra progesterone, essentially obviating the need for the endometrial biopsy in most patients. At the present time, the endometrial biopsy is most reliable as a means to rule out endometrial cancer in those patients who are at increased risk of this disease. Patients at increased risk for endometrial cancer include those who have polycystic ovarian syndrome and infrequent, heavy periods but who do not receive the protective benefit of oral contraceptives or other progesterone-containing medications.

In patients who have experienced repeated IVF failures in spite of the transfer of good quality embryos, it is reasonable to perform an endometrial biopsy to ensure that the lining demonstrates the appropriate hormonal response, the absence of infection/inflammation and even the correct expression of cell surface proteins called integrins that play a putative role in implantation. Abnormal integrin expression has been demonstrated in a range of clinical situations including the presence of a fluid filled fallopian tube or hydrosalpinx, but most experts consider testing for integrins to be investigational and limited to special circumstances.

The postcoital test was initially proposed as a means to evaluate the interaction of the male partner’s sperm and the female partner’s cervical mucus. This test is performed approximately 8 to 24 hours after intercourse at midcycle (around days 12 to 14 of the menstrual cycle). During a speculum exam, the physician collects a sample of cervical mucus. This sample is then placed on a slide and examined under a microscope for the presence of motile sperm. In addition to the presence or absence of sperm, the physician records the quality, quantity, and appearance of the mucus. Unfortunately, the postcoital test has very poor reproducibility and limited utility in the evaluation of infertile couples. For example, couples for whom no motile sperm were observed during the postcoital test have conceived. and although the spontaneous pregnancy rates are higher in those patients with a normal postcoital test, the information gathered in this way seldom provides any useful insight when developing a therapeutic plan.

Postcoital tests may prove more valuable in couples in whom, for social or religious reasons, the male partner is unable to provide a specimen for semen analysis. In these cases, a postcoital test reassures all parties that sperm are actually deposited in the vagina during the act of intercourse.

In January, 2019, 41 of our patients out of 49 embryo transfers got pregnant?  Why were they so successful?  The answer is PGT or preimplantation genetic testing.

Dominion Fertility utilizes PGT on almost all of our embryos and any patient undergoing IVF can utilize PGT to further enhance their chances for pregnancy.

Advantages of PGT:

Simply put, IVF with PGT allows doctors to learn about the embryo’s genetics before it is transferred to the uterus and the most common cause of IVF failure is embryo aneuploidy-abnormal genetics.  PGT sorts out the genetically normal embryos with 99% accuracy and this allows us to transfer a single embryo, generally resulting in over a 50% live birth rate per transfer across all age groups.

PGT actually accelerates the time to pregnancy, so most of our patients are successfully pregnant within their first or second transfer after a single oocyte retrieval.  Since only one embryo is transferred, the twin rate is reduced to 1%.

How Does PGT Work?

So how does PGT work, exactly?  A few cells are removed from the outer layer of the embryo called the trophectoderm – this is called an embryo biopsy which is safe and far from the inner cell mass where the baby develops.  The cells are tested in the genetic lab and the chromosomes are counted.  The embryo is then determined to be genetically normal or abnormal.  The normal embryos are frozen and safely stored in our laboratory for later transfer, one embryo at a time.

Dominion Fertility performs PGT on over 3,000 embryos a year.  We are fortunate to have experienced and highly skilled embryologists that regularly perform PGT and experience matters with PGT.

PGT is cost effective.  Several recent studies have now shown PGT actually decreases the cost of IVF because the time to pregnancy is decreased with most patients achieving success within their first or second embryo transfer.  IVF with PGT also results in fewer miscarriages as embryo aneuploidy is the most common cause for miscarriage.

Cost Transparency:

At Dominion Fertility, PGT is $150 per embryo tested plus a biopsy fee ($1,500), one of the lowest costs for PGT in the nation.  Many IVF centers mark up the laboratory fee such that the costs for PGT are $400-500 per embryo in addition to the biopsy fee.   

Dominion Fertility is now exploring performing PGT using embryo culture media.  It is hoped that we can ultimately make PGT a Reproductive standard as we continue to stay on the cutting edge of Reproductive Medicine.

Michael DiMattina, M.D.
Founder and Medical Director at Dominion Fertility

 

I’m Dr. Michael DiMattina, Medical Director and Founder of Dominion Fertility in Arlington, Virginia. One of my favorite expressions is nothing was ever gained by saying no. Another expression that I often use when I teach medical students, interns and residents is that we don’t treat numbers, we treat patients. Today I have a patient story I would like to share with you.

This was a lady who came to me early in 2017 at the age of 43.  She had been seen by another local infertility clinic and was told that her serum FSH level was too high, and that she could only get pregnant using egg donor IVF. Interestingly this lady still had regular menstrual cycles at the age of 43, so that meant she ovulated regularly each month.  However, her FSH and AMH indicated that her egg quantity was extremely low. I told her we could give you a chance and see how this goes. I used a stimulation protocol from my old days in IVF called the Stop Lupron protocol and she did make two follicles.  I told her many IVF programs would simply cancel your cycle because they require a minimum of three follicles before proceeding with the egg collection.

However, here at Dominion Fertility, we make babies all the time with one egg, one embryo, so I offered her a chance. She accepted, remember nothing was ever gained by saying no.  Sure enough we went ahead and did the collection and we got two eggs both fertilized and both grew to blastocyst embryos.  We then tested the embryos during an embryo biopsy for preimplantation genetic screening or PGS. Dominion Fertility is one of the leaders in the United States for PGS.  We found that one of her two blastocyst embryos was genetically normal.

We were able to transfer that single embryo into her, which resulted in pregnancy.  I just sent her back to her OBGYN for pregnancy care and delivery. We are so thrilled for this patient.  I called her OBGYN yesterday and he was incredulous as to how we could make this happen.  He was elated, as well as his patient with Dominion Fertility!

Michael DiMattina, M.D.
Founder and Medical Director at Dominion Fertility

As readers of this blog are well aware, Gordon men are completely unreasonable when it comes to their devotion to their 4 legged friends. My Dad was a perfect example of how problematic this behavior can become. Later in life, his Miniature Schnauzer, Chester, developed some rather unpleasant habits that involved his answering the “call of nature” in ways that are better left unsaid. Bleah….Suffice it to say that I have tried to be a good dog owner and if you are ever driving in my neighborhood late at night or early in the AM there is a good chance that you will see me walking our two shelter dogs: Lucky and Molly.

When we adopted Molly over 2 years ago I started feeding her a mix of dry and canned dog food that was not inexpensive and was “grain-free”….whatever that really means to a dog that was found in a ditch and rescued from a high-kill dog shelter in Pickens, SC. But in any case, she seemed to like the food. A lot.

Unfortunately, she and Lucky got into a tussle 2 months ago that result in hundreds of dollars of vet bills and Molly wearing a donut collar to ensure that the wound inflicted by her larger friend Lucky would heal correctly. Once the scab came off I cleaned the wound with chlorhexadine. Unfortunately, Molly did not listen to my admonition that chlorhexadine was for external use only and she licked off the excess in spite of my efforts to clean it off myself. It now appears to me in retrospect that chlorhexadine has powerful laxative-like properties and poor Molly was placed into a state of constant gastric/colonic distress. In order to break the cycle I resorted to the recipe suggested by another insane dog lover, my son Seth, who swears by the boiled chicken and white rice diet for these type of doggie issues. Since Seth is earning his PhD and I have a lowly MD, I deferred to his judgement.

So for the past six weeks or so Molly has existed on a diet restricted to boiled chicken and white rice (see other photo). Slowly her bowel functioned has returned to normal but in addition she has lost weight, has more energy and she no longer has eye goobers (that’s a technical veterinary medical term). I am impressed. In spite of the near-constant ridicule that I must endure from my wife and daughters, I am thinking that I should keep this new diet for Molly. If you see me with boxes of Uncle Ben’s Boil in a Bag Minute Rice, now you will know why…

But what in the world could this shaggy dog story have to do with infertility? Well, not a lot I guess except for this…

For many years, all of us REI types who did stimulated IVF performed embryo transfers in the same cycle as the egg retrieval. All patients were triggered with HCG and some ended up freezing all embryos to attempt to decrease the risk of ovarian hyperstimulation syndrome. We routinely transferred at least 2 and sometimes a lot more embryos. Many patients had success but some also had complications related to this approach including multiple pregnancies and severe hyperstimulation syndrome (occasionally even requiring hospitalization). Other patients failed to conceive with no understanding of why beautiful looking embryos had failed to generate a pregnancy. We were sticking with one recipe with no idea that there may be a better option out there.

10 years ago we introduced a radical concept to the Washington DC area…Natural Cycle IVF. Patients who had tried a traditional stimulated IVF recipe and had found it wanting could now try a markedly different approach. By allowing the follicle to grow on its own there was no risk of hyperstimulation and no problems with cycle cancellation for a poor response to medications either! Since 2007 we have helped many women succeed with this approach including a number who have had 2 and 3 children with us using NC IVF.

Since 2007 we have helped many women succeed with this approach including a number who have had 2 and 3 children with us using NC IVF.

Another seismic shift occurred a few years ago when we dropped HCG as a trigger shot for most IVF cycles and replaced it with GnRH-a (Lupron) trigger. Overnight we essentially eliminated ovarian hyperstimulation syndrome but also made the decision to go with a freeze-all approach and eliminate all fresh ET in stimulated IVF. We believed that the evidence strongly supported that the endometrial lining was not ideal in stimulated cycles and outcomes for babies and mothers were better in frozen embryo transfer cycles in which the hormone levels were more similar to natural cycle levels. Finally, as most patients were now electing to pursue Preimplantation Genetic Screening (PGS) on their embryos there was no reason not to pursue a freeze all strategy since PGS precluded a fresh ET while awaiting the results of the embryo biopsy.

… there was no reason not to pursue a freeze all strategy since PGS precluded a fresh ET while awaiting the results of the embryo biopsy.

Finally, we now have a tool to assess the precise timing of the embryo transfer in an FET cycle: the Endometrial Receptivity Assay (see my previous blog on this topic). All of these changes were clearly for the good. The old recipe and approach tossed out and the adoption of the new paradigm shown to improve outcomes ranging from the elimination of OHSS to the identification of the ideal embryo to pick for transfer.

…we now have a tool to assess the precise timing of the embryo transfer in an FET cycle

Change can be good …although I am not very good at handling change…just ask my wife why she has given up asking me to try new dishes at our favorite restaurants. But at Dominion we embraced these changes and our patients ended up benefiting in many ways. Just like Molly when I said “Good bye expensive grain free dog food and hello Uncle Ben’s white rice! “

Next year is the 40th anniversary for the world’s first IVF baby…and we have been performing IVF for 33 years.

Hello! Dr. Michael Dimattina, Medical Director at Dominion Fertility in Arlington, Virginia. Next year is the 40th anniversary for the world’s first IVF baby, or test tube baby, produced in 1978 in England.

Next year is the 40th anniversary for the world’s first IVF baby…I have been performing in vitro fertilization for 33 years. In the United States

We are quite excited about that. I have been performing in vitro fertilization for 33 years. In the United States, the first IVF baby occurred in 1982, and I began practicing IVF in 1984. Dominion Fertility has stayed on the ultra-cutting edge throughout this time, with their IVF program. In the early days, the pregnancy rates were extremely low, often single digit pregnancy rates.

Now, at Dominion Fertility, we expect that our patients will become pregnant in over 50% of the transfers we perform transferring a single genetically-normal embryo. In other words, most of our patients at Dominion Fertility are successful after only one or two embryo transfers of a single embryo – and that’s great news! We have come so far! In the early days, IVF was a surgical procedure. It involved taking fertility medications and drugs for several weeks. Now, the procedure is performed entirely within the medical office at Dominion Fertility, in a very simple nonsurgical procedure. It takes about 5-10 minutes to perform. We obtain the eggs, fertilize the eggs, and then take the embryos and do an embryo biopsy, testing the embryos using preimplantation genetic screening, which allows us to see if they are genetically normal prior to putting the embryo back into the patient’s uterus. This increases the chances for pregnancy, decreases the miscarriage rate, and with 99% certainty, we avoid a genetically abnormal pregnancy, such as a Down syndrome pregnancy.

At Dominion Fertility, we expect that our patients will become pregnant in over 50% of the transfers we perform transferring a single genetically-normal embryo. In other words, most of our patients at Dominion Fertility are successful after only one or two embryo transfers of a single embryo – and that’s great news!

Dominion Fertility has stayed on the cutting edge or beyond throughout this time. A recent paper just came out that validated this approach that we have used at Dominion Fertility for the past three years. We are quite excited. We believe that the treatments we perform are very cutting edge. Most of our pregnancies occur after only one or two embryo transfers. If the patient is not pregnant after her second transfer, we begin to wonder if perhaps there’s something wrong with the uterus, or if there are other factors involved. So, it’s been an exciting journey for me, personally. We love what we do. We take a lot of pride in our work and our patients seem to appreciate our methods and technologies and our partnering with them throughout these procedures. IVF is here to stay. It should only get better in the future. I can assure you Dominion Fertility will continue to be on the ultra-cutting edge of reproductive medicine.

 

Dr. Michael DiMattina, Medical Director, Dominion Fertility

Arlington, Virginia

Of course, patients want to know what their chances are for success with IVF. They want to know how many treatment cycles are needed before they have a good chance of becoming pregnant.

How many treatment cycles are needed before they have a good chance of becoming pregnant?.

A recent article in the Wall Street Journal commented on a study from the U.K. that asked the question “how many IVF cycles should a woman try”. They found that 65% of patients were successful after 6 stimulated IVF cycles from 2003-10. That’s a lot of treatment cycles! And expensive too! Today, the success rates for stimulated IVF are much better.

Recall back in 2003, did you even own a cell phone and if you did, what was it like compared to your cell phone today? The quality of your phone today is far better than those of 2003-10. Similarly the success rates for IVF have tremendously improved too. At Dominion Fertility, we no longer transfer fresh embryos produced in the stimulate IVF cycle, rather, all embryos are frozen and later thawed and transferred outside of the stimulated cycle. By performing the embryo transfer in a non-stimulated cycle the chances for embryo implantation greatly improves. Data showing this effect has been around since 2011. In addition, almost all of the embryos that we produce at Dominion Fertility undergo embryo biopsy and preimplantation genetic screening (PGS). This allows us to determine with about 99% accuracy that the embryo is genetically normal prior to performing the embryo transfer and this further increases the chances for success and reduces the chance of miscarriage.

To me it’s interesting that the Journal would publish “outdated” data when the success rates of IVF have tremendously improved over the past 6 years. At Dominion Fertility, we only transfer one embryo for almost all of our patients and their chances for pregnancy are above 50% per transfer of the one embryo. After 2 single embryo transfers of PGS normal embryos, we at Dominion Fertility expect the vast majority of our patients to be pregnant. We have shown that our pregnancy rates per transfer after PGS is constant through maternal age. (Jordan et al, 2015 ASRM abstract) In other words, a 41 year old patient should have the same chances for pregnancy as a 30 year old patient providing the embryo is first determined to be normal using PGS.

A 41 year old patient should have the same chances for pregnancy as a 30 year old patient providing the embryo is first determined to be normal using PGS.

Last year, I treated a 41 year- old patient from Saudi Arabia using IVF and PGS. Previously, she had failed 13 cycles of stimulated IVF in Saudi Arabia when she was 38-40 years old. At Dominion Fertility, we retrieved 20 eggs and produced 8 embryos but only one of her embryos was genetically normal. That embryo was frozen-thawed and transferred in a non-stimulated cycle and she became pregnant after only one treatment with us.

So, if you have read the Journal’s article on IVF and number of cycles to try, please know that the world of IVF has greatly improved from the IVF success rates published in 2003-10. Now, embryos are routinely genetically tested, frozen and transferred outside of the stimulated IVF cycle and this improves one’s chances for success with fewer treatments!

Michael DiMattina, M.D.