2 OPINION nd
Writing for the PRO position: Zhaoxia Huang. BSN, RN
PRO I
n the last 25 years, assisted reproductive technology (ART) has been the principal cause of multiple births internationally, with many infertility practices transferring multiple embryos to achieve a higher pregnancy rates after the in-vitro fertilization (IVF) procedure; a direct outcome of this practice is a high incidence of multiple pregnancies and the accompanying complications. Today, the science of fertility has advanced to include a new, highly successful method of single embryo transfer (SET) (Cutting, Morroll, Roberts, Pickering, & Rutherford, 2008). In my opinion, limiting the number of embryos transferred to one or two is the most appropriate practice for infertility services. Complications associated with multiples include increased risks of pregnancy-induced hypertension and eclampsia, gestational diabetes, gastrointestinal disorders, anemia, premature labor, and postpartum bleeding. For the fetus/baby, untoward effects include premature birth, low birthweight, growth restriction, and birth defects such as cerebral palsy (Penn Medicine, 2010). Complications rise significantly as the number of fetuses increases, and increase the economic burden for both families and society, thus negatively impacting quality of life for parents and their babies. There are also ethical challenges with multiple pregnancies, including the practice of pregnancy reduction, usually done with triplets and above. Successful IVF cycles require the harvest of high-quality ovum and sperm leading to high-quality embryos. Therefore, ART practitioners assess and evaluate the woman’s
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Should There Be a Limit of One Single Embryo Implanted During an IVF Cycle? ovarian reserve before starting infertility treatments knowing that higher ovarian reserves lead to higher quality ovum harvests. For the male, semen analysis guides treatment and IVF protocols, and for women, powerful drugs must be taken. Infertility treatments are difficult and costly for couples, and medical management must include addressing anxiety and concerns to optimize physical and psychosocial well-being. New methods using biomarkers to improve IVF outcomes conclude that SETs can be standard (Fisch, Keskintepe, Ginsburg, Adamowicz, & Sher, 2007) to reduce multiple pregnancy rates. Several studies have found that SET for patients younger than 30 years old and double embryo transfer for patients who are 30 or older will result in satisfactory pregnancy rate and low incidence of multiple pregnancies (Shibahara et al., 2007). The rapid advancements in the science of the IVF-ET laboratory have made microstimulation and natural period protocols hot topics in reproductive medicine research. A number of European countries, Japan, and the United Complications rise significantly as States are using SET protocols, either legislated the number of fetuses increases, or by medical ART thus escalating the economic burden guidelines. These guidelines are not yet followed for both families and society. in China, but are expected to be global as the evidence-based science of IVF reaches practices (Cutting et al., 2008). In countries where the cost of IVF is borne by the government, such as the United Kingdom, Belgium, and Switzerland, SET is the standard by regulation. As ART research improves techniques, SET should become the standard practice in IVF for both couples and healthcare providers (Shibahara et al., 2007). Zhaoxia Huang is a Nurse Manager, Assistive Reproductive Medical Center of the Number 2 Affiliated Hospital, Wenzhou Medical College, Wenzhou, Zhejiang Province, Republic of China. References Cutting, R., Morroll, D., Roberts, S. A., Pickering, S., & Rutherford, A. (2008). Elective single embryo transfer: Guidelines for practice British Fertility Society and Association of Clinical Embryologists. Human Fertility (Cambridge), 11(3), 131-146. doi:10.1080/14647270802302629 Fisch, J. D., Keskintepe, L., Ginsburg, M., Adamowicz, M., & Sher, G. (2007). Graduated embryo score and soluble human leukocyte antigen-G expression improves assisted reproductive technology outcomes and suggest basis for elective single-embryo transfer. Fertility & Sterility, 87(4), 757-763. Penn Medicine. (2010). Pregnancy Health Center. Retrieve from www.pennmedicine.org/health_ info/pregnancy/000199.htm Shibahara, H., Hirano, Y., Okajima, T, Shimada, K., Kikuchi, K., Suzuki, T., ..., Suzuki, M. (2007). Establishment of criteria for elective single embryo transfer at day 2 or day 3 by analyzing cases with successful implantation of all embryos transferred. Journal of Obstetrics & Gynaecology Research, 33(4), 501-505. doi:10.1111/j.1447-0756.2007.00556.x May/Jun 2011
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
2 OPINION nd
Second Opinion columns are coordinated by Kathleen Leask Capitulo and Judy Beal. Dr. Capitulo can be reached via e-mail at: DrKatieRN@ hotmail.com. Dr. Beal can be reached via e-mail at: [email protected]
Writing for the CON position: Xiaohong Hou, MD Writing for the CON position: Xxx
CON S
Coordinated by Kathleen Leask Capitulo, DNSc, RN, FAAN
ince the 1970s, assisted reproductive technology (ART) has enabled millions of infertile couples to become parents. Many seek to optimize their success at fertility by transferring multiple embryos. This can increase ART multiple births , and has been a controversial issue for both professionals and couples seeking treatment. Several experts believe that the multiple pregnancy rates can be reduced through transferring one embryo selectively. However, selective single embryo transfer (SET) has not resulted in a satisfactory pregnancy rate. Research has found that SET requires more resources: both embryos (fresh & frozen) and IVF cycles, without reducing the overall twin rate (Aafke, et al, 2007). Today, the standard practice in China is the transfer of two embryos in every IVF-ET cycle for women
Writing for the PRO position: Zhaoxia Huang. BSN, RN
PRO I
n the last 25 years, assisted reproductive technology (ART) has been the principal cause of multiple births internationally, with many infertility practices transferring multiple embryos to achieve a higher pregnancy rates after the in-vitro fertilization (IVF) procedure; a direct outcome of this practice is a high incidence of multiple pregnancies and the accompanying complications. Today, the science of fertility has advanced to include a new, highly successful method of single embryo transfer (SET) (Cutting, Morroll, Roberts, Pickering, & Rutherford, 2008). In my opinion, limiting the number of embryos transferred to one or two is the most appropriate practice for infertility services. Complications associated with multiples include increased risks of pregnancy-induced hypertension and eclampsia, gestational diabetes, gastrointestinal disorders, anemia, premature labor, and postpartum bleeding. For the fetus/baby, untoward effects include premature birth, low birthweight, growth restriction, and birth defects such as cerebral palsy (Penn Medicine, 2010). Complications rise significantly as the number of fetuses increases, and increase the economic burden for both families and society, thus negatively impacting quality of life for parents and their babies. There are also ethical challenges with multiple pregnancies, including the practice of pregnancy reduction, usually done with triplets and above. Successful IVF cycles require the harvest of high-quality ovum and sperm leading to high-quality embryos. Therefore, ART practitioners assess and evaluate the woman’s
152
volume 36
|
number 3
Should There Be a Limit of One Single Embryo Implanted During an IVF Cycle? ovarian reserve before starting infertility treatments knowing that higher ovarian reserves lead to higher quality ovum harvests. For the male, semen analysis guides treatment and IVF protocols, and for women, powerful drugs must be taken. Infertility treatments are difficult and costly for couples, and medical management must include addressing anxiety and concerns to optimize physical and psychosocial well-being. New methods using biomarkers to improve IVF outcomes conclude that SETs can be standard (Fisch, Keskintepe, Ginsburg, Adamowicz, & Sher, 2007) to reduce multiple pregnancy rates. Several studies have found that SET for patients younger than 30 years old and double embryo transfer for patients who are 30 or older will result in satisfactory pregnancy rate and low incidence of multiple pregnancies (Shibahara et al., 2007). The rapid advancements in the science of the IVF-ET laboratory have made microstimulation and natural period protocols hot topics in reproductive medicine research. A number of European countries, Japan, and the United Complications rise significantly as States are using SET protocols, either legislated the number of fetuses increases, or by medical ART thus escalating the economic burden guidelines. These guidelines are not yet followed for both families and society. in China, but are expected to be global as the evidence-based science of IVF reaches practices (Cutting et al., 2008). In countries where the cost of IVF is borne by the government, such as the United Kingdom, Belgium, and Switzerland, SET is the standard by regulation. As ART research improves techniques, SET should become the standard practice in IVF for both couples and healthcare providers (Shibahara et al., 2007). Zhaoxia Huang is a Nurse Manager, Assistive Reproductive Medical Center of the Number 2 Affiliated Hospital, Wenzhou Medical College, Wenzhou, Zhejiang Province, Republic of China. References Cutting, R., Morroll, D., Roberts, S. A., Pickering, S., & Rutherford, A. (2008). Elective single embryo transfer: Guidelines for practice British Fertility Society and Association of Clinical Embryologists. Human Fertility (Cambridge), 11(3), 131-146. doi:10.1080/14647270802302629 Fisch, J. D., Keskintepe, L., Ginsburg, M., Adamowicz, M., & Sher, G. (2007). Graduated embryo score and soluble human leukocyte antigen-G expression improves assisted reproductive technology outcomes and suggest basis for elective single-embryo transfer. Fertility & Sterility, 87(4), 757-763. Penn Medicine. (2010). Pregnancy Health Center. Retrieve from www.pennmedicine.org/health_ info/pregnancy/000199.htm Shibahara, H., Hirano, Y., Okajima, T, Shimada, K., Kikuchi, K., Suzuki, T., ..., Suzuki, M. (2007). Establishment of criteria for elective single embryo transfer at day 2 or day 3 by analyzing cases with successful implantation of all embryos transferred. Journal of Obstetrics & Gynaecology Research, 33(4), 501-505. doi:10.1111/j.1447-0756.2007.00556.x May/Jun 2011
Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
2 OPINION nd
Second Opinion columns are coordinated by Kathleen Leask Capitulo and Judy Beal. Dr. Capitulo can be reached via e-mail at: DrKatieRN@ hotmail.com. Dr. Beal can be reached via e-mail at: [email protected]
Writing for the CON position: Xiaohong Hou, MD Writing for the CON position: Xxx
CON S
Coordinated by Kathleen Leask Capitulo, DNSc, RN, FAAN
ince the 1970s, assisted reproductive technology (ART) has enabled millions of infertile couples to become parents. Many seek to optimize their success at fertility by transferring multiple embryos. This can increase ART multiple births , and has been a controversial issue for both professionals and couples seeking treatment. Several experts believe that the multiple pregnancy rates can be reduced through transferring one embryo selectively. However, selective single embryo transfer (SET) has not resulted in a satisfactory pregnancy rate. Research has found that SET requires more resources: both embryos (fresh & frozen) and IVF cycles, without reducing the overall twin rate (Aafke, et al, 2007). Today, the standard practice in China is the transfer of two embryos in every IVF-ET cycle for women
