Monday, September 12, 2005

There is a significant amount of “embryo wastage” during in vitro fertilization (IVF) and other assisted reproductive techniques, according to research released yesterday by the Yale School of Medicine.

The study, in fact, found that 85 percent of embryos transferred during the processes fail to become live births because of “shortfalls” in procedures meant to help infertile couples.

“Something in nature has decided that these implanted embryos are not viable,” said Dr. Pasquale Patrizio, an obstetrics professor and author of the study, which analyzed patient data from American fertility clinics from 1995 through 2001.

“We as practitioners in the reproductive clinic are in a paradoxical situation,” Dr. Patrizio said. “There is pressure to reduce multiple births, but we need to do so knowing that the majority of the embryos that are transferred do not implant. It is difficult to strike a balance between these two needs.”

Developed in Britain in 1978, IVF was introduced in the U.S. three years later. During the process, a physician removes a woman’s eggs from her body. The eggs are fertilized with sperm in a petri dish and then placed in the woman’s womb 40 hours later as an embryo.

About 300 fertility clinics perform more than 100,000 IVF procedures per year in the U.S. Since 1985, about 139,000 babies conceived through IVF have been born, according to the Alabama-based American Society for Reproductive Medicine.

The popularity of the procedure, in fact, has grown 82 percent in past decade, Dr. Patrizio said.

The cost ranges from $12,000 to $25,000. Although the scope varies, 14 states require insurers to offer infertility diagnosis and treatment.

Infertility is an emotionally charged issue. NBC will debut the television show “Inconceivable” on Sept. 23. The melodrama focuses on a fertility clinic and is based on the premise that “life inside this clinic is anything but sterile.”

Meanwhile, Dr. Patrizio said, “Many shortfalls of the treatment remain unresolved.”

Physicians are unable, for example, to determine whether an implanted embryo is even normal.

In addition, clinicians routinely transfer multiple embryos, hoping to increase the odds the procedure will yield a baby.

Stark statistics reveal the odds. In 2001 in the U.S., 201,710 embryos were “transferred” via assisted reproductive technology, resulting in 30,451 births. The numbers reveal that 84.9 percent of the embryos were “wasted.”

Although this is a five percentage point improvement over data from 1995, Dr. Patrizio still deems it “very high,” adding, “the vast majority of embryos … fail to develop into an infant. This observation has multiple important clinical and ethical implications.”

He recommends the procedure become a more exact science and questions the practice of stimulating a woman’s ovaries with drugs to produce multiple eggs, advising clinicians to refine and “perfect” this aspect.

Dr. Patrizio also calls for “preimplantation genetic diagnosis” to evaluate embryos, but says the technique’s availability is limited because it is expensive and inaccurate.

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