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The Future of Fertility Treatment
In parallel, IVF laboratory procedures and culture media have improved, Another major predictive factor in determining IVF success is the patient’s
and embryological laboratories have become aware that the environment weight. As can be seen in the Dokras article (see pages 9–12), there is a
is extremely important: they now use filtered air, for example. As a result, strong correlation between increased weight and polycycstic ovary
we are achieving better results. syndrome (PCOS). Fifty percent of women with PCOS are obese. Obese
patients respond more poorly to gonadotropin therapy and may need
Acceptance of In Vitro Fertilization higher drug levels to achieve the same response compared with their
The sociological aspects of IVF have also changed a great deal. At the leaner counterparts.
very beginning there was considerable opposition from groups flying
under the flag of ‘right to life.’ Many of our patients had to cross a picket There are also other demographic factors to consider. For example, on a
line to get into the hospital. population basis the use of IVF in the US is the lowest of any developed
country. The number of live IVF births here is a little less than 1%. On the
other hand, in many European countries—in particular Scandinavia and
Iceland—and Israel, that number is often above 5%. This is the result of
At the very beginning there was
two factors: the first is economic, because in Europe the cost of IVF is
often covered by the government for a specific number of IVF cycles; the
considerable opposition from groups
second is that it is almost a full-time job to have an IVF baby as you have
flying under the flag of ‘right to life.’
to be monitored so frequently. Therefore, if IVF insurance were to be
more widespread in the US with more states mandating comprehensive
Many of our patients had to cross a
coverage, and if clinical practices such as monitoring and gonadotropin
picket line to get into the hospital.
administration could be further simplified, it would be sociologically
easier to carry out IVF.
Future Changes
Around 1984, both my wife and I were invited to the Vatican to discuss
IVF. There were 12 of us in total: one other gynecologist—René Frydman Harvesting and Implanting
from Paris—me, Georgeanna, and nine moral theologians discussing this Until now, the goal of COH has been to maximize the number of eggs
issue around a table for almost a week. Unfortunately, we lost. Following retrieved, although this has resulted in the problem of multiple
that conference, the Vatican issued a document stating that IVF was pregnancies. Moving forward, it may be that we will give up the notion
illicit, which is still the official position of the Roman Catholic Church. of having large numbers of eggs, with the happy result of simplifying
even further both the monitoring and administration of medication.
Nevertheless, resistance has now greatly diminished. We performed a Lately, there has been a trend toward reducing the number of embryos
survey of the religious persuasion of our patients and found that the transferred during assisted reproduction procedures. However, since not
Roman Catholic segment corresponded to the percentage of Roman all physicians are in agreement that a multiple pregnancy is an adverse
Catholics in the general population. event, there may be some resistance to trying to make single-embryo
transfer more commonplace.
Over time, IVF has become a more widely available option for
overcoming infertility, and appears to have gained social acceptance as
well. However, at the same time studies have shown that public
knowledge of reproductive health is remarkably low, and there is a
general lack of understanding about fertility.
On a population basis the use of IVF in
the US is the lowest of any developed
Some projections show that the prevalence of infertility may increase
two-fold in the next 20 years. Therefore, it is the responsibility of the
country. The number of live IVF births
healthcare community—with the support of the pharmaceutical
here is a little less than 1%.
industry—to boost infertility awareness through patient education.
Patient Demographics
Age is a major predictive factor in determining IVF success. As described
in the Rosenwaks article (see pages 5–8), oocyte quantity and quality is This issue of single-embryo transfer, elaborated in the article by Scott
inversely related to the age of the patient. When we first began the IVF (see pages 27–29), is a contentious one; however, the experience of
program, the cut-off age was 35 because, ordinarily, the probability of some countries is positive. In Belgium, for instance, since 2003 infertile
achieving a pregnancy after 35 years of age is not very good. We then couples have been eligible for up to six free cycles of IVF, provided that
discovered that, because of this, patients were being imprecise about in women under the age of 36 only one embryo is transferred in the first
their age, but were getting pregnant anyway. Nowadays, the average two cycles. As a consequence, they have reduced their 30%
age of the patients in some clinics is over 35. In our own experience, the multiple pregnancy rate to less than 10% with no compromise on
highest pregnancy rate is in patients between the ages of 35 and 40. overall pregnancy rate.
FERTILITY TREATMENT REVIEW 31
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