Best of ESHRE and ASRM 2019 is a joint congress organized by a European Society for Human Reproduction and Embryology (ESHRE) and American Society of Reproductive Medicine (ASRM). It was held for the 6th time and traditionally gathered leading specialists in the sphere of reproductive medicine from all over the world. The format is the key feature of the congress. The main purpose of the Best of ESHRE and ASRM event is to compare alternative points of view regarding the issues of modern reproductive medicine.
Most of the sessions at the 3-day New York meeting were held the following way: first of all, two presenters offer two alternative approaches (for example, one of them argues for the implementation of the ICSI procedure along with all the ART programs, the other one insists on the necessity of medical reasons for it), and then the discussion section follows.
According to Anna Ilyina and Julia Koloda, the most interesting issues raised at the congress were:
ICSI for everyone or on the doctor's advice?
One of the American speakers broad to the audience's attention an approach in which ICSI procedure (intracytoplasmic injection of a sperm into an egg) is undertaken in 100% of ART programs. He also provided figures proving that the general health condition of ICSI babies does not differ much from those of babies conceived under IVF without ISCI. His opponent argued that under ART programs the ICSI procedure can only be implemented due to medical reasons (in case of male infertility factor or failure of IVF programs in anamnesis).
Both sides presented their research data. Supporters of the implementation of ICSI only on the doctor's advice provided the strongest arguments. Specifically, they demonstrated research results that proved the following: if the procedure is not recommended its implementation does not improve the chances for successful IVF outcome.
About the necessity of preimplantation genetic diagnosis of embryos and a new no-biopsy PGD method
It is well known that PGD significantly contributes to the success of ART programs. However, some USA specialists are against its implementation in all the patients (even though, it is common practice in the country). Opponents of such approach claim that for the patients with few embryos, especially for the women of advanced maternal age, it is necessary to transfer the maximum possible number of embryos. Firstly, their point of view is supported by the fact of having little chances for multiple pregnancy at that age. Secondly, specialists refer to the potential risk of damaging an embryo during biopsy due to mosaicism or theoretically possible self-correction.
However, an alternative opinion criticizing a no-PGD approach was presented as well. The argument is that the aneuploidy embryo transfer can result in an increase of missed miscarriage frequency and expand time to get pregnant. The speakers demonstrated that undertaking of preimplantation genetic screening improves the frequency of normal pregnancy and decreases the frequency of early termination which leads to painful emotional distress in patients so that the next transfer has to be postponed for 3 months at a minimum.
Furthermore, another piece of data showed that researches failed to prove that there is any threat for embryos during modern biopsy procedure which is the detachment of some trophectoderm cells for testing.
Life Line doctors take the view that has already become conventional wisdom - PGD should be conducted on the doctor’s advice (in cases of advanced maternal age, monogenic diseases, unsuccessful ART programs in the past, recurrent pregnancy loss and so on).
In the future fears about PGD risks will be removed with a new diagnostic technology which will obviate the need for the biopsy procedure. This method presupposes the study of the medium in which embryos are cultured (in the process of development embryos secrete cell markers needed for analysis, extracellular DNA, in ambient liquid) rather than of trophectoderm cells.
All the gained information confirms a high level of correlation between conventional and non-invasive PGD procedures that is why the widespread introduction of no- biopsy PGD method is considered to be within reach. Life Line care center will traditionally be among the first clinics to offer this method for the patients.
Should the procedure of embryo transfer in fresh cycle be rejected and a cryo transfer be planned in 100% of cases?
Embryo vitrification and transfer in cryo cycle is a common practice all over the world. The usefulness of cryo transfer raises no objection. Yet, should embryos be frozen and cryo cycle is planned in 100% of cases? In one of the congress reports the answer was ‘yes’. It allows for a better endometrium preparation, brings to naught the risks of ovarian hyperstimulation syndrome, increases the chances for normal pregnancy, and ensure the birth of a healthy child.
To support the idea of “total freezing” approach the speaker provided new meta-analysis data that once again proved cryo protocols to improve IVF efficiency, decrease risks of health deterioration in the mother-to-be and have a positive impact on the babies’ health. Aforementioned is also confirmed by our own practical experience as cryo protocols are conducted quite often in Life Line care center. However, they are not prescribed to all the patients.
It is this kind of treatment that was explained by the second speaker during the session devoted to cryo transfer issues. He agreed upon the necessity of cryo cycle in situations when there are risks of ovarian hyperstimulation, indications for PGD procedure or other significant reasons. But in case of the absence of such recommendations, no transfer delay is needed.
How many embryos to transfer?
This question seems to finally have a definite answer. Even in the US where people used to strongly believe that the transfer of many embryos would increase chances for pregnancy, now tend to implement the procedure by using only one. Research results presented at the congress showed that transfer of some embryos does not increase the chances for pregnancy compared to the transfer of one thoroughly selected embryo. In addition, it is important to remember the possible risks of multiple pregnancy. In our care center, we only transfer one or - at maximum - two embryos.
Conclusion: It is important to follow an individual treatment plan in each case. Considering the level of modern reproductive medicine development it is inappropriate to undertake the same technique for everyone.
Best of ESHRE and ASRM 2019 proved Life Line care center to use modern and evidence-based medicine approach to infertility treatment. Therefore, our record on strong protocol performance leading to a desired baby delivery is so high.
Life Line representatives participate in all the major thematic Russian, European and global gatherings. Our doctors are now getting prepared for new significant scientific events. We will keep you updated.