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CONTINUING EDUCATION
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PROGRAM OGI3 • RELEASE DATE: JUNE 26, 2010 • EXPIRATION DATE: JUNE 26, 2011 • ESTIMATED TIME TO COMPLETE: 1.0 HOUR
Elective Single-Embryo Transfer Success The Ultimate Measure of Safety and Efficacy for an IVF Center Juergen Liebermann, PhD, HCLD Director of Laboratory, Fertility Centers of Illinois, River North, Chicago, IL STATEMENT OF NEED The goal of in-vitro fertilization (IVF) “is the birth of 1 single healthy child, with a twin pregnancy being regarded as a complication.” The Fertility Centers of Illinois (FCI), Chicago, report how they have optimized the IVF cycle by maintaining a balance between the end result and the efforts, costs, and complications of the IVF cycle, and have implemented elective single-embryo transfer (eSET) as a viable alternative to multiple-embryo transfers. Based on the experience of FCI and others, steps can be implemented that support successful eSET, thus achieving a healthy outcome for mother and child. TARGET AUDIENCE Advanced practice nurses, registered nurses, and other interested healthcare professionals. LEARNING OBJECTIVES After completing this activity, the reader should be better able to: • Assess the potential benefits gained through elective singleembryo transfer (eSET) • Discuss practices that support successful eSET as a viable alternative to multiple-embryo transfers • Encourage women and couples undergoing IVF treatment to consider using single-embryo transfer rather than multiple-embryo transfer EDITORIAL BOARD Juergen Liebermann, PhD, HCLD Chicago/River North IVF Center 900 N. Kingsbury, Ste RW6 Chicago, IL 60610 Amy E.T. Sparks, PhD, HCLD UI Hospitals and Clinics 200 Hawkins Drive, 3RCP Iowa City, IA 52242-1089 PLANNING COMMITTEE Gloria Mui Medical Director Veritas Institute for Medical Education, Inc. 611 Route 46 West Hasbrouck Heights, NJ 07604 Julie Ann Tagliareni CME Director Veritas Institute for Medical Education, Inc. 611 Route 46 West Hasbrouck Heights, NJ 07604 Anne L. Finger President Veritas Institute for Medical Education, Inc. 611 Route 46 West Hasbrouck Heights, NJ 07604 Dalia Buffery Editorial Director Novellus Healthcare Communications, LLC 241 Forsgate Drive Monroe Twp, NJ 08831
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n 1996, the Centers for Disease Control and Prevention (CDC) initiated data collection on assisted reproductive technology (ART). In 2006, the CDC reported a national multiple pregnancy rate with ART or in-vitro fertilization (IVF) of 48%, with a 43% rate for twin pregnancies and 4% for triplet or higher-order multiples.1 In the early days of IVF, the goal of treatment was to maximize the chance of achieving a pregnancy by transferring several embryos, regardless of any known complications created by multiple-order pregnancies.1,2 It has since been shown that the risk of multipleorder births increases with the number of embryos being transferred, which is associated with shifting from pregnancy success to complications.1,3 The increased risk of multiple pregnancies is therefore associated with potential complications, which are attributed to an increase in maternal and perinatal mortality and morbidity and increased costs for all parties involved.4,5 Multiple pregnancies always cause iatrogenic effects.4,5 Ombelet and colleagues reported stepped increases in neonatal morbidity after assisted reproduction treatment in twins and triplets compared with singletons.5 Their results indicate that there was an increased incidence of congenital malformations—3.0%, 3.5%, and 2.0%—and a higher incidence of respiratory distress syndrome—8.0%, 20.4%, and 1.6%— in twins and triplets compared with sin-
These data show that successful implementation of eSET for clinical application can be achieved by using basic embryonic knowledge rather than relying on expensive equipment and complex technology that is still under scientific development. gleton births, respectively.5 The risk of perinatal death for twin pregnancies is 3 to 4 times higher than for singletons, and 6 to 10 times for triplets and quadruplets.4-6 Over the past decade, ART has made progress worldwide in terms of greater infertility treatment success.1,3 This can be attributed to the availability of complex culture media, a better understanding of in-vitro culture conditions for human embryos, which allow use of culture until the blastocyst stage, and improved cryopreservation techniques for surplus embryos not chosen for transfer.3 To increase the success rate of an IVF cycle, it has become an accepted practice to transfer more than 1 embryo to the uterus. Therefore, ART (including IVF) is associated with a greater number of multiple-order pregnancies compared with natural conception.1,3,5 But clinical experience also shows that many patients are confronted with dilemmas when deciding whether to
CONTINUING NURSING EDUCATION ACCREDITATION AND CONTACT HOURS STATEMENT Veritas Institute for Medical Education, Inc., is approved by the California Board of Registered Nursing Provider #13986 for 1.0 Contact Hour. METHOD OF PARTICIPATION 1. Read the article in its entirety 2. Log on to www.obgyn-infertility-nurse.com 3. Click on “CE Credits” 4. Click on “Click here to complete the posttest and obtain a CE certificate online” 5. Register to participate 6. Enter program number OGI3 7. Complete and submit the CE posttest and CE Activity Evaluation and Request for Credit Form online 8. Print your Statement of Completion This activity is provided free of charge to participants. FINANCIAL DISCLOSURES Veritas Institute for Medical Education, Inc., is required to disclose to the activity audience
choose 1 or 2 embryos for embryo transfer. The nature of some of these dilemmas may lie in: • The emotional stress that a patient may be undergoing (urgency to get pregnant) • The financial aspects of the treatment (cost to the infertile couple, which increases with no IVF insurance coverage) • Educational issues (lack of information about the risks of multiple gestation) • Statistical concerns (being aware of the low ongoing pregnancy rate per treatment cycle from national data). International meetings, such as the Bertarelli Foundation Conference3 or the European Society of Human Reproduction and Embryology Consensus Conference,7 raised awareness of the problem of infertility therapy–associated multiple pregnancies, suggesting that the goal of IVF “is the birth of 1 single healthy child, with a twin pregnancy being regarded as a complication.”7
the relevant financial relationships of the planners and faculty involved in the development of CE content. An individual has a relevant financial relationship if he or she has a financial relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CE activity content over which the individual has control. In addition, all faculty are expected to openly disclose any unlabeled/unapproved/investigational uses of drugs or devices discussed in this activity. Disclosures are as follows: • Juergen Liebermann, PhD, HCLD, is a consultant to Origio. • Amy E.T. Sparks, PhD, HCLD, is a consultant to the Center for Reproductive Medicine, Wichita, KS. • The staffs of Veritas Institute for Medical Education, Inc., and Novellus Healthcare Communications, LLC, have nothing to disclose. DISCLAIMER The opinions expressed in this activity are those of the presenters and do not necessarily reflect the opinions or recommendation of Veritas Institute for Medical Education, Inc. Copyright © 2010 Veritas Institute for Medical Education, Inc. All rights reserved.
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