Fertility Guidelines Updated on Number of Embryos to Be Transferred During In Vitro Fertilization

See the following article from Medscape Today:

October 20, 2009 — The American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART) have released new guidelines for the number of embryos to be transferred in in vitro fertilization cycles in an effort to reduce high-risk multiple pregnancies. The guidelines, based on ASRM and SART data from 2007, were published online October 19 in Fertility and Sterility.

"High-order multiple pregnancy (three or more implanted embryos) is an undesirable consequence (outcome) of assisted reproductive technologies (ART)," the guidelines state. "Multiple gestations lead to an increased risk of complications in both the fetuses and the mothers."

The guidelines are meant to assist ART programs and patients to determine the appropriate number of cleavage-stage (usually 2 or 3 days after fertilization) embryos or blastocysts (usually 5 or 6 days after fertilization) to transfer, and they can be modified according to the patient's age, embryo quality, and the opportunity for cryopreservation. They may also be changed as clinical experience with newer techniques accumulates.

The guidelines include the following recommendations:

In women younger than 35 years who have a more favorable prognosis, no more than 2 embryos (cleavage stage or blastocyst) should be transferred, and consideration should be given to transferring only a single embryo.
In women between the ages of 35 and 37 years who have a more favorable prognosis, no more than 2 cleavage-stage embryos should be transferred; all others in this age group should have no more than 3 cleavage-stage embryos transferred, and no more than 2 blastocysts should be transferred if extended culture is performed.
In women between the ages of 38 and 40 years who have a more favorable prognosis, no more than 3 cleavage-stage embryos or 2 blastocysts should be transferred; all others in this age group should have no more than 4 cleavage-stage embryos or 3 blastocysts transferred.
In women between the ages of 41 to 42 years, no more than 5 cleavage-stage embryos or 3 blastocysts should be transferred.
The guidelines also state that women with 2 or more failed fresh in vitro fertilization cycles or a less favorable prognosis may have 1 embryo transferred according to individual circumstances. These women must also be counseled about the risks for multiple pregnancies, and both the counseling and the reason for exceeding the recommended limits must be documented in the patient's permanent medical record.

The guidelines also state that data are insufficient to recommend a limit on the number of embryos to transfer in women 43 years and older.

The guidelines warn that in vitro fertilization programs that have a high-order multiple pregnancy rate that is more than 2 SDs above the mean rate for all SART reporting clinics for 2 consecutive years may be audited by SART.

This report was developed under the direction of the Practice Committee of the SART and the Practice Committee of the ASRM. Members of the ASRM Practice Committee have disclosed various financial relationships with IntegraMed, Xanodyne Pharmaceuticals, Inc; Third Wave Technologies, Inc; Wyeth; EMD Serono, Inc; Ferring Pharmaceuticals; Tokai Pharmaceuticals, Inc; Pfizer Inc; Boehringer Ingelheim GmbH; Teva Pharmaceuticals USA; Solvay Pharmaceuticals, Inc; Schering-Plough; Theralogix, LLC; Femasys Inc; Watson Pharmaceuticals, Inc; Bayer HealthCare; and Ausio Pharmaceuticals, LLC. Members of the SART Practice Committee have disclosed various financial relationships with EMD Serono, Inc; Schering-Plough; Ferring Pharmaceuticals; Theralogix, LLC; Femasys Inc; Irvine Scientific, Inc; Incept BioSystems, Inc; and Molecular Biometrics, Inc.

Fertil Steril. Published online October 19, 2009.