OBGYN.net Conference CoverageFrom the ESHRE 2000 Conference Bologna, Italy
Dr. Hans van der Slikke: "Good afternoon, I'm with Professor Lynn Fraser from the U.K. You are the President of the ESHRE, and this afternoon at the ESHRE Conference there was a preliminary report about the IVF results in Europe. Could you tell us what your impression is about these figures?"
Professor Lynn Fraser: "Yes, the data were presented in a preliminary form by individuals who've been involved with the European IVF Monitoring Consortium. They now have data on over 200,000 cycles that have been carried out in 18 different countries throughout Europe, and they have looked at the data for the year 1997. It's extremely interesting to see, in particular, the different practices that are carried out in different countries; different particularly in the sense of the numbers of embryos that are replaced at the time of embryo transfer. Many of the Scandinavian countries are moving very swiftly to transferring on average only two embryos and a number of units are actually trying to go to one assuming that the woman has all the right characteristics, the most important of which is being young in age because her chances of success are much greater than an older woman. Certainly a woman over thirty-five has less success in any one cycle than a younger woman, say, under thirty. Of course, a number of countries have legislation that prevents more than a certain number of embryos being transferred so, for example, in the United Kingdom where I live, there's a maximum of three that can be transferred although, again, there is a move that's beginning to build up to transfer a maximum of two unless you have older women or if there are other indications that would suggest that three might be better than two. If you look at some of the other countries, particularly in the more southern geographical countries, there are fewer restrictions and there are a number of countries where four or more embryos are replaced on a fairly routine basis. The concern I think for all people working in assisted reproduction is that the more embryos you put back, the greater the chance is you'll have multiple pregnancies, and there are many risks both for the mother and the fetuses and any babies that are born as a result of multiple pregnancy. Even twins carry with them a fair degree of difficulty or potential difficulty and certainly triplets or quadruplets. The attitude is changing now and multiple pregnancies are not being seen as a success of assisted reproduction but rather something that needs to be addressed because it's a problem."
Dr. Hans van der Slikke: "Yes, some even say it's a complication of IVF."
Professor Lynn Fraser: "Exactly."
Dr. Hans van der Slikke: "Talking about older women, it's known that at their age, they have a bigger chance of having a multiple pregnancy even without IVF so don't you think it's dangerous even for 39-40 year old women to transfer more than two embryos?"
Professor Lynn Fraser: "I can only speak on the basis of the data published by the Human Fertilization and Embryology authority in the United Kingdom. It's quite clear that for women over the age of thirty-five with either two or three embryos being transferred, their chances of success, i.e. a pregnancy - multiple or singleton is significantly lower. Certainly for any woman who is forty years of age or older, the success rate goes down to 5% or less and of course the indications are that the problem with older women is primarily much poorer quality eggs. So you may get a lot of eggs when you give the hormones but they tend to have very poor quality and, therefore, even if you get embryos, the chances that those embryos will go on and form babies is much reduced. I think it is the experience of most of the clinics for whom I have any knowledge of that with the older women that would certainly be a category of patient where they would consider putting back three embryos rather than two. I doubt they would go to one unless they only had one."
Dr. Hans van der Slikke: "Could you tell us when we'll find these figures in print?"
Professor Lynn Fraser: "The data that were presented today, as was stated by my colleagues who did the presentation, are preliminary but the data should be complete a bit later on in this year. The whole report with the figures will be submitted for publication in one of our journals, the Journal of Human Reproduction, so it will be available to anyone throughout the entire world. We're very pleased and very proud of ESHRE's activities in this area because we think this is very important. Over 200,000 cycles makes this the biggest single study on aspects relating to in vitro fertilization that have been published so we think that this is going to give a lot of information to people around the world."
Dr. Hans van der Slikke: "Yes, I agree. I think this is really a topic to congratulate you on. Thank you very much for this interview."