In the news...

I really enjoyed this article by Pamela Tsigdinos -Fertility Industry: Boon and Curse. She wrote it as a response to the article the New York Times ran on Sunday - "The Gift of Life, and Its Price" that I didn't find particularly interesting, but I have heard it drew a lot of comments that people going through infertility found offensive (I do my best to avoid reading them - I have enough stress in my life.)

Monday's New York Times ran an article about multiples & selective reduction that, once again, caused me to think that unmonitored IUI should be a crime (although one of the cases they talk about was monitored and still ended up with high order multiples).

If things are going to change, it should be based on the research that's been done on e-SET - elective single embryo transfer. Having read many journal articles about it and its advantages (I was planning to write a seminar paper about it, but came up with some ethical issues that got in the way), it's clear that guidelines could be written to avoid unnecessary premature births and pregnancies with high-order-multiples that endanger the mother.

The New York Times also has an online presentation about e-SET.

'Tis the Season

But I can't figure out for what - whether it's a good time to blog, since so few people are that it makes my newly-updated blog more appealing or to take a blogging-vacation (since hardly anyone's around to read blogs, as is clearly obvious from the relative lack of comments about the results of Kirby's cancelled IUI... well, that and my stats, which are basically in the toilet.)

As I mentioned in a previous post, I spent last month reading journal articles about eSET - elective Single Embryo Transfer - when couples have more than one good embryo available, but choose to transfer only one. It's fairly obvious that this is the trend of the future, since pregnancies with multiples are far riskier than singleton pregnancies. It also isn't surprising that deciding on eSET is really hard*, especially for women. Not only is there a sense that the pregnancy rate is lower (per cycle, it is, but if you transfer one embryo one cycle and then thaw and transfer another the following cycle, the pregnancy rates are similar- at least according to one team of researchers**) but it pretty much eliminates the chance of having twins. A survey done among IVF mothers who had already conceived found that mothers with twins perferred twins, but also that 62% of mothers with singletons would have preferred to have twins.***

I'm sure I've said this before, but even after knowing all the risks (which I didn't when I chose to transfer 4 embryos) I still think I would have found myself in the group that was unable to make the decision to transfer a single embryo - if you're going to finally achieve pregnancy, a pregnancy that might be your only one, it almost makes sense to 'try for' twins...

Funding is a partial solution - couples who know they'll be able to have treatment toward an additional pregnancy are more likely to agree to transfer a single embryo. This, apparently, is a good economic choice, since pregnancy with multiples and then multiples are prone to increased health risks, which are a burden to the health system - meaning that long-term it will be cheaper to finance additional IVF cycles than let the current twin rate of 20-25% continue. I believe Finland is one of the first countries to make this decision, but other countries have begun or are at least talking about it. In Finland, the multiple pregnancy rates dropped from 25% to 7.5% between 1997 and 2001 (when eSET increased from about 11 to 56%)**** The overall pregnancy rate per oocyte retrieval was almost unchanged.

One last (and totally subjective) thing I'll mention is that from reading many infertility blogs, it seems that the successful freeze-thaw rate in the US is terrible. It appears that relatively few embryos are frozen and that not enough survive the thaw. Having had lousy embryos frozen and thawed in 1995, when there were only 4 excess embryos, all were frozen and all survived the thaw, I wonder if improving the methods used in the US (or perhaps just being less strict about what embryos clinics freeze) might result in higher FET pregnancy rates. (My FET resulted in my 11-1/2 year old twins.)

*Blennborn et al. (2005)
**Thurin et al. (2004)
*** Pinborg et al. (2003)
****Tiitinen et al (2003)

Ah, and to all those celebrating, Merry Christmas & a Happy New Year :-)
Need some tips on surviving the holidays? (Not an ad, just an article I posted in the past.)