Some logical reason behind IVF patients drop out of treatment?

Patients should be provided with adequate information about their chances of pregnancy in the programme they are about to join before they start In-Vitro Fertilization (IVF) treatment. The estimation of the likelihood of pregnancy for couples is often based on the pregnancy rate per cycle obtained in a programme. However, several methods can be used to express pregnancy rates in IVF programmes. The definition of clinical or ongoing pregnancy can differ, and pregnancy rates can be calculated per started cycle, per oocyte retrieval, or per embryo transfer. When informing patients about success rates, a possible reduction in pregnancy rates in successive cycles should be considered. For a randomly chosen patient each unsuccessful cycle constitutes evidence in favour of lower fertility potential.

IVF pregnancy rates are compromised by the large number of couples who drop-out of treatment before achieving pregnancy. Our aim is to identify the role of the treatment strategy applied, and potential other factors that influence the decision of couples to discontinue treatment. Reducing drop-out rate is crucial to further improve the efficacy and cost-effectiveness of IVF treatment. An important factor determining the risk of drop-out is the burden of the treatment strategy. The application of a mild treatment strategy and managing patient's expectations might reduce drop-out rates.

Some answers will be fairly obvious; one of them would be financial reasons because there are lots of patient who simply couldn't afford to do a second or third IVF treatment cycle. Others may have had a terrible experience because the doctor was rude or unkind. However, some psychological differences between women who continue with IVF treatments as compared to those who drop out. This would be a very interesting area of study for psychologists and for IVF specialists because it would help us to identify women who have the emotional resilience to understand that IVF treatment is a process, which may take time rather than a single shot affair. It would also help us to identify those women who had unrealistic expectations. It would help us to counsel them so that they are better prepared for the possibility of failure. This will stop them from going to pieces in case their first cycle fails. This is an area which is ripe for study, which has been quite neglected so far.

Failure of IVF treatment after a number of cycles can be devastating for couples. Although mild IVF strategies reduce the psychological burden of treatment, failure may cause feelings of regret that a more aggressive approach, including the transfer of two embryos, was not employed. Women who experienced treatment failure after standard IVF treatment presented more symptoms of depression one week after treatment termination compared with women who had undergone mild IVF. Failure of IVF treatment after a mild treatment strategy may result in fewer short-term symptoms of depression as compared to failure after a standard treatment strategy. These findings may further encourage the application of mild IVF treatment strategies in clinical practice.

Reducing drop-out rate is crucial to further improve the efficacy and cost-effectiveness of IVF treatment. An important factor determining the risk of drop-out is the burden of the treatment strategy. The application of a mild treatment strategy and managing patient's expectations might reduce drop-out rates.

Is mock transfer is essential before actual embryo transfer, know the facts

Embryo transfer is a simple procedure that follows In Vitro Fertilization (IVF) and is often considered the simplest and final step of the in vitro fertilization process. The objective of embryo transfer is to facilitate conception following fertilization from the in vitro fertilization procedure. Embryo transfer is one of the rate-limiting steps in an IVF cycle and plays a pivotal role in determining IVF success. The day when our in-vitro embryos return back to us is one of the most exciting moments of an IVF cycle. We forget the all our struggles; we went through during the whole procedure; since the invention of IVF, major developments have been made in ovarian stimulation protocols; the way oocytes are collected; and in the IVF lab; but the embryo transfer method remains largely unchanged. When different individuals perform embryo transfer within the same ART programme, the pregnancy rate of each doctor varies widely. This shows the importance of the embryo transfer technique and how it determines IVF outcome. It is estimated that 30% of IVF cycles fail because of shortcomings in this crucial procedure.

There are many questions, what actually happens during an embryo transfer? Is it an easy procedure? Will it be painful? Can my embryos fall out of my uterus after the transfer? Come let us find the answers together

When does the embryo transfer procedure occur?

Embryos are generally transferred to the woman’s uterus at the 2-8 cell stage. Embryos may be transferred anytime between Day- 1 through day 6 after the retrieval of the egg, although it is usually between days 2 -4. Some clinics are now allowing the embryo to reach blastocysts stage before transferring, which occurs around day 5.

What is an embryo transfer (ET)?

Transferring one or more embryos into the uterine cavity of the recipient is called embryo transfer (ET).  It is the final and crucial step of an IVF process. The embryos in the IVF lab are grown usually until day 3 or day 5 in an incubator in a Petri dish. The qualities of embryos are graded by inspection under a microscope. The top quality embryo(s) are returned back to the uterus, where they belong! Even though more than 90% of patients who undergo IVF reach the embryo transfer stage, only a small percentage of them actually get pregnant. Unfortunately, not all the embryos which are transferred to the uterus become deeply desired babies!

What risks are there with embryo transfer?

There are minimal risks associated with the embryo transfer procedure. They include the loss of the embryos during transfer or implanting the embryos in the wrong place such as the fallopian tubes. Although some women experience mild cramping, the procedure is usually painless.

How is an ET performed?

During Embryo Transfer, the doctor puts you in the undignified Lithotomy position in the OR, and inspects your cervix with the help of a speculum. The sticky cervical mucus is cleared away using a moist cotton swab carefully. Then the cervix is washed with a sterile fluid. The best embryos are then loaded into the transfer catheter by the embryologist in the adjoining IVF lab. He does this under the microscope, and sucks up the embryos into the catheter by applying negative pressure with the help of a 1 ml syringe.  He brings the loaded catheter to your doctor, who performs the ET slowly by inserting the catheter into the uterine cavity through the cervix; and then expelling its contents by gently pushing the barrel of the syringe. This deposits the embryos into the cavity of your uterus. This method of transferring embryo(s) to the uterus is called transcervical embryo transfer. After transferring the embryos, the doctor hands over the catheter to the embryologist, who then examines it immediately under the microscope, to see whether there are any embryo(s) retained in the catheter. If this is the case, the retained embryo(s) are transferred back again to the recipient. An embryo transfer procedure is normally painless, and takes only few minutes to perform. You do not need anesthesia for this procedure. Most embryo transfers are easy but some embryo transfers can be difficult too; normally your husband is allowed to stay with you during the Embryo Transfer procedure, in order to hold your hand and provide you with emotional support, so that you remain stress-free and relaxed. 

Are there any instructions following the embryo transfer procedure?

Once embryos are transferred, there is nothing a patient can do to influence the outcome of her cycle. Currently, there is no documented evidence as to whether bed rest or continuing normal activities following the procedure make a difference in the outcome. Some physicians encourage the patients to rest for twenty four hours. Others suggest returning to normal activities as soon as possible. Some patients choose to rest because they think that by doing so they are improving their chances. Additional rest also gives them an opportunity to think about the potential baby. Other women elect to return to normal activities to help them avoid worrying about things that could go wrong. Together with counsel from the doctor, the state of your body and mind should help you decide your course of action.

Again, there is no documented evidence showing that physical activity has any impact upon embryo implantation or conception. Conception is a natural event that depends primarily upon the genetic quality of the eggs.

How many embryos should be transferred?

The number of embryos that should be transferred during any single IVF cycle is subject to debate. Medical experts and writers seem to agree that transferring no more than four embryos per IVF cycle will yield optimal results. Transferring more than four is believed to result in excess numbers of multiple pregnancies leading to the increase of other complications; transferring four embryos instead of only one or two increases the probability of pregnancy but with the risk that all four embryos could implant.

Are there any variations in the transcervical embryo transfer method?

Transcervical embryo transfer is performed in two ways – without ultrasound guidance and with ultrasound guidance.

In the traditional ‘clinical touch’ method, the catheter is positioned blindly in the desired position, by relying on the clinician’s tactile senses. In other words the ‘clinical touch’ embryo transfer method relies on the experience of the person who transfers the embryo; During ultrasound-guided embryo transfer, the clinician is able to find the appropriate position for placing the catheter and releasing the embryos using the ultrasound scan image. During ultrasound-guided embryo transfer, you need to have a full bladder, so that the uterus can be viewed clearly; It does create a lot of discomfort for the patient because the embryo transfer procedure can cause pressure on the already full urinary bladder; the uterus should not be disturbed during the transfer in order to avoid uterine contractions - if the uterus contracts, there is a danger of the embryo being expelled from the cavity.

Is ultrasound-guided embryo transfer better than ‘clinical touch’ method?

This is a passionately debated topic. There are studies which reported that ultrasound-guided embryo transfer significantly enhanced embryo implantation rates; and there are studies which found no difference if the ET was done by an experienced clinician in the absence of ultrasound guidance. This is a decision which is best made by your doctor, based on what works best for him; for junior doctors, an ultrasound guided transfer seems better, as they learn how to master this procedure.

What are trial transfers or mock embryo transfer?

Trial transfers or dummy transfers are performed before the actual embryo transfer. They can be done just before the ET; or during the ovum pick-up; or prior to the start of the IVF cycle. During a trial transfer the doctor inserts an empty catheter into the uterine cavity, to find the easiest passage to the cavity; and to measure the length of the uterus and the cervical canal. This allows him to measure how deep he has to insert the catheter, so that he can place the embryo at the appropriate position inside the uterus, without disturbing the fundus. Most embryo transfers can be performed easily, but there are some women where the doctor finds it technically difficult to negotiate the catheter through the cervix. In such a situation, their cervix has to be dilated to widen the cervical canal, so that the embryo transfer catheter passes easily through the cervix. There are women where the doctor needs to use a tenaculum to straighten the uterine axis and sometimes the uterus is so tilted that the passage of the catheter from the internal opening of the cervical canal into the uterus is difficult. Sometimes pulling on the tenaculum alone cannot do the job, especially if the uterus is acutely angulated in relation to the cervical canal. Then it may be necessary to curve the catheter, so it conforms to the curve of the uterus. In these patients, using specially designed catheter sets allows the doctor more freedom in gently guiding the catheter through the cervix. 

What factors play a role in affecting embryo transfer results?

The embryo transfer should be smooth and trauma-free. Many studies have shown that the pregnancy rate after embryo transfer is better if it is performed by an experienced physician, as compared to a newbie.

·         Placement of the embryo: Placing the embryo 2 cm from the uterine fundus (the upper rounded extremity of the uterus, above the openings of the fallopian tubes) helps in enhancing embryo implantation. This is the region which is thought to possess maximum implantation capacity.

·         Uterus contraction: When the cervix is handled roughly or if the catheter touches the uterine fundus, the uterus can contract. This can expel the embryos from the uterine cavity into the fallopian tubes or cervical canal, and compromising IVF success.

·         Cervical mucus: Carefully removing the cervical mucus without causing trauma to the cervix improves IVF outcome. The cervical mucus can plug the catheter tip , thus preventing the deposition of the embryo in the uterus. It can also be a source of introducing bacterial contamination into the otherwise sterile uterine cavity.

·         Catheter choice: Soft catheters have a better IVF outcome because they avoid trauma to the uterine wall.

·         After the doctor has done the transfer, the embryologist checks it under the microscope. The presence of blood in the catheter suggests that the transfer was technically difficult – and this may reduce pregnancy rates.

·         Trapped embryos:  Sometimes the embryos remain trapped with the catheter, even through the doctor has plunged the barrel of the syringe completely. When the embryologist identifies the trapped embryos in his petri dish, he simple reloads them again into a new catheter, and the doctor can then re-transfer them. This does not seem to affect pregnancy rates. 

Why are some embryo transfers difficult to perform? 

Some embryo transfers are difficult to perform because of the following problems in patients:

1.    Cervical stenosis (narrowing) or anatomical distortion of the cervical canal and uterus

2.    Acute Utero-Cervical Angulations

If a physician has several years of experience in doing IVF, then most embryo transfers are like a cakewalk. But in some women, the embryo transfer can become an arduous adventure because of the difficulty encountered in traversing the cervix. This is commoner in women of Indian and African origin, where pelvic inflammatory disease (PID) and cervical infections are more prevalent. There can also be anatomical distortion of the cervical canal and uterus because of previous surgery. These conditions might lead to a traumatic embryo transfer; or the embryo transfer cannot be performed at all. The presence of an acute curvature between uterus and cervical canal can also make the embryo transfer hard to perform.

How to avoid difficult embryo transfers?

Performing mock transfers before the actual embryo transfer helps in identifying the problem before hand, and can help the doctor to take precautionary measure. For example patients with cervical stenosis can undergo a process called cervical dilation to widen the cervical canal. This might help in the atraumatic passage of the ET catheter into the uterine cavity. But there are some patients in which transcervical embryo transfer becomes impossible! In such rare cases, there are other techniques which could be used to transfer the embryo to the uterus. 

What are the methods which bypass the transcervical route for embryo transfer?

Trans-myometrial embryo transfer (TET)

In this method, using a special set, two needles (one inside of the other) are passed through the vagina into the uterus wall, under ultrasound guidance, until the needle tip reaches the edge of the endometrial lining. The inner needle is then removed and a thin catheter is inserted inside the outer needle, which carries the embryo into the cavity. The embryos are then released in the endometrium. But the success rate with such embryo transfers are less when compared to transcervical embryo transfers.

Zygote Intra Fallopian Transfer (ZIFT)

ZIFT stands for zygote intra fallopian transfer. During ZIFT, cleavage stage embryos are transferred into the fallopian tubes, instead of the uterus, using laparoscopy. ZIFT is a very good option for women who cannot have a transcervical embryo transfer, but who have at least one normal fallopian tube. Since cleavage stage embryos belong to the fallopian tube and not to the uterus, ZIFT has a higher pregnancy rate than conventional ET. Most clinics are not able to offer the option of doing a ZIFT, because of the lack of surgical skills and anesthesia facilities. If your embryo transfers are difficult, then find a clinic which offers this option!

E-SET (Elective Single Embryo Transfer)

Elective single embryo transfer (e-SET) is becoming popular for women who are young and have good ovarian reserve. While transferring multiple embryos improves the pregnancy rate, it also increases the risk of multiple gestations. Children who are a result of multiple pregnancies have an increased risk of health problems, because of the increased risk of preterm delivery and low birth weight. With the advent of better embryo selection strategies such as comprehensive chromosome screening (CCS), single embryo transfer may become the norm in the future.

IVF - the hope comes true for infertile couples

Sperm Collection and Preparation

On the day of egg collection, the husband gives a sperm sample. The semen specimen should be obtained following a 3-4 day abstinence from sexual activity and masturbation is the preferred method of collection. A shorter or longer period of time or the use of a different method of collection may affect semen parameters. After collection the semen sample is delivered to the lab where it is properly prepared for IVF. The purpose of the preparation is to isolate the motile spermatozoa from other elements of the semen and activate them in order to be capable to fertilize the mature oocytes.

It should be noticed that masturbation, especially at the clinic, is sometimes difficult and stressful for men on the day of egg collection. Therefore men could bring the semen sample from home or can freeze a sample several days before the day of oocyte retrieval (fresh samples are always preferred). In cases of men with azoospermia, spermatozoa are retrieved directly from the testis (surgical sperm retrieval).

Egg Retrieval

The ability to collect mature eggs from a woman's ovaries for fertilization outside of the body has revolutionized fertility treatment. Originally developed as a way to help women whose fallopian tubes were irreparably blocked, IVF now allows couples who suffer from a wide range of fertility problems to successfully conceive. In vitro fertilization begins with ovulation induction, a process of stimulating and monitoring the ovaries. Once it is determined that the ovarian follicles are the right size and the eggs ready to be collected, a dose of human chorionic gonadotropin (hCG) is administered to trigger the final maturation process and egg retrieval will take place approximately 36 hours later. Prior to the procedure, anesthesia will be given. In most cases, egg retrieval is performed under moderate sedation (aka MAC), allowing the patient to be asleep for the procedure. The actual technique used to collect eggs for in vitro fertilization is known as an ultrasound-guided transvaginal aspiration.

While an ultrasound probe is used to provide a visual image of the ovary and the surrounding structures, a very fine needle is inserted through the upper wall of the vagina and into the ovary. Through magnification of the ultrasound image, the physician can locate the individual follicles that contain mature eggs and apply gentle suction to remove the contents of each one, which is known as aspiration. The fluid and egg from each follicle are collected into an individual container, which will then be taken to the lab for examination and preparation for fertilization. The procedure is performed on both ovaries, usually taking between 10 and 15 minutes to complete. Once the egg retrieval process is finished, the patient will remain under observation for one or two hours before being sent home. Patients may experience some discomfort after egg retrieval and are encouraged to rest as much as possible. Mild soreness, cramping, and light spotting are normal.

Vigorous exercise and other strenuous activities should be avoided. Specific instructions will be provided prior to the procedure and should be followed carefully. Progesterone, a hormone that would normally be released by the follicle after ovulation, is vital to the support of early pregnancy. Because aspiration of the follicles can interrupt the normal hormonal process and prevent adequate amounts of progesterone from being produced, the patient will generally be given supplemental progesterone from the time of egg retrieval through the end of the cycle.

The whole process is performed under mild sedation with a recovery period of approximately an hour. However, it is important to notice that for safety reasons, women scheduled for egg retrieval must be at the clinic at least 30 minutes before the procedure in order to have a cardiograph and talk to the anesthesiologist about allergies, any medication they are taking and any other health problems they may have. Last but not least, women programmed for this procedure shouldn’t eat or drink anything from the previous night.

Oocyte Fertilization

Several hours after egg retrieval and semen preparation, fertilization occurs. More specifically at a conventional IVF cycle the mature oocytes are placed in 4-well dishes of culture medium containing processed sperm. One of the spermatozoa will penetrate and fertilize the oocyte. In cases of severe male infertility, other laboratory techniques are required following egg retrieval. Fertilization may be assisted by intracytoplasmic sperm injection (ICSI), a micromanipulation technique which involves the injection of a sperm directly into the egg. The eggs are then incubated in the lab overnight.

The next morning, 16-18 hours after the time of fertilization, fertilization check is performed by the embryologists. The first signs of normal fertilization are shown by the presence of two pronuclei (small round structures) within the egg. The fertilization rate is usually between 50 and 100%. The maturity of the oocytes, semen parameters, handling procedures and culture systems are some factors that are responsible for the variance in the fertilization rate.

Embryo culture, selection and transfer

The earliest stages of human development, until day five or six after fertilization, normally occur in the woman’s fallopian tube. However, after in vitro fertilization (IVF), much of this period of early development occurs in the laboratory. The conditions under which the embryos are “cultured” have been carefully formulated to provide an environment that as closely as possible that of the fallopian tube. Recently, commercially prepared culture media have become available. These media support embryo development in the laboratory for up to six days. By allowing the embryo to reach the blastocyst stage, we can make a more stringent selection of those to be transferred during an IVF cycle; as a result, these systems may be preferable for patients who would prefer or benefit from a one- or two-embryo transfer.

Once the embryos have been created in the laboratory, they are placed into the uterus. At this point, in order for pregnancy to occur, an embryo must implant into the uterine lining. For many patients, the two-week wait between the embryo transfer procedure and the initial pregnancy test is the most difficult stage of the process. While the embryos are developing in the laboratory, they are monitored for rate of growth, size, form, and signs of irregularity. Based on this data, the embryos are graded by quality, which helps us to estimate which are most likely to successfully implant and continue to develop. Typically, the embryos of the highest grade are selected for the first IVF transfer. Embryos with significant abnormalities are not suitable for transfer and will be discarded. In most instances, no more than two or three embryos will be transferred during any given IVF cycle. This number allows the best chances for implantation while still keeping the risk of a multiple pregnancy to a minimum. In some cases, depending on age and other factors, our physicians recommend electing a single embryo transfer. Any additional embryos that are created will be cryopreserved for later transfer. The embryo transfer procedure will be scheduled for three to five days after the egg retrieval. In IVF cycles where frozen embryos are to be used, the patient will be closely monitored via ultrasound and the embryos will be placed about two days after ovulation takes place.

This stage of in vitro fertilization treatment involves threading a thin catheter through the opening in the cervix, through which the embryos are gently deposited into the uterus. There is very little discomfort during this part of treatment and anesthesia is not necessary. After the transfer procedure, our IVF patients are advised to take it easy for the next few days. Physical activity should be limited and strenuous exercise should be avoided. Although there is little that can be done at this point that will affect the chances of successful implantation, eating well, getting enough sleep, and minimizing stress will go a long way toward the health and wellbeing of the patient. The process of implantation is complex and unpredictable. First, the embryo must escape, or hatch, from the zona Pellucida. Even if the embryos are transferred on day three, this will not occur until after the embryos have reached the blastocyst stage on day five or six. Once an embryo has hatched, it must attach to the endometrium, or uterine lining, and gradually become imbedded in it. Once an embryo has completed this process, pregnancy is achieved and the in vitro fertilization cycle is a success.

Approximately fourteen days after the embryo transfer procedure, a blood test will be conducted to measure the amount of human chorionic gonadotropin (HCG) in the patient's system. This hormone is released only after implantation and is an accurate indicator of pregnancy. However, because HCG is sometimes used during the ovulation induction process to trigger the final maturation of the oocytes, small amounts may exist even if the patient is not pregnant. For this reason, at-home pregnancy tests that detect the presence of HCG but do not measure the quantity are not considered accurate for women undergoing in vitro fertilization. Elevated levels of HCG indicate that implantation has occurred and the patient is pregnant. If pregnancy is detected, the patient will then undergo an ultrasound examination to confirm the findings, determine how many embryos have implanted, and ensure that everything is progressing normally.

If pregnancy has occurred, progesterone treatments will be continued for a period of time and then be gradually reduced as the patient's body takes over normal hormone production. The patient will continue to visit our IVF Centre for blood work and ultrasounds during the early weeks of pregnancy to ensure that everything is proceeding as it should. Once we are able to detect the fetal heartbeat, the patient will be referred to an OB-GYN (if she does not have one already), who will handle the remainder of the patient's prenatal care. A high-risk obstetrician is only necessary if certain medical problems are a factor.

If pregnancy has not occurred, progesterone supplements will be ceased and the cycle will come to an end. If the couple has opted to try another in vitro fertilization cycle, we may recommend waiting one or even two complete menstrual cycles before resuming treatment. This allows the body to rest and gives us a chance to examine our treatment strategy and possibly change our approach in future cycles. In subsequent IVF cycles, the ovulation induction phase may not be necessary if frozen embryos are available for transfer.

Complications & Risk Factors after Embryo Transfer

Assisted reproduction technique (ART) is an efficacious treatment in sub fertile couples. So far little attention has been paid to the safety of ART, i.e. to its adverse events and complications; the consensus meeting on Risks and Complications in ART.

Multiple pregnancies

If 25% of all pregnancies after IVF/ICSI are twin pregnancies, 40% of all babies born after ART are born as part of a twin pair. Many physicians and patient couples underestimate the negative consequences of twin pregnancies. Perinatal as well as maternal mortality and morbidity are increased in multiple pregnancies as compared with singleton Pregnancies due to a higher rate of prematurity and low birth weights in the children; and due to pregnancy complications in the mothers. Furthermore, parents of multiple births have more stress, and siblings of multiples are more likely to have behavior problems.

Long-term effects of ART on women

Hormonal and reproductive factors are involved in the etiology of breast cancer and cancers of the female genital tract. Therefore, the effect of fertility drugs on the risk of these

Cancers has been investigated. Many studies have not been able to reach solid conclusions due to low statistical power, lack of control for important confounders (such as cause of sub fertility and parity) and short duration of follow-up.

Effects of ART on offspring

Much concern has been expressed about the health of children born after ART. In particular, the risk of boys born to couples with male factor sub fertility has drawn attention, since in a substantial number of male factor sub fertility cases, a genetic cause can be suspected.

Patient selection and counseling for eSET (elective single-embryo transfer)

It was agreed that the essential aim of IVF/ICSI is the birth of one single healthy child, with a twin pregnancy being regarded as a complication. The chances of having a single healthy child after eSET have increased, and equal the spontaneous pregnancy rate in a normally fertile couple.

Women who can get pregnant without fertility drugs or medical procedures usually have only one baby. Women who need fertility treatment are at higher risk to get pregnant with twins, and rarely with triplets or more. This is called multiple gestations. Multiple gestations can increase the risk of pregnancy for the mother and for all the babies. Multiple gestations are risky for the babies. Because there are too many babies in the womb, you may have a miscarriage. A miscarriage occurs when your pregnancy ends without the birth of any infants that can survive, before the 20^th week of pregnancy. Or you could have a premature delivery when the babies may be born too early (but after 20 weeks of pregnancy) and have problems with lungs, stomach, or intestinal tract. They may have bleeding in the brain, which can cause problems with the baby's brain, nervous system, and hamper its development. If the babies are born very early, they will probably be very small and may even die.  Twins, triplets, and other multiples are more likely to have problems with their brain development and nerves if they are born early. One of the more common problems is cerebral palsy, a condition that affects movement. Other problems associated with multiple births may not present for many years after delivery

Embryo transfer and elective single embryo transfer have become popular topics as more couples turn to fertility treatments to conceive. Our Fertility doctor takes your age and in vitro fertilization (IVF) prognosis into account when performing embryo transfer. Pahlajani Test Tube Baby has a clear guidelines offer you the best chances for a healthy pregnancy and delivery. Do you have a good prognosis for IVF? A good, or favorable, IVF prognosis applies to women who:

» Are in their first IVF cycle

» Have healthy embryos or multiple frozen embryos

» Have already had success with IVF

If you are under 35, and have a favorable prognosis for IVF, you are more likely to conceive with a single embryo transfer. If you're over 35 and have a good IVF prognosis, our doctor may prefer to transfer more than one embryo.

» Under 35: 1-2 embryos

» 35 to 37: 2 embryos

» 38 to 40: 2 to 3 embryos

» 41 to 42: 3 to 5 embryos

Becoming pregnant with multiples increases the risk of complications for you and your babies. Single embryo transfer can help you avoid these risks. The most common complications associated with multiples are increased rates of preterm labor and preterm delivery. Preterm delivery can cause a host of problems for the infant, including:

» Respiratory, growth, and digestive problems

» Long-term learning and developmental difficulties

» Low birth weight

Complications for mom are also increased with multiple gestations. Here are some of the increased health risks for moms of multiples:

» C-section

» Emotional stress

» Gestational diabetes

» High blood pressure and preeclampsia

» Increased cost for medical care

» Increased risk of miscarriage

This is why doctors prefer single embryo transfer, or transferring a lower number of embryos during IVF, when possible.