MORE COUPLES THAN ever are turning to in vitro fertilization to help build their families.

Over the past decade, the number of IVF treatment cycles performed annually has risen dramatically as more couples choose this powerful technology to achieve their family-building goals. In 2003, doctors performed approximately 113,000 treatment cycles; that number rose by 50% to about 165,000 in 2012. In that same year, babies conceived via IVF made up 1.5% of the 3.9 million births in the United States.

“More couples are choosing to delay starting their families,” says Dr. John Storment, medical director for FertilityAnswers—a multicenter network of offices providing fertility care to over two-thirds of Louisiana. “This means that many women are older when they are ready to conceive, and this ultimately results in more couples needing IVF services.”

Rapidly advancing IVF technology has accomplished two much-needed goals. First is the patient’s markedly improved chances of successful conception and delivery of a healthy child. And second, with new technology there is a much lower risk of multiple gestations with twins, triplets or more.

“The goal of infertility treatment is for each patient to have one healthy child at a time,” says Dr. Bobby Webster, reproductive endocrinologist at FertilityAnswers. In the past, doctors often had to transfer three or more embryos during IVF to boost the chance of pregnancy, especially in older moms. As the technology expanded and IVF pregnancy rates climbed, so did the rates of multiple gestations. Between 1971 and 2011, the rate of multiple births doubled in the U.S., from 1.8% to 3.5%. That spike has been almost entirely due to fertility treatments.

“The problem with twins and triplets,” says Webster, “is that such pregnancies are dangerous for both moms and babies. Mothers pregnant with twins and triplets have much higher risks for gestational diabetes, Cesarean sections and a dangerous form of hypertension called pre-eclampsia. Pre-term labor is a frequent occurrence. Twins are delivered about a month prematurely, on average, and most will require close observation in an intensive care unit on a ventilator. The risks are even higher for triplets and beyond.” 

The average number of embryos transferred per cycle has been steadily declining in all age groups over the past decade. Two years ago, a study in England confirmed that transferring more than two embryos does not increase the odds for a successful live birth. In fact, IVF is no longer the top culprit for high-risk multiple births. Rather, that distinction belongs to the uncontrolled use of ovulation-inducing fertility drugs, such as Clomid. 

Newer technology now allows doctors to improve the chance of success even further by transferring only one genetically normal embryo at a time. Pre-implantation Genetic Screening (PGS) helps to answer the question of which embryos have the greatest potential to become a healthy pregnancy and baby. Aneuploidy occurs when an embryo has too many or too few normal chromosomes and occurs most frequently at the time of fertilization in humans. It is a major cause of miscarriage and increases dramatically with maternal age. To test for aneuploidy in embryos, a few cells are taken from the outer layer of the embryo during an IVF procedure and screened for chromosomal abnormalities. PGS gives the patient two advantages: 1) 99% certainty the embryo has the correct number of chromosomes, thereby increasing the chance for a healthy pregnancy, and 2) transfer of only one embryo thereby dramatically decreasing the chance of multiple gestations. The pregnancy rate following transfer of just one normal screened embryo is the same as that following transfer of two unscreened embryos.

Some couples request an extension of this technology, also known as Pre-implantation Genetic Diagnosis (PGD), to detect specific genetic conditions that may run in their families, such as Tay-Sachs disease, cystic fibrosis, muscular dystrophy, Fragile X syndrome or spinal muscular atrophy. Dr. Storment recalls a recent case: “We recently had a couple come to us who discovered they were both carriers for a rare and lethal form of brittle bone disease after their first child died within hours of birth. In a subsequent IVF cycle, we were able to test their embryos to determine which were not affected with the disease and they were able to have a healthy child.”

PGS or PGD may be recommended for couples undergoing IVF when:

• one or both partners has a history of heritable genetic disorders,

• one or both partners is a carrier of a chromosomal abnormality,

• the mother is of advanced maternal age,

• the mother has a history of recurrent miscarriages or prior IVF failures, or

• the couple wants the best chance of conception when transferring a single embryo.

In the U.S., an average IVF cycle costs about $12,400. The overall chance for a baby is about 1 in 3. But the odds depend largely on the age of the woman. For those under age 35, success rates are conservatively more than 40%. By age 42, chances fall to about 10% per cycle.

In vitro fertilization continues to be the most powerful and successful form of fertility treatment. Dr. Storment reiterates, “The key is to use technology in a safe, ethical and effective way to not just help a woman conceive at all costs, but to conceive a healthy pregnancy.” 

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Pre-implantation Genetic Screening (PGS) helps to answer the question of which embryos have the greatest potential to become a healthy pregnancy.