The success of IVF/ART had been improving in previous decades, until about 20 years ago - reaching a plateau for another several years, and, disappointingly, decreasing in the last decade.
For example, the live birth rate was 15% in the early- to mid-nineties, climbing significantly to around 27-30% in the first decade of the millennium, and decreasing thereafter to around 21-22% in the year 2016, according to the data from the annual CDC ART success rate reports. Possible causes for the last decade decrease in the pregnancy rate and delivery rates of IVF/ART were attributed to several “adds on” suggested and experienced over the last years.
Among such possible causes, the following “new practices” were mentioned:
• ‘Industrialization’ of IVF/ART: the transition to an investor-driven industry and competitive emphasis on profit and revenue rather than IVF outcomes.
• Mild stimulation
• Elective single embryo transfer
• PGT-A
• “Freeze-all” policy
• Blastocyst culture
• Others
Whereas many IVF centers are private, for profit-organizations, many couples in their forties, and sometimes, even women of over 44 or 45 have been accepted for IVF with their own gametes, rather than discouraging this approach and, instead, offering donation of oocytes from young donors.
Another approach, embryo transfer (ET) of blastocyst, has increased the pregnancy rate per ET. However, less than half of the fertilized ova reach the blastocyst stage. For women where 8-12 oocytes or more are retrieved, the culture to blastocyst stage may indeed increase the pregnancy and delivery rate. However, for low responders, where less than three or four eggs are retrieved, a substantial number of patients may end up in no embrya to be transferred.
It is the objective of this collection to analyze each of the above "add on" possible factors, and others, and criticize their possible effect on the change in the outcome(s) of IVF/ART.
We welcome Original Research, Review, Systematic Review and Opinion articles as part of this Research Topic.
The success of IVF/ART had been improving in previous decades, until about 20 years ago - reaching a plateau for another several years, and, disappointingly, decreasing in the last decade.
For example, the live birth rate was 15% in the early- to mid-nineties, climbing significantly to around 27-30% in the first decade of the millennium, and decreasing thereafter to around 21-22% in the year 2016, according to the data from the annual CDC ART success rate reports. Possible causes for the last decade decrease in the pregnancy rate and delivery rates of IVF/ART were attributed to several “adds on” suggested and experienced over the last years.
Among such possible causes, the following “new practices” were mentioned:
• ‘Industrialization’ of IVF/ART: the transition to an investor-driven industry and competitive emphasis on profit and revenue rather than IVF outcomes.
• Mild stimulation
• Elective single embryo transfer
• PGT-A
• “Freeze-all” policy
• Blastocyst culture
• Others
Whereas many IVF centers are private, for profit-organizations, many couples in their forties, and sometimes, even women of over 44 or 45 have been accepted for IVF with their own gametes, rather than discouraging this approach and, instead, offering donation of oocytes from young donors.
Another approach, embryo transfer (ET) of blastocyst, has increased the pregnancy rate per ET. However, less than half of the fertilized ova reach the blastocyst stage. For women where 8-12 oocytes or more are retrieved, the culture to blastocyst stage may indeed increase the pregnancy and delivery rate. However, for low responders, where less than three or four eggs are retrieved, a substantial number of patients may end up in no embrya to be transferred.
It is the objective of this collection to analyze each of the above "add on" possible factors, and others, and criticize their possible effect on the change in the outcome(s) of IVF/ART.
We welcome Original Research, Review, Systematic Review and Opinion articles as part of this Research Topic.
