Dr. Shefali Shastri is a reproductive endocrinologist with the RMA Network, a research-focused fertility group in the United States with success rates consistently higher than the national average. She practices in New Jersey, the headquarters of the RMA Network.
Dr. Shefali Shastri
Reproductive Endocrinologist, RMA Network
Is IVF still synonymous with twins?
Absolutely not! Many people don’t realize that in advanced clinics across the country, doctors no longer routinely transfer two or more embryos at a time. Today the standard of care is to transfer only one embryo at a time, known as single embryo transfer (SET).
RMA, the fertility group to which I belong, has been transferring one embryo routinely for years. SET lowers the risk for both mother and baby due to a drastic reduction in multiple gestation. In fact, late last year we announced an industry first: for the first time since the advent of IVF over four decades ago, babies born through IVF at RMA have equaled their naturally conceived counterparts in birth weights. A newborn’s birthweight is an important indicator of health, as babies born with low or very low birth weights may experience significantly more morbidity and mortality.
Research conducted at RMA found a steady increase in birthweights in infants born through IVF from 2000 to 2017, finally reaching parity with birth weights of babies born without assisted reproduction (about 2,500 grams). Historically, IVF babies have been born with much lower birth weights, commonly associated with multiple gestation pregnancies and preterm delivery. The practice of SET has helped our patients experience healthier pregnancies and deliver healthier babies.
What led to this increase in birth weights for IVF babies?
The increase in birth weights for IVF babies is correlated to advancements in technology that drove the change in the standard of care regarding numbers of embryos to transfer. Today, when a couple undergoes In Vitro Fertilization, we are able to screen their embryos for chromosomal abnormalities and transfer only a chromosomally normal embryo which has the greatest potential for live birth. Previously, before this genetic testing was available, the philosophy was to transfer back two or in some cases even more embryos in the hopes that one of the embryos would be viable and able to develop to a live birth. With the current standard of Single Embryo Transfer (SET), we have a much lower likelihood of twin or higher order multiple pregnancies, resulting in a much lower chance of preterm labor and preterm delivery and a higher likelihood of delivering one healthy baby.
How specifically has SET helped increase IVF birth weights?
Since twins tend to have higher instances of being born premature, and thus underweight, almost completely eliminating twins through the use of SET has allowed RMA to lower prematurity rates and increase birth weights. Studies done at RMA have shown that SET with screened embryos results in high success rates and dramatically lowers risk for mother and child.
What impact does rising maternal age have on a woman’s ability to conceive?
Today, more and more women are putting off parenthood, often until their mid-30s. A woman’s peak fertility is actually in her mid- to late-20s, and begins to decline more significantly after the age of 35. As a woman ages, her egg reserve goes down along with her egg quality. Thus, women who wait until their mid-30s or later to attempt conception may have a much more difficult time getting pregnant. As the age of maternal child-bearing rises, so does the need for fertility treatment like intrauterine insemination (IUI) or in vitro fertilization (IVF).
How exactly does age impact fertility?
As a woman ages, her egg number goes down along with her egg quality. A woman is born with all the eggs she’ll ever have, and every month, even prior to hitting puberty, a woman loses thousands of eggs. At puberty, a young female will have approximately 400,000 eggs, and that number will drop down close to zero at menopause.
Clinically, this translates into a slight drop in female fertility after age thirty, and much more significant drop off in pregnancy in women after age 37.
Are there other factors that contribute to infertility?
There are a number of female and male factors that contribute to fertility. Today, diminished ovarian reserve, often related to maternal aging, is one of the most common causes of infertility.
Additionally, there may be tubal issues related to prior infection, surgery, or endometriosis, or concerns with ovulation or irregular menses related to hormonal irregularities, such as polycystic ovarian syndrome (PCOS). A male factor makes up nearly half of all infertility cases; specifically, this includes abnormalities in sperm parameters or erectile dysfunction. The good news for all these conditions is that there is help and fertility success rates have never been higher than today, when the industry is at its most advanced and safest stage.
How does third-party reproduction work?
Third-party reproduction refers to using a third party for donor eggs, donor sperm, or a surrogate.
There are many reasons why a third party is required for the reproduction process.
- Advanced maternal age or the onset of early menopause can mean some women will benefit from using a donor egg.
- Male factor infertility can require donor sperm.
- Single women can also use donor sperm to achieve pregnancy.
- In the LGBTQ community, female couples require donor sperm. Male couples require donor egg and a gestational surrogate.
For all these patients, donor services would work in largely the same way: they would allow for the completion of the fertility “puzzle.” The puzzle has three key elements, all of which are necessary to have a baby. The first is a healthy egg, the second is viable sperm, and the last is a uterus in which the embryo will implant and grow into a healthy baby. Depending on which piece of the puzzle is missing for any particular couple or individual, the piece can be provided by a donor or gestational surrogate (to carry the pregnancy and deliver the baby), and the rest of the fertility treatment plan will follow the way it normally would.
What is IUI?
Intrauterine insemination (IUI) is a procedure where a catheter is used to place sperm through a woman’s cervix and into her uterus at the time of ovulation in hopes of achieving pregnancy. Prior to IUI, a woman either takes medication to stimulate her ovaries to help her develop a mature egg and ovulate, or ovulates naturally. Either a partner can provide the sperm sample or donor sperm can be used for the insemination. The semen sample provided will undergo a sperm wash and the filtered sample will be used for insemination at the optimal time for egg and sperm to meet.
What is IVF?
In vitro fertilization (IVF) is a medical procedure where an egg is fertilized with a sperm to create an embryo in a laboratory. Once the embryo develops to a certain stage, it can be transferred back into a woman’s uterus to implant and develop into a baby.
In order for the egg and sperm to be joined in the laboratory, a woman undergoes hormonal stimulation of her ovaries to develop multiple mature eggs, followed by an egg retrieval procedure to remove all viable eggs from her ovaries. Once the eggs are fertilized by her partner’s sperm and they grow to day five of development, the resulting embryos are genetically tested, and a normal embryo is transferred back into the intended mother. About 10 days later, the woman will take a pregnancy test to determine whether the procedure worked.
What is egg freezing?
Egg freezing is a great option for women who want to safeguard their fertility but are not ready to have children right now. With egg freezing, women are able to press pause on their biological clock by having a procedure to collect all the eggs in any given cycle and freeze those eggs so they don’t age any further.
An egg freezing treatment cycle is similar to an IVF cycle in that a woman would undergo hormonal stimulation of her ovaries for about 10 days to grow all the follicles (which contain tiny eggs) she has in that cycle. She then undergoes a procedure – done using an ultrasound-guided needle under twilight anesthesia – to retrieve those eggs. The embryologist will determine which eggs are mature, and they will be frozen until she is ready to use them in the future.