Watch the webinar with Vanessa Vergara Bravo, Medical Coordinator at IVI Clinic Madrid, who discusses the components that are crucial in improving IVF pregnancy success rates and those that have been developed over the last few years.
Vanessa started her presentation by explaining the different types of protocols that are available at the clinics. The most important protocols are defined as “Protocols to follow regulations”, which are divided into Local and Regional regulations. Firstly, local regulations are established by the European directive. In the same way, regional regulations are established by laws and regulations of different countries that ultimately determine what type of treatments are allowed.
Additionally, Vanessa stated that several steps in the process of IVF and Egg donation treatment are measurable in terms of effectiveness by indicators. In particular, she mentioned the implantation rates and the proportion of blastocysts, among others. Accordingly, these indicators are useful to achieve the major objective and purpose of the treatment, which is to have a healthy child.
The major objective of the treatment is for the patient to have a healthy child at home.
She later explained the difference between the indicators, which are all based on innovation and research. On the one hand, IVF is not only improving and measuring techniques but acquiring new technology and equipment as well. Besides, the training of the embryologists is also implied.
On the other hand, in the clinical work, the indicators are said to be based on a deep understanding of both the physiology and the individualization of controlled ovarian stimulation as well as the experience of the clinicians as these factors play a relevant role in the outcomes.
The outcomes are measured as follows:
She added that the ongoing pregnancy rates and life-birth rates from all the transferred embryos obtained in one cycle are referred to as cumulative rates.
Moreover, according to Vanessa, all the outcomes are based on different consensus and international guidelines in terms of how the IVF laboratory outcomes should be measured in order to achieve an average objective.
Above all, it was explained that there are a variety of different strategies to improve outcomes based on research. In the first place, in the IVF lab, the strategies are based on having the best possibility for both embryo selection and the best option for embryo culture.
In addition, as regards the clinical side, individualized controlled ovarian stimulation should be of the utmost importance due to the importance given to single embryo transfer.
On the graph shown, it is visible how the outcomes and implantation rates have improved over the last 15 years. There have been significant changes, such as transitioning from incubator-standardized protocols to gradually introducing benchtop incubators. In 2017, 100% of all incubators at the IVI clinic were of the benchtop type, enabling to implement of a policy of transferring all embryos at the blastocyst stage.
PGT-A testing has also been introduced, especially for patients over 44 years old and those undergoing egg donation. This allowed to improve outcomes by 20% across all age groups. However, there is a drop in success rates after the age of 40, particularly in cycles without PGT-A testing.
The implementation of blastocyst stage biopsy, time-lapse imaging, and the use of artificial intelligence for embryo selection are among the technologies introduced to enhance the lab’s capabilities. These advancements have enabled more information for better embryo selection and to implementation of a single embryo transfer strategy.
We believe in the benefits of preimplantation genetic testing for aneuploidy (PGT-A), not only because it improves implantation rates per embryo transfer but also because it is cost-effective. It reduces the treatment time and minimizes the risk of failed embryo transfer and pregnancy loss.
In general, all these changes in the IVF laboratory paved the way for single embryo transfer. With double embryo transfer, the possibility of having a twin pregnancy is higher, which might result in a series of fetal and maternal complications that can persist throughout childhood. Fetal complications are related to intrauterine growth restriction, while maternal complications cater to diseases such as diabetes and hypertension. The principal complications are based on the risk of premature delivery.
Considering that maternal age is the most important factor that affects the quality of the oocytes, all efforts are focused on obtaining euploid embryos. The number of mature oocytes that can be retrieved is still a clinical challenge for responders.
We have been working on strategies to have more oocytes available for an IVF cycle. One of the strategies is the accumulation of oocytes, made possible because of the high survival rates after thawing. This allowed us to do the accumulation of oocytes to get more for an IVF cycle. Dual stimulation is another promising strategy for patients with a low response. Two stimulations are performed during the same month, the first one in the follicular phase, and a few days after, retrieve all and start a new stimulation. We identify the corresponding individualization of ovarian stimulation, control of new stimulation, and the best approach. This gives a better chance of success and the best luteal phase support.