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Assessment of the Field of Assisted n: In V tio itro za li - Brown et al., JFIV Reprod Med Genet 2015, 3:3 I ti V r F e - F W f o Journal of Fertilization : In Vitro, IVF-Worldwide, DOI: 10.4172/2375-4508.1000156 o r l l d a w n r i d u e o J ISSN: 2375-4508 Reproductive Medicine, Genetics & Stem Cell Biology Review Article Assessment of the Field of Assisted Reproductive Technology: Improvements and the Future of Human In Vitro Fertilization Elizabeth G Brown, Sanam T Shahrooz, Sannah S Vasaya, Shahrad Shadman and G Ian Gallicano* Department of Biochemistry and Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC 20057, USA Abstract In vitro fertilization (IVF), a form of assisted reproductive technology, has expanded since its introduction in the 1970’s to enable patients with prolonged infertility and/or clinical complications to produce biological offspring. This review analyzes the topics of controversy surrounding IVF, weighing evidence concerning contemporary fertility techniques that aim to advance the field of IVF. A comparison of single embryo transfer to double embryo transfer, in the context of economic expenditure and the likelihood of multiple pregnancy, provides support for electing the former. An ethically controversial topic is preimplantation genetic screening, a technology with the potential to reduce the incidence of genetic abnormalities, thereby increasing rates of healthy pregnancies. Lastly, the integration of in vitro maturation (IVM) can allow for a more diverse patient population to benefit from IVF treatment, while simultaneously avoiding several of the associated disadvantages. The future of IVF rests on continued research, and the resulting widespread integration of increasingly effective methods. Keywords: Embryo transfer; Insurance coverage of infertility; The use of one embryo to achieve pregnancy is specifically known Outcome prediction models; Preimplantation genetic screening; In as ‘single embryo transfer’ (SET) and a single fetus brought to term vitro maturation; Polycystic ovarian syndrome is designated a singleton pregnancy [5]. Another procedure to assist in fertility is intra-cytoplasmic sperm injection (ICSI), an application Abbreviations: aCGH: Array Comparative Genomic Hybridization; of ART designed for male-factor infertility. ICSI, insertion of sperm AMA: Advanced Maternal Age; ART: Assisted Reproductive directly into the oocyte as to avoid the many obstacles the sperm Technology; ASRM: American Society for Reproductive Medicine; encounter naturally, may be used concomitantly to or in place of IVF, DET: Double Embryo Transfer; E2: Estradiol; eDET: Elective Double depending on the patient circumstances [5,6]. Embryo Transfer; eSET: Elective Single Embryo Transfer; ES-IVM – Estrogen Suppresed In Vitro Maturation; ET: – Embryo Transfer; Preimplantation genetic screening (PGS), a profiling technique FISH: Fluorescence In Situ Hybridization; FSH: Follicle-Stimulating that screens for specific genetic diseases and aneuploidy (abnormal Hormone; GnRH: Gonadotrophin-Releasing Hormone; hCG: Human chromosome number) prior to embryo implantation, is partially Chorionic Gonadotrophin; ICSI: Intra-Cytoplasmic Sperm Injection; responsible for the popularity of IVF among both fertile and infertile IVF: In Vitro Fertilization; IVM: In Vitro Maturation; LH: Luteinizing couples. In vitro maturation (IVM), an emerging variation to IVF in Hormone; MET: Multiple Embryo Transfer; NHS: National Health which the oocyte is not only fertilized but also matured outside of the Service; NICE: National Institute for Clinical Excellence; OHSS: uterus, has also broadened the field by enabling women with a variety Ovarian Hyperstimulation Syndrome; PCOS: Polycystic Ovarian of contraindications to standard IVF, including women with polycystic Syndrome; PCR: Polymerase Chain Reaction; PGD: Preimplantation ovarian syndrome (PCOS) or cancer patients undergoing chemotherapy, Genetic Diagnosis; PGD-AS: Preimplantation Genetic Diagnosis with to take advantage of ART [7-10]. Despite the excitement surrounding Aneuploidy Screening; PGS: Preimplantation Genetic Screening; POF: IVF, the use of multiple embryo transfer (MET), introducing more Premature Ovarian Failure; SART: Society for Assisted Reproductive than one embryo during the IVF procedure (with emphasis here on Technology; SET: Single Embryo Transfer; SGDs: Single-Gene double embryo transfer (DET)), significantly improves the probability Disorders; US: United States of multiple pregnancy, which is defined as the delivery of two or more Introduction infants with at least one born alive [11]. Multiple gestations introduces various potential complications to both mother and child, ensuing costs, The emergence of assisted reproductive technology (ART) and in as well as increases the risk of prematurity and intrauterine growth vitro fertilization (IVF) was marked by the birth of Louise Brown in restriction among others, hence the ensuing skepticism regarding a 1978 in the United Kingdom following the materialization of assisted MET approach to IVF. reproduction in the 1960s and 70s [1,2]. Shortly thereafter, crucial developments were made within this field. Although ART, defined as a treatment for both fertile and presumed infertile patients during which both the eggs and sperm are processed in order to establish *Corresponding author: G. Ian Gallicano, Department of Biochemistry a viable pregnancy, is predominantly used for infertility treatments, and Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC 20057, USA, Tel: 2026870228; E-mail: [email protected] it has also developed into a suitable option for fertile couples with a familial history of inheritable genetic conditions [3]. ART consists Received July 14, 2015; Accepted August 18, 2015; Published August 25, 2015 of varied approaches, with IVF recognized as a prominent method, Citation: Brown EG, Shahrooz ST, Vasaya SS, Shadman S, Gallicano GI (2015) responsible for over 99% of the 176,247 total ART cycles [4]. In Assessment of the Field of Assisted Reproductive Technology: Improvements and the Future of Human In Vitro Fertilization. JFIV Reprod Med Genet 3: 156. IVF, harvested eggs and sperm are introduced in vitro to initiate doi:10.4172/2375-4508.1000156 fertilization and ultimately, embryo development. Once the embryo matures to either the cleavage (day 2-3) or the blastocyst (day 5-6) Copyright: © 2015 Brown EG, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits stage, it is transferred to the mother’s uterus with the ultimate goal unrestricted use, distribution, and reproduction in any medium, provided the of implantation within the uterine lining and initiation of pregnancy. original author and source are credited. JFIV Reprod Med Genet Volume 3 • Issue 3 • 1000156 ISSN: 2375-4508 JFIV, an open access journal Citation: Brown EG, Shahrooz ST, Vasaya SS, Shadman S, Gallicano GI (2015) Assessment of the Field of Assisted Reproductive Technology: Improvements and the Future of Human In Vitro Fertilization. JFIV Reprod Med Genet 3: 156. doi:10.4172/2375-4508.1000156 Page 2 of 10 SET versus DET and MET The enhanced likelihood of adverse outcomes due to multiple pregnancies following DET prompted researchers to generate a Multiple pregnancy and MET mathematical model, the Combined Formula, to predict pregnancy A challenge in IVF is selecting the appropriate number of outcomes using only implantation rates and the number of embryos embryos for uterine transfer in order to both enhance the pregnancy transferred. The Combined Formula was applied to data from rate and reduce the chance of multiple pregnancy. The frequent use multiple IVF centers to predict either failed or multiple pregnancy, of DET is partially attributed to a higher probability of implantation with an error rate of 1.4% [15]. Estimation of the implantation rate, and pregnancy simply due to the fact that an additional embryo is the total number of viable fetal heartbeats divided by the total number transferred [12]. However, the potential for both embryos to implant is of embryos transferred, can drive the course of treatment to attain higher, leading to a greater incidence of multiple pregnancy [13]. From the desirous outcome. For example, this study suggests that a high a patient’s standpoint, the exhaustive process of IVF would ideally be implantation rate combined with an increased number of transferred completed in one cycle, which may explain the frequency with which embryos substantially heightens the risk of multiple pregnancies while DET is opted for, especially among patients struggling with infertility insignificantly affecting the overall frequency of pregnancy [15]. who want to maximize their chance of implantation [12]. A 2006 As the issue of multiple pregnancies becomes an increasingly Canadian study showed that DET was utilized in 55.8% of all ART relevant public health concern [16], researchers are putting more focus procedures, with 46% of all births attributable to multiple pregnancy. on the development of models capable of predicting the outcome Not only was there a high rate of twin births, but, when compared with of a given pregnancy, based on certain characteristics identified as singletons conceived via IVF, twins showed a 10-fold increased risk of indicators of either adverse or favorable ART results. As Dr. Hunault preterm delivery (<37 weeks), a 7-fold increased risk of delivery prior and colleagues stated, “The
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