AMSTERDAM — New embryo transfer guidelines are expected soon from the American Society for Reproductive Medicine, prompted in part by the birth of the California octuplets earlier this year, according to Dr. David Adamson, immediate past president of the society.
The guidelines will “unquestionably lower the number of embryos transferred or modify how choices are made,” with the goal of further reducing the risk of multiple births, he said in an interview.
Despite considerable pressure to tighten the guidelines in the wake of the octuplets' delivery, the ASRM must carefully protect its vision of individualized patient treatment, Dr. Adamson said at the annual meeting of the European Society of Human Reproduction and Embryology.
“There certainly has been some perspective in the media and elsewhere that, because this occurred, there should be more regulation on the number of embryos transferred, but my perspective is that this was an extreme outlier and you don't want to make regulation based on extreme exceptions to the rule,” said Dr. Adamson, who is in private practice in Palo Alto, Calif. “It's impossible for any regulation, no matter how rigorous, to prevent sociopathic, psychopathic, illegal, or just plain crazy behavior.”
Nevertheless, the new guidelines, expected less than a year since the last ones were issued, reflect the ASRM's awareness of the need to tackle the problem of multiple births more aggressively.
While European experts released figures at the meeting showing that in 2006 twin deliveries resulting from assisted reproductive technologies in Europe dipped below 20% for the first time, the latest U.S. figures (2007) show the rate of IVF twin pregnancies at 33% in women under age 35, 28% in the 35- to 37-year-old age group, 22% in women aged 38–40, and 15% in the over 40 age group.
In the United States, elective single embryo transfer (SET) was performed in just 4.5% of cycles in women under age 35, dropping to 2.6% in women aged 35–37, 1% in those aged 38–40, and 0.3% in those over the age of 40.
In contrast, SET comprised 67% of all transfers in Sweden, where the practice is mandatory in women under age 40, said Dr. Adamson.
“But the average Swedish patient is 30 years old, and treatment is covered by the state,” he commented. “In the U.S. patients are 5 or 6 years older, they've had infertility for much longer, and they have to pay.”
Compared to laws and guidelines in many European countries, the current ASRM guidelines are more vague and less ambitious. For example, the ASRM guidelines simply state that “consideration should be given” to SET in women who are under the age of 35 and have a good chance of getting pregnant. But there is more emphasis placed on double embryo transfer, and the door is left open for the transfer of even more embryos, depending on the age of the patient and the prognosis.
While he said that the U.S. twin pregnancy rate following IVF needs to come down, Dr. Adamson added that this should not be at the cost of removing the ASRM's individualized approach to care.
“The risks are higher for twins and for their mothers, but they are not so high that twins are necessarily always a bad outcome. Clearly, the objective is a healthy singleton baby, but we have to make sure we don't reduce the overall quality of care by trying to make the twin rate 0% because that won't happen unless no one becomes pregnant,” he said.
Dr. Adamson receives research funding from Institut Biochimique SA and EMD Serono Inc.