The Single Embryo debate
Meet Dr Dean Morbeck, Scientific Director at Fertility Associates in New Zealand and Sunfert International Fertility Centre in Malaysia, which combined have 10 fertility clinics in the two countries. Prior to moving to New Zealand, he was an Associate Professor at the Mayo Clinic for 10 years. He is an internationally recognized expert on quality in the IVF laboratory, having published more than 40 papers, numerous book chapters and is the coeditor of a book that is a practical guide for embryologists. He is taking his passion and expertise for the science of IVF beyond the laboratory to engage with patients with the goal to improve the patient experience.
In his spare time, Dean has written many research papers, book chapters and is the co-author of a practical guide for Embryologists.
If that wasn’t enough, in 2010 Dean is also starting a Podcast with the aim of improving the patient experience, called "The Fertility Patient Revolution". Look for it in 2020!
Single embryo transfer vs Multiple
We interview Dean while he is at the American Society for Reproductive Medicine conference (ARSM) in the US, and he talks about his views on single embryo transfer vs multiple. In the US this is the first year that has seen a decrease in twin rate in both natural pregnancy and IVF.
As a clinician, this is the preferred outcome to reduce the risks associated with multiple births. Twin pregnancies result in 8 times the risk of complications to both mother and baby but also an increased financial and time burden once the babies are born. New Zealand has seen less than 10% twin rate overall.
The IVF League Tables
Dean has recently been reviewing the HFEA data for individual clinics in the UK and was surprised to see a number of clinics with high twin rates of 20% or higher. He feels there is a trade-off between clinics desiring high pregnancy rates and therefore an increase in twin pregnancy rate. Dean’s impression is that patients are attracted to clinics high pregnancy rates but may not necessarily take on board the resulting twin pregnancy rate and what this might mean for adverse pregnancy outcomes.
Increasing the chances of success
In New Zealand 97% patients receive a single embryo transfer, however in particular clinical situations, women may receive a double embryo transfer. However Dean states that it is a myth that transferring more than one embryo increases the chances of success, you actually have the same or higher by transferring single embryos consecutively. Dean feels that it is critical that patients receive the right information at the right time to help them make informed decisions based on the risks associated with twin pregnancies.
Changing the narrative
Dean is noticing a sea change globally and in particular in the US, with regards to an increase in single embryo transfers. This increase is impart, as a result of greater success with frozen embryo cycles.
Dean is also seeing more focus globally on supporting the patient and in particular supporting the couple and their relationship. Managing the expectations of a couples treatment is also vital, particularly with regards to the success rates of an initial cycle.
The multiple births foundation - as referred to in this episode
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