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Anonymous asked:
Any comments on 5 embryos being transfered into a 40+ y/o woman using intra-fallopian transfer?

Well, Anonymous, I'm glad you asked if I had any "comments" vs. "opinions". Because obviously I don't know the specifics of the circumstances, so I'll comment, but only because you asked, and please do bear in mind that I know absolutely nothing about the situation at hand.

Now that I have that out of the way, there's another important thing to point out. You don't say if this was Gamete Intra-Fallopian Transfer or Zygote Intra-Fallopian Transfer. Actually, I take that back - you said embryos. So I guess it's Zygote. Though, do bear in mind that with ZIFT the fertilized eggs, as far as I understand, are transferred into the fallopian tubes immediately after fertilization, before they've had any time to develop in the laboratory environment.

You say that the woman is 40+ y/o, but you don't give any additional information. Were they HER eggs used? Had she had previous ART failures? What is the reason for her doing ZIFT vs. IVF?

I've actually never known anyone to do ZIFT for any reason. I don't know why anyone would. I do know people who have done GIFT for various reasons - the primary reason being religious reasons that bar in vitro fertilization, but would permit fertilization to occur within the woman's body where medically chances would still be greater by going through egg retrieval for whatever reason. Still, GIFT and ZIFT are becoming a far less popular. Many clinics don't even offer ZIFT at all (and many also don't even offer GIFT either). Actually, even the people I know who have had GIFT - well, I don't know anyone who's had a successful GIFT cycle (and like I said, I don't know anyone who's done a zygote transfer at all).

My quick little bit of research with Dr. Google suggests that the "normal" number of embryos to transfer in a ZIFT cycle is between one and four. So five is out of that range, but not significantly. Further, the success rate with ZIFT is approximately 26% and the chance of multiple gestation if you do get pregnant is 35%. My guess is that there's also a slightly higher rate of ectopic pregnancy with ZIFT than with IVF also, but of course IVF raises your rate of ectopic pregnancy over spontaneous pregnancy anyway.

Frankly, I can't find a single article via Dr. Google that suggests any reason for doing ZIFT over IVF. Does anyone know? I can understand the reasons for doing GIFT, but ZIFT? It's more expensive, more risky, less successful, has a high rate of multiple pregnancy when you do have a successful pregnancy (not very often), involves invasive surgery, and doesn't have the advantage that GIFT has of having fertilization inside the body thereby avoiding the ethical/religious issue that IVF has for some people. So what gives?

Oh! I *just* found one thing suggesting a reason to do ZIFT. ONE! From the Huntington Reproductive Center:

The use of ZIFT is not that widespread. However, at HRC we have leaned towards performing ZIFT on a select group of patients because early on we noticed an increase in pregnancy rates especially amongst older patients and those with unexplained infertility.HRC's overall take home baby rate for 500 egg retrievals performed for ZIFT is 48%. This elivered rate includes 81 egg retrievals performed on patients over 40 years of age.

The above data suggests that at our center patients who have had multiple failed IVF cycles or who have patent tubes but are older should consider ZIFT/TET as a treatment option. It is possible that the fallopian tube may have the capacity to rescue "marginal embryos" as well as allowing the developing embryos to remain in the tube and then as in a natural pregnancy move into the uterus at the appropriate physiological time for implantation.

At last! A reason!

Okay, so let's assume this 40+yo woman has had multiple failed IVF cycles and she has marginal embryos. Let's also remember that the ASRM/SART guidelines for IVF (and I can only assume that they'd be the same for GIFT) for a woman that age is to not transfer more than five embryos in a cycle. So five embryos is within those guidelines.

Would I do it? Would I take that risk? No. But I'm 33, and I already have kids, so it's easy for me to say, isn't it? I've also had a set of HOMs and I'm flat out petrified of that happening again, but the risk of HOMs in a woman over 40 is much lower, because, frankly, the pregnancy rate is much lower. So I don't have the same circumstances.

SO... all that being said - I'll have to assume that this mystery 40+y.o.'s doctor was acting responsibly with her best interests in mind with the best available medical literature at his or her fingertips. And I wish her the best of luck and a healthy SINGLETON pregnancy as a result.

I'm filing this under "FAQ's" even though, clearly, this is not a frequently asked question.