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Published in: Journal of Assisted Reproduction and Genetics 2/2017

01-02-2017 | Assisted Reproduction Technologies

Embryo wastage rates remain high in assisted reproductive technology (ART): a look at the trends from 2004–2013 in the USA

Authors: Sanaz Ghazal, Pasquale Patrizio

Published in: Journal of Assisted Reproduction and Genetics | Issue 2/2017

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Abstract

This work examined the trend in “embryo wastage” rates after ART in USA and its relationship to the number of embryos transferred, live born infants delivered across patient age, and the yearly percentage of embryos wasted. The data were obtained from the US-clinics SART databank for the years 2004–2013. A total of 1,808,082 non-donor embryos were transferred in 748,394 fresh cycles resulting in 358,214 liveborn. During the years of analysis, the mean number of embryos transferred has progressively decreased leading to an overall significant decrease in Embryo Wastage rates (83.2 to 76.5%, p < 0.001) while the percentage of transfers leading to a live born increased (24.8 to 27.8%, p = 0.002). Embryo Wastage negatively correlated with percentage of transfers resulting in live birth (p = 0.001), and the average number of embryos transferred positively correlated with the percentage of embryos wasted (p < 0.001). The overwhelming majority of embryos transferred still do not result into a live birth confirming that only few embryos per ART cycle are competent. The overall “Embryo Wastage” rates have consistently decreased from a high of 90% in 1995 to a rate of 76.5% in 2013. Transferring fewer embryos particularly at the blastocyst-stage and improved methods of embryo selection may further decrease “Embryo Wastage” rates.
Literature
2.
go back to reference Patrizio P, Bianchi V, Lalioti MD, Gerasimova T, Sakkas D. High rate of biological loss in assisted reproduction: it is in the seed, not in the soil. Reprod Biomed Online. 2007;14(1):92–5.CrossRefPubMed Patrizio P, Bianchi V, Lalioti MD, Gerasimova T, Sakkas D. High rate of biological loss in assisted reproduction: it is in the seed, not in the soil. Reprod Biomed Online. 2007;14(1):92–5.CrossRefPubMed
3.
go back to reference Patrizio P, Sakkas D. From oocyte to baby: a clinical evaluation of the biological efficiency of in vitro fertilization. Fertil Steril. 2009;91(4):1061–6.CrossRefPubMed Patrizio P, Sakkas D. From oocyte to baby: a clinical evaluation of the biological efficiency of in vitro fertilization. Fertil Steril. 2009;91(4):1061–6.CrossRefPubMed
4.
go back to reference Kovalevsky G, Patrizio P. High rates of embryo wastage with use of assisted reproductive technology: a look at the trends between 1995 and 2001 in the United States. Fertil Steril. 2005;84(2):325–30.CrossRefPubMed Kovalevsky G, Patrizio P. High rates of embryo wastage with use of assisted reproductive technology: a look at the trends between 1995 and 2001 in the United States. Fertil Steril. 2005;84(2):325–30.CrossRefPubMed
5.
go back to reference Scott Jr RT, Hofmann GE, Veeck LL, Jones Jr HW, Muasher SJ. Embryo quality and pregnancy rates in patients attempting pregnancy through in vitro fertilization. Fertil Steril. 1991;55(2):426–8.CrossRefPubMed Scott Jr RT, Hofmann GE, Veeck LL, Jones Jr HW, Muasher SJ. Embryo quality and pregnancy rates in patients attempting pregnancy through in vitro fertilization. Fertil Steril. 1991;55(2):426–8.CrossRefPubMed
6.
go back to reference Shulman A, Ben-Nun I, Ghetler Y, Kaneti H, Shilon M, Beyth Y. Relationship between embryo morphology and implantation rate after in vitro fertilization treatment in conception cycles. Fertil Steril. 1993;60(1):123–6.CrossRefPubMed Shulman A, Ben-Nun I, Ghetler Y, Kaneti H, Shilon M, Beyth Y. Relationship between embryo morphology and implantation rate after in vitro fertilization treatment in conception cycles. Fertil Steril. 1993;60(1):123–6.CrossRefPubMed
7.
go back to reference Sandalinas M, Sadowy S, Alikani M, Calderon G, Cohen J, Munne S. Developmental ability of chromosomally abnormal human embryos to develop to the blastocyst stage. Hum Reprod. 2001;16:1954–8.CrossRefPubMed Sandalinas M, Sadowy S, Alikani M, Calderon G, Cohen J, Munne S. Developmental ability of chromosomally abnormal human embryos to develop to the blastocyst stage. Hum Reprod. 2001;16:1954–8.CrossRefPubMed
8.
go back to reference Rubio I, Galan A, Larreategui Z, Ayerdi F, Bellver J, Herrero J, et al. Clinical validation of embryo culture and selection by morphokinetic analysis: a randomized, controlled trial of the EmbryoScope. Fertil Steril. 2014;102(5):1287–94.CrossRefPubMed Rubio I, Galan A, Larreategui Z, Ayerdi F, Bellver J, Herrero J, et al. Clinical validation of embryo culture and selection by morphokinetic analysis: a randomized, controlled trial of the EmbryoScope. Fertil Steril. 2014;102(5):1287–94.CrossRefPubMed
9.
go back to reference Kaser DJ, Racowsky C. Clinical outcomes following selection of human preimplantation embryos with time-lapse monitoring: a systematic review. Hum Reprod Update. 2014;20(5):617–31.CrossRefPubMed Kaser DJ, Racowsky C. Clinical outcomes following selection of human preimplantation embryos with time-lapse monitoring: a systematic review. Hum Reprod Update. 2014;20(5):617–31.CrossRefPubMed
10.
go back to reference Armstrong S, Arroll N, Cree LM, Hordan V, Farquhar C. Time-lapse systems for embryo incubation and assessment in assisted reproduction. Cochrane Database Syst Rev. 2015;2:CD011320. Armstrong S, Arroll N, Cree LM, Hordan V, Farquhar C. Time-lapse systems for embryo incubation and assessment in assisted reproduction. Cochrane Database Syst Rev. 2015;2:CD011320.
11.
go back to reference Racowsky C, Kovacs P, Martins WP. A critical appraisal of time-lapse imaging for embryo selection: where are we and where do we need to go? J Assist Reprod Genet. 2015;32:1025–30.CrossRefPubMedPubMedCentral Racowsky C, Kovacs P, Martins WP. A critical appraisal of time-lapse imaging for embryo selection: where are we and where do we need to go? J Assist Reprod Genet. 2015;32:1025–30.CrossRefPubMedPubMedCentral
12.
go back to reference Kirkegaard K, Ahlstrom A, Ingerslev JH, Hardarson T. Choosing the best embryo by time lapse versus standard morphology. Fertil Steril. 2015;103(2):323–32.CrossRefPubMed Kirkegaard K, Ahlstrom A, Ingerslev JH, Hardarson T. Choosing the best embryo by time lapse versus standard morphology. Fertil Steril. 2015;103(2):323–32.CrossRefPubMed
13.
go back to reference Goodman LR, Goldberg J, Falcone T, Austin C, Desai N. Does the addition of time-lapse morphokinetics in the selection of embryos for transfer improve pregnancy rates? A randomized controlled trial. Fertil Steril. 2016;105(2):275–85.CrossRefPubMed Goodman LR, Goldberg J, Falcone T, Austin C, Desai N. Does the addition of time-lapse morphokinetics in the selection of embryos for transfer improve pregnancy rates? A randomized controlled trial. Fertil Steril. 2016;105(2):275–85.CrossRefPubMed
14.
go back to reference Wu YG, Lazzaroni-Tealdi E, Wang Q, Zhang L, Barad DH, Kushnir VA, et al. Different effectiveness of closed embryo culture system with time-lapse imaging in comparison to standard manual embryology in good and poor prognosis patients: a prospectively randomized pilot study. Reprod Biol Endocrinol. 2016;14(1):49.CrossRefPubMedPubMedCentral Wu YG, Lazzaroni-Tealdi E, Wang Q, Zhang L, Barad DH, Kushnir VA, et al. Different effectiveness of closed embryo culture system with time-lapse imaging in comparison to standard manual embryology in good and poor prognosis patients: a prospectively randomized pilot study. Reprod Biol Endocrinol. 2016;14(1):49.CrossRefPubMedPubMedCentral
15.
go back to reference Scott Jr RT, Upham KM, Forman EJ, Hong KH, Scott KL, Taylor D, et al. Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial. Fertil Steril. 2013;100(3):697–703.CrossRefPubMed Scott Jr RT, Upham KM, Forman EJ, Hong KH, Scott KL, Taylor D, et al. Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial. Fertil Steril. 2013;100(3):697–703.CrossRefPubMed
16.
go back to reference Franasiak JM, Forman EJ, Hong KH, Werner MD, Upham KM, Treff NR, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril. 2014;101(3):656–63.CrossRefPubMed Franasiak JM, Forman EJ, Hong KH, Werner MD, Upham KM, Treff NR, et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril. 2014;101(3):656–63.CrossRefPubMed
17.
go back to reference Forman EJ, Hong KH, Franasiak JM, Scott Jr RT. Obstetrical and neonatal outcomes from the BEST Trial: single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates. Am J Obstet Gynecol. 2014;210(2):157.e1–6.CrossRef Forman EJ, Hong KH, Franasiak JM, Scott Jr RT. Obstetrical and neonatal outcomes from the BEST Trial: single embryo transfer with aneuploidy screening improves outcomes after in vitro fertilization without compromising delivery rates. Am J Obstet Gynecol. 2014;210(2):157.e1–6.CrossRef
18.
go back to reference Murugappan G, Ohno MS, Lathi RB. Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss. Fertil Steril. 2015;103(5):1215–20.CrossRefPubMed Murugappan G, Ohno MS, Lathi RB. Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss. Fertil Steril. 2015;103(5):1215–20.CrossRefPubMed
19.
go back to reference Mastenbroek S, Twisk M, van der Vein F, Repping S. Preimplantation genetic screening: a systematic review and meta-analysis of RCTs. Hum Reprod. 2011;17(4):454–66.CrossRef Mastenbroek S, Twisk M, van der Vein F, Repping S. Preimplantation genetic screening: a systematic review and meta-analysis of RCTs. Hum Reprod. 2011;17(4):454–66.CrossRef
20.
go back to reference Brezina PR, Kutteh WH. Clinical applications of preimplantation genetic testing. BMJ. 2015;350:7611.CrossRef Brezina PR, Kutteh WH. Clinical applications of preimplantation genetic testing. BMJ. 2015;350:7611.CrossRef
21.
go back to reference Greco E, Minasi MG, Fiorentino F. Healthy babies after intrauterine transfer of mosaic aneuploid blastocysts. N Engl J Med. 2015;373(21):2089–90.CrossRefPubMed Greco E, Minasi MG, Fiorentino F. Healthy babies after intrauterine transfer of mosaic aneuploid blastocysts. N Engl J Med. 2015;373(21):2089–90.CrossRefPubMed
22.
go back to reference Orvieto R, Shuly Y, Brengauz M, Feldman B. Should pre-implantation genetic screening be implemented to routine clinical practice? Gynecol Endocrinol. 2016;32(6):506–8.CrossRefPubMed Orvieto R, Shuly Y, Brengauz M, Feldman B. Should pre-implantation genetic screening be implemented to routine clinical practice? Gynecol Endocrinol. 2016;32(6):506–8.CrossRefPubMed
23.
go back to reference Gleicher N, Vidali A, Braverman J, Kushnir VA, Barad DH, Hudson C, et al. Accuracy of preimplantation genetic screening (PGS) is compromised by degree of mosaicism of human embryos. Reprod Biol Endocrinol. 2016;14(1):54.CrossRefPubMedPubMedCentral Gleicher N, Vidali A, Braverman J, Kushnir VA, Barad DH, Hudson C, et al. Accuracy of preimplantation genetic screening (PGS) is compromised by degree of mosaicism of human embryos. Reprod Biol Endocrinol. 2016;14(1):54.CrossRefPubMedPubMedCentral
24.
go back to reference Katz-Jaffe MG, Gardner DK, Schoolcraft WB. Proteomic analysis of individual human embryos to identify novel biomarkers of development and viability. Fertil Steril. 2006;85(1):101–7.CrossRefPubMed Katz-Jaffe MG, Gardner DK, Schoolcraft WB. Proteomic analysis of individual human embryos to identify novel biomarkers of development and viability. Fertil Steril. 2006;85(1):101–7.CrossRefPubMed
25.
go back to reference Katz-Jaffe MG, McReynolds S, Gardner KD, Schoolcraft WB. The role of proteomics in defining the human embryonic secretome. Mol Hum Reprod. 2009;15(5):271–7.CrossRefPubMedPubMedCentral Katz-Jaffe MG, McReynolds S, Gardner KD, Schoolcraft WB. The role of proteomics in defining the human embryonic secretome. Mol Hum Reprod. 2009;15(5):271–7.CrossRefPubMedPubMedCentral
26.
go back to reference Krisher RL, Schoolcraft WB, Katz-Jaffe MG. Omics as a window to view embryo viability. Fertil Steril. 2015;103(2):333–41.CrossRefPubMed Krisher RL, Schoolcraft WB, Katz-Jaffe MG. Omics as a window to view embryo viability. Fertil Steril. 2015;103(2):333–41.CrossRefPubMed
27.
go back to reference Fragouli E, Wells D, Iager AE, Kayisli UA, Patrizio P. Alteration of gene expression in human cumulus cells as a potential indicator of oocyte aneuploidy. Hum Reprod. 2012;27(8):2559–68.CrossRefPubMed Fragouli E, Wells D, Iager AE, Kayisli UA, Patrizio P. Alteration of gene expression in human cumulus cells as a potential indicator of oocyte aneuploidy. Hum Reprod. 2012;27(8):2559–68.CrossRefPubMed
28.
go back to reference Practice Committee of the Society for Assisted Reproductive Technology and Practice Committee of the American Society for Reproductive Medicine. Elective single-embryo transfer. Fertil Steril. 2012;97:835–42.CrossRef Practice Committee of the Society for Assisted Reproductive Technology and Practice Committee of the American Society for Reproductive Medicine. Elective single-embryo transfer. Fertil Steril. 2012;97:835–42.CrossRef
29.
go back to reference Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Criteria for number of embryos to transfer: a committee opinion. Fertil Steril. 2013;99:44–6.CrossRef Practice Committee of the American Society for Reproductive Medicine and the Practice Committee of the Society for Assisted Reproductive Technology. Criteria for number of embryos to transfer: a committee opinion. Fertil Steril. 2013;99:44–6.CrossRef
30.
go back to reference Practice Committee of the American Society for Reproductive Medicine. Multiple gestations associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion. Fertil Steril. 2012;97:825–34.CrossRef Practice Committee of the American Society for Reproductive Medicine. Multiple gestations associated with infertility therapy: an American Society for Reproductive Medicine Practice Committee opinion. Fertil Steril. 2012;97:825–34.CrossRef
31.
go back to reference Ombelet W, de Sutter P, van der Elst J, Martens G. Multiple gestation and infertility treatment: registration, reflection and reaction—the Belgian project. Hum Reprod Update. 2005;11:3–14.CrossRefPubMed Ombelet W, de Sutter P, van der Elst J, Martens G. Multiple gestation and infertility treatment: registration, reflection and reaction—the Belgian project. Hum Reprod Update. 2005;11:3–14.CrossRefPubMed
32.
go back to reference Johnston J, Gusmano MK, Patrizio P. Multiple births following fertility treatments: causes, consequences and opportunities for changes. Fertil Steril. 2014;102(1):36–9.CrossRefPubMed Johnston J, Gusmano MK, Patrizio P. Multiple births following fertility treatments: causes, consequences and opportunities for changes. Fertil Steril. 2014;102(1):36–9.CrossRefPubMed
33.
go back to reference Helmerhorst FM, Perquin DA, Donker D, Keirse MJ. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004;328(7434):261.CrossRefPubMedPubMedCentral Helmerhorst FM, Perquin DA, Donker D, Keirse MJ. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004;328(7434):261.CrossRefPubMedPubMedCentral
34.
go back to reference Harton GL, Munne S, Surrey M, Grifo J, Kaplan B, McCulloh DH, et al. PGD Practitioners Group. Diminished effect of maternal age on implantation after preimplantation genetic diagnosis with array comparative genomic hybridization. Fertil Steril. 2013;100(6):1695–703.CrossRefPubMed Harton GL, Munne S, Surrey M, Grifo J, Kaplan B, McCulloh DH, et al. PGD Practitioners Group. Diminished effect of maternal age on implantation after preimplantation genetic diagnosis with array comparative genomic hybridization. Fertil Steril. 2013;100(6):1695–703.CrossRefPubMed
35.
go back to reference Glujovsky D, Blake D, Farquhar C, Bardach A. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2012;7:CD002118. Glujovsky D, Blake D, Farquhar C, Bardach A. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev. 2012;7:CD002118.
36.
go back to reference Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev 2016; (6):CD002118 Glujovsky D, Farquhar C, Quinteiro Retamar AM, Alvarez Sedo CR, Blake D. Cleavage stage versus blastocyst stage embryo transfer in assisted reproductive technology. Cochrane Database Syst Rev 2016; (6):CD002118
37.
go back to reference Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, et al. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Hum Reprod. 2007;22(4):980–8.CrossRefPubMed Baart EB, Martini E, Eijkemans MJ, Van Opstal D, Beckers NG, Verhoeff A, et al. Milder ovarian stimulation for in-vitro fertilization reduces aneuploidy in the human preimplantation embryo: a randomized controlled trial. Hum Reprod. 2007;22(4):980–8.CrossRefPubMed
38.
go back to reference Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update. 2009;15(1):5–12.CrossRefPubMed Verberg MF, Eijkemans MJ, Macklon NS, Heijnen EM, Baart EB, Hohmann FP. The clinical significance of the retrieval of a low number of oocytes following mild ovarian stimulation for IVF: a meta-analysis. Hum Reprod Update. 2009;15(1):5–12.CrossRefPubMed
39.
go back to reference Verberg MF, Macklon NS, Nargund G, Frydman R, Devroey P, Broekmans FJ, et al. Mild ovarian stimulation for IVF. Hum Reprod Update. 2009;15(1):13–29.CrossRefPubMed Verberg MF, Macklon NS, Nargund G, Frydman R, Devroey P, Broekmans FJ, et al. Mild ovarian stimulation for IVF. Hum Reprod Update. 2009;15(1):13–29.CrossRefPubMed
40.
go back to reference Polinder S, Heijnen EM, Macklon NS, Habbema JD, Fauser BJ, Eijkemans MJ. Cost-effectiveness of a mild compared with a standard strategy for IVF: a randomized comparison using cumulative term live birth as the primary endpoint. Hum Reprod. 2008;23(2):316–23.CrossRefPubMed Polinder S, Heijnen EM, Macklon NS, Habbema JD, Fauser BJ, Eijkemans MJ. Cost-effectiveness of a mild compared with a standard strategy for IVF: a randomized comparison using cumulative term live birth as the primary endpoint. Hum Reprod. 2008;23(2):316–23.CrossRefPubMed
41.
go back to reference Fauser BC, Devroey P, Yen SS, Gosden R, Crowley Jr WF, Baird DT, et al. Minimal ovarian stimulation for IVF: appraisal of potential benefits and drawbacks. Hum Reprod. 1999;14(11):2681–6.CrossRefPubMed Fauser BC, Devroey P, Yen SS, Gosden R, Crowley Jr WF, Baird DT, et al. Minimal ovarian stimulation for IVF: appraisal of potential benefits and drawbacks. Hum Reprod. 1999;14(11):2681–6.CrossRefPubMed
42.
go back to reference Rubio C, Mercader A, Alama P, Lizan C, Rodrigo L, Labarta E, et al. Prospective cohort study in high responder oocyte donors using two hormonal stimulation protocols: impact on embryo aneuploidy and development. Hum Reprod. 2010;25(9):2290–7.CrossRefPubMed Rubio C, Mercader A, Alama P, Lizan C, Rodrigo L, Labarta E, et al. Prospective cohort study in high responder oocyte donors using two hormonal stimulation protocols: impact on embryo aneuploidy and development. Hum Reprod. 2010;25(9):2290–7.CrossRefPubMed
43.
go back to reference Pereira N, Rosenwaks Z. A fresh(er) perspective on frozen embryo transfer. Fertil Steril. 2016;106(2):257–8.CrossRefPubMed Pereira N, Rosenwaks Z. A fresh(er) perspective on frozen embryo transfer. Fertil Steril. 2016;106(2):257–8.CrossRefPubMed
44.
go back to reference Adler A, Lee HL, McCulloh DH, Ampeloquio E, Clarke-Williams M, Wertz BH, et al. Blastocyst culture selects for euploid embryos: comparison of blastomere and trophectoderm biopsies. Reprod Biomed Online. 2014;28(4):485–91.CrossRefPubMed Adler A, Lee HL, McCulloh DH, Ampeloquio E, Clarke-Williams M, Wertz BH, et al. Blastocyst culture selects for euploid embryos: comparison of blastomere and trophectoderm biopsies. Reprod Biomed Online. 2014;28(4):485–91.CrossRefPubMed
45.
go back to reference Gardner DK, Meseguer M, Rubio C, Treff NR. Diagnosis of human preimplantation embryo viability. Hum Reprod Update. 2015;21(6):727–47.CrossRefPubMed Gardner DK, Meseguer M, Rubio C, Treff NR. Diagnosis of human preimplantation embryo viability. Hum Reprod Update. 2015;21(6):727–47.CrossRefPubMed
Metadata
Title
Embryo wastage rates remain high in assisted reproductive technology (ART): a look at the trends from 2004–2013 in the USA
Authors
Sanaz Ghazal
Pasquale Patrizio
Publication date
01-02-2017
Publisher
Springer US
Published in
Journal of Assisted Reproduction and Genetics / Issue 2/2017
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI
https://doi.org/10.1007/s10815-016-0858-2

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