ASRM 2004 Conference: Key Findings

 Each year physicians and staff of Pacific Fertility Center attend the annual conference of the American Society for Reproductive Medicine (ASRM), a non-profit member-based organization established for the advancement of reproductive medicine. This gathering draws thousands of professionals from around the world to share advances in the field. Over 1600 abstracts were submitted for inclusion in the 2004 program. Our physicians Drs. Schriock and Chenette, and Lab Director Joe Conaghan have summarized a few topics here, based on the research's relevance to clinical practice.**Same Success for Single Embryo Transfer** Some countries have mandated single embryo transfers (SET) in order to reduce the high rate of multiple-births from IVF treatment. Sweden's rule was set into place January 1, 2003. A retrospective study has examined 1664 fresh IVF/ICSI/ET cycles before, during and after the transition to the new policy. Patients were of similar maternal age (mean 33.3-33.4), similar demographic characteristics and embryo quality scores. The study revealed no difference in overall clinical pregnancy rate (33.3%, 32.8%, 33.8%) among those women studied. (Note that their mean age is less than the average age of PFC's patients. Age is a key factor in the success or failure of IVF.) But the rate of twinning drastically reduced as a result of the new law prohibiting more than one embryo transfer (8.8% vs. 22.6% prior, and 16.3% during transition to the new policy). Sweden's new policy appears to be resulting in a significant reduction of multiple births in young patients, while not impacting the overall clinical pregnancy rate. **Obesity Reduces Pregnancy Outcome** An extensive study has revealed that patients with a high body mass index (BMI), the method of measuring normal weight range, face a significant obstacle to getting pregnant. Specifically, researchers at the Beth Israel Deaconess Medical Center in Boston identified a 60% reduction in pregnancy rates in those with high BMI, or very obese, compared to those with a moderate to low BMI. Researchers analyzed the records of 6,827 fresh non-donor cycles in which patients' BMI had been recorded. The group was divided into five different weight categories, the maximum being a BMI 35 -39 kg/m2- considered obese. Researchers found no significant difference among participants with respect to the number of mature follicles observed, oocytes retrieved, mature oocytes produced, cycle number per patient and number of embryos transferred. However, they noticed significantly lower implantation rates and clinical pregnancy rates in those with a BMI >35 kg/m2 compared to all other BMI groups. **Progesterone Supplementation Not Needed** A group of researchers at the Carolinas Medical Center in Charlotte examined two groups of IVF patients to determine significant difference in pregnancy rates between those who continued progesterone supplements into the 12th week of pregnancy vs. those who had not. 237 patients categorized as the "long group" received 25mg intramuscular dose of progesterone the day of retrieval followed by a daily dose of 50mg IM until the pregnancy test and then daily through the first trimester. Another group of 121 patients, the "short group" continued same dose progesterone but only until the pregnancy test. The study revealed similar conception rates for both groups. There was no significant difference in delivery rates when comparing all patients with a positive pregnancy test. However, both groups showed a similar degree of pregnancy loss, but at different times. Researchers concluded that long progesterone supplementation may support early pregnancy development through viability at 7 weeks but does not improve overall survival through the first trimester, showing more of a trend of delaying, not preventing miscarriage. For this reason, progesterone support of early pregnancy does not appear to be justified. **FDA Changes Ahead** Starting in May 2004, the Food and Drug Administration will be taking an active role in overseeing all aspects of health and safety of IVF clinical laboratory procedures, which are currently regulated by states. The changes are expected to increase the number of, and frequency of tests that patients will be required to undergo. Fertility Flash will publish a more extensive summary of this topic and how it will impact rates/procedures at PFC in one of our Spring 2005 issues. If you have any questions in the meantime, feel free to email us.  Drs. Chenette and Schriock attended the 2004 ASRM convention along with Lab Director Joe Conaghan and other PFC staff members. PFC's medical team is continually evaluating the latest research. Our patients' welfare is PFC's first priority. With this in mind, be assured we do not include new technologies and treatments unless they are backed with solid, evidenced-based research.  Each year physicians and staff of Pacific Fertility Center attend the annual conference of the American Society for Reproductive Medicine (ASRM), a non-profit member-based organization established for the advancement of reproductive medicine. This gathering draws thousands of professionals from around the world to share advances in the field. Over 1600 abstracts were submitted for inclusion in the 2004 program. Our physicians Drs. Schriock and Chenette, and Lab Director Joe Conaghan have summarized a few topics here, based on the research's relevance to clinical practice.**Same Success for Single Embryo Transfer** Some countries have mandated single embryo transfers (SET) in order to reduce the high rate of multiple-births from IVF treatment. Sweden's rule was set into place January 1, 2003. A retrospective study has examined 1664 fresh IVF/ICSI/ET cycles before, during and after the transition to the new policy. Patients were of similar maternal age (mean 33.3-33.4), similar demographic characteristics and embryo quality scores. The study revealed no difference in overall clinical pregnancy rate (33.3%, 32.8%, 33.8%) among those women studied. (Note that their mean age is less than the average age of PFC's patients. Age is a key factor in the success or failure of IVF.) But the rate of twinning drastically reduced as a result of the new law prohibiting more than one embryo transfer (8.8% vs. 22.6% prior, and 16.3% during transition to the new policy). Sweden's new policy appears to be resulting in a significant reduction of multiple births in young patients, while not impacting the overall clinical pregnancy rate. **Obesity Reduces Pregnancy Outcome** An extensive study has revealed that patients with a high body mass index (BMI), the method of measuring normal weight range, face a significant obstacle to getting pregnant. Specifically, researchers at the Beth Israel Deaconess Medical Center in Boston identified a 60% reduction in pregnancy rates in those with high BMI, or very obese, compared to those with a moderate to low BMI. Researchers analyzed the records of 6,827 fresh non-donor cycles in which patients' BMI had been recorded. The group was divided into five different weight categories, the maximum being a BMI 35 -39 kg/m2- considered obese. Researchers found no significant difference among participants with respect to the number of mature follicles observed, oocytes retrieved, mature oocytes produced, cycle number per patient and number of embryos transferred. However, they noticed significantly lower implantation rates and clinical pregnancy rates in those with a BMI >35 kg/m2 compared to all other BMI groups. **Progesterone Supplementation Not Needed** A group of researchers at the Carolinas Medical Center in Charlotte examined two groups of IVF patients to determine significant difference in pregnancy rates between those who continued progesterone supplements into the 12th week of pregnancy vs. those who had not. 237 patients categorized as the "long group" received 25mg intramuscular dose of progesterone the day of retrieval followed by a daily dose of 50mg IM until the pregnancy test and then daily through the first trimester. Another group of 121 patients, the "short group" continued same dose progesterone but only until the pregnancy test. The study revealed similar conception rates for both groups. There was no significant difference in delivery rates when comparing all patients with a positive pregnancy test. However, both groups showed a similar degree of pregnancy loss, but at different times. Researchers concluded that long progesterone supplementation may support early pregnancy development through viability at 7 weeks but does not improve overall survival through the first trimester, showing more of a trend of delaying, not preventing miscarriage. For this reason, progesterone support of early pregnancy does not appear to be justified. **FDA Changes Ahead** Starting in May 2004, the Food and Drug Administration will be taking an active role in overseeing all aspects of health and safety of IVF clinical laboratory procedures, which are currently regulated by states. The changes are expected to increase the number of, and frequency of tests that patients will be required to undergo. Fertility Flash will publish a more extensive summary of this topic and how it will impact rates/procedures at PFC in one of our Spring 2005 issues. If you have any questions in the meantime, feel free to email us.  Drs. Chenette and Schriock attended the 2004 ASRM convention along with Lab Director Joe Conaghan and other PFC staff members. PFC's medical team is continually evaluating the latest research. Our patients' welfare is PFC's first priority. With this in mind, be assured we do not include new technologies and treatments unless they are backed with solid, evidenced-based research.