In Vitro Fertilization (IVF)
Evolution of Cost-Effective Embryo Screens
ART advances have increased dramatically including the evolution of cost-effective embryo screens. In the 1990s, PGS was proposed to improve IVF outcomes with transfer of chromosomally-normal embryos. Initially, it was designed for women of more advanced reproductive age, women experiencing recurrent pregnancy loss and those anticipated to have lower success. Fast forward twenty years to an era where assessment of chromosomes and embryos occur at lightening speed.
In 2008, cost-effective analysis compared conventional IVF with IVF and PGS screening. For women under 38, IVF costs were approx $120,000 per healthy infant for PGS and $68,000 for conventional IVF. In women over 40, IVF with PGS was equivalent in cost to women undergoing conventional IVF. The 2008 analysis demonstrated that selected categories of patients benefit from PGS. The science for PGS prior to this time involved (FISH) which requires selected number of chromosomes to be flagged with fluorescence markers. This technology had significant limitations of the number of chromosomes that could be analyzed and the possibility of false positives and negatives.
The science continues to advance. In a mere 5 years, the technology changes. The advent of CGH (comparative genomic hybridization) has allowed for higher sensitivities and accuracy of these tests and analysis of all 23 pairs of chromosomes (as opposed to 5-9 markers with FISH).
Results with CGH are extremely promising. Implantation rates with CGH are doubled that of earlier-generation FISH assessment (which significantly decreases the costs of IVF). This decrease is expected to be from decreased time to pregnancy, decreased costs associated with spontaneous and therapeutic abortions. Increased rates of healthy births can be optimized with PGS.
As with the earlier modicums, it is anticipated that these studies will be performed and cost-analysis reported. As the science evolves, so does our ability to foster one healthy baby during one pregnancy. It is possible that soon, IVF with PGS will become the cost-effective mode of treatment and not conventional IVF.
These data and discussions were most recently discussed at the ASRM (American Society for Reproductive Medicine) conference in Boston; fertility and evolving management remains the forefront of the roundtable discussions.