The purpose of this exercise is to provide persons with a reference framework that can help them take evidence-based reproductive decisions.
Assisted Reproduction Techniques (ART), whether IVF or ICSI, involve a sequence of interventions. Each of them implies physical and emotional costs, as well as complications, which must be assessed in relation to the ultimate goal, which is to have a healthy baby at home.
The balance between the high economic costs and potential risks resulting from hormone stimulation and follicular aspiration must be compared with the happiness of having a healthy child. This balance between risks and benefits must be the result of a thorough analysis between the patients and the professional team.
There are different ways to calculate therapeutic success which, without a doubt, means having a healthy child. However, the mathematical odds of having a child are different according to which is the starting point: hormone stimulation, follicular aspiration or embryo transfer. For practical purposes, the exercise we have designed regards embryo transfer as the starting point, considering that, to reach this stage, hormone stimulation must have been successful, mature oocytes must have been obtained, they must have been properly fertilized, and one or more embryos must have been generated. All these stages are barriers that must be discussed with your professional team. In the next Figure (A), we can see the differences in delivery rates when either follicular aspiration or embryo transfer are used as a starting point.
Figure A. Pregnancy and delivery rates in autonomous IVF and ICSI cycles according to woman’s age. RLA, 2021.
In this exercise, we have included a total of 25,475 embryo transfers performed at accredited centers from the Latin American Network of Assisted Reproduction between 2020 and 2021, and babies born up to September 2022. As a variable to consider, we have included those factors which bear a higher influence in the results, such as:
1) Woman’s age
2) Number of transferred embryos, a maximum of two, because transferring three does not report benefits and disproportionately increases risks.
3) If there is only one embryo available, or if it is one embryo from a larger cohort.
4) If the embryo is transferred fresh or after freezing/thawing (Freeze all).
5) If there is an added probability by transferring a fresh embryo (without a positive result) plus a later frozen/thawed embryo transfer from the same patient (cumulative rate).
6) If preimplantation genetic testing (PGT) is performed.
For each variable, the percentages of delivery of livebirth and multiple gestation rates are shown, that is, the birth of twins and triplets. In fact, twins resulting from one embryo are identical twins, from the splitting of an embryo into two.
The results obtained in this exercise, from more than 200 institutions in 16 countries, may differ from any particular centers.
THE MOST COMMON ACRONYMS ARE:
SET : Single Embryo Transfer
eSET: elective single embryo transfer.
DET: double embryo transfer.
eDET: elective double embryo transfer.
FET: frozen embryo transfer. Transfer of an embryo frozen and thawed.
Freeze all: transfer of a frozen/thawed embryo which was not preceded by the transfer of a fresh embryo.
eSET + FET: cumulative transfer of a fresh embryo plus one frozen/thawed, from the same initial cohort.
PGT: pre-implantation chromosomic or genetic embryo testing.
This exercise is designed to determine the probability of success of an ART treatment according to my age and possible embryological results and to the decisions taken with my doctor.
The Latin American Registry of Assisted Reproduction (RLA) thanks the 204 institutions accredited by REDLARA which, every year, report their data to RLA.
This voluntary and rigorous contribution makes it possible to generate a powerful database, which helps doctors and patients take decisions based on the best existing regional evidence.
This educational portal is the result of a collaborative activity between the Latin American Network of Assisted Reproduction (REDLARA), and University Diego Portales from Chile, which allow the link between the reproductive science and technology advances with the needs of people suffering from infertility and other forms of reproductive impairments.
We thank Dr. Ariel Ahumanda and Dr. Gustavo Martínez from Argentina for: images and videos of spontaneous in vitro fertilization, ICSI and PGT,
Dr. Roger Molinas from Paraguay for: videos of follicular aspiration and embryo transfer,
Dr. Javier Crosby from Chile for: images of different stages of in vitro embryo development,
Dr. Yasuyuki Mio from Japan for his video of in vitro embryo development.
We especially thank the industry for providing the financial support, which is so necessary to keep the Latin American registry as a pillar of this international cooperation, which today includes 16 countries and more than 200 collaborative institutions, from Mexico in the north to Chile in the far south.
