Modern IVF is allowing couples to have children who otherwise would remain childless. However, human reproduction is inherently inefficient and assisted reproductive technologies (ARTs) cannot overcome this biological limit. In fact, despite what appears superficially to be continual improvement in IVF results, there may be an ultimate limit to the reproductive potential of the human oocyte. In fact, the great majority of oocytes (about 90%) harvested after ovarian stimulation and many embryos (about 80%) produced during ART and transferred, do not result in a live birth. In contrast, recent experience from oocytes retrieved for IVF in natural cycles, i.e., without stimulation, followed by single-embryo transfer, has demonstrated much less oocyte and embryo wastage rates, with about 25% of the oocytes (up to age 37) able to produce a live birth and then gradually declining as women age, completely in line with rates of natural fecundity. However with aggressive ovarian stimulation protocols, the collection of many oocytes is associated with an increased biological wastage since many are not able to result in a live birth. Properly validated embryo selection methods, not available at the time of this writing, would be keys to higher pregnancy rates per transfer, but not per patient.
This is a preview of subscription content, log in to check access.
Society for Assisted Reproductive Technologies (SART). www.sart.org. 2015.
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;84:325–30.CrossRefGoogle Scholar
Ghazal S, Patrizio P. Embryo wastage rates remain high in assisted reproductive technology (ART): a look at the trends from 2004-2013 in the United States. JARG. 2017;34(2):159–66.Google Scholar
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;14:92–5.CrossRefGoogle Scholar
Patrizio P, Sakkas D. From oocyte to baby: a clinical evaluation of the biological efficiency of in vitro fertilization. Fertil Steril. 2009;91:1061–6.CrossRefGoogle Scholar
Martin JR, Bromer JG, Sakkas D, Patrizio P. Live babies born per oocyte retrieved in a subpopulation of oocyte donors with repetitive reproductive success. Fertil Steril. 2010;94:2064–8.CrossRefGoogle Scholar
Doherty L, Martin JR, Kayisli U, Sakkas D, Patrizio P. Fresh transfer outcome predicts the success of a subsequent frozen transfer utilizing blastocysts of the same cohort. Reprod Biomed Online. 2014;28(2):204–8.CrossRefGoogle Scholar
Patrizio P, Silber S. Improving IVF: is there a limit to our ability to manipulate human biology? JARG. 2017;34(1):7–9.Google Scholar
Opitz JM, Fitzgerald JM, Reynolds JF, Lewin SO, Daniel A, Ekblom SL, Phillips S. The Montana fetal genetic pathology program and a review of prenatal death in human. Am J Med Genet Suppl. 1987;3:93–112.CrossRefGoogle Scholar
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.Google Scholar
Greco E, Minasi MG, Fiorentino F. Healthy babies after intrauterine transfer of mosaic aneuploid blastocysts. N Engl J Med. 2015;373:2089–90.CrossRefGoogle Scholar
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. (e-pub Feb 12, 2016).CrossRefGoogle Scholar
Scott RT, Galliano D. The challenge of embryonic mosaicism in preimplantation genetic screening. Fertil Steril. 105(5):1150–2. (e-pub Feb.10, 2016).CrossRefGoogle Scholar
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.CrossRefGoogle Scholar
Kang HJ, Melnick AP, Stewart JD, Xu K, Rosenwaks Z. Pre-implantation genetic screening: who benefits? Fertil Steril. 2016;106(93):597–602.CrossRefGoogle Scholar
Orvieto R, Gleicher N. Should pre implantation genetic screening (PGS) be implemented to routine IVF practice? J Assist Reprod Genet. 2016;33(11):1445–8. (e pub Sept.15).CrossRefGoogle Scholar
Murugappan G, Shahine LK, Perfetto CO, Hickok LR, Lathi RB. Intent to treat analysis of in vitro fertilization and preimplantation genetic screening versus expectant management in patients with recurrent pregnancy loss. Hum Reprod. 2016;31:1668–74.CrossRefGoogle Scholar
Stecher A, Vanderzwalmen P, Zintz M, Wirleitner B, Schuff M, Spitzer D, Zech NH. Transfer of blastocysts with deviant morphological and morphokinetic parameters at early stages of in-vitro development: a case series. Reprod Biomed Online. 2014;28(4):424–35.CrossRefGoogle Scholar
Goldman 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.CrossRefGoogle Scholar
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):49–54.CrossRefGoogle Scholar
Baker VL, Brown MB, Luke B, Smith GW, Ireland JJ. Gonadotropin dose is negatively correlated with live birth rate: analysis of more than 650,000 assisted reproductive technology cycles. Fertil Steril. 2015;104:1145–52 e5.CrossRefGoogle Scholar
Silber S, Kato K, Aoyama N, Yabuuchi A, Skaletsky H, Fan Y, Liao C, et al. Intrinsic fertility of human oocytes. Fertil Steril. 2017;107(5):1232–7.CrossRefGoogle Scholar