"From Machon Puah"
New Techniques in In-Vitro Fertilization - Rabbi Elyashiv's Opinion
The Best Eggs
Last week we discussed some of the history and development of the techniques of in-vitro fertilization and the attempts to transfer the least number of embryos and achieve a pregnancy. Therefore there is a search for the best embryos.
However this is not such an easy task; in a paper presented a few years ago to the Annual Meeting of the American Society of Reproductive Medicine (ASRM), a fertility group wanted to test the abilities of expert embryologists to pick the “best embryo”. The embryologists were asked on the third day after fertilization to mark the best embryos and those that they would pick to transfer. Instead of transferring these fertilized eggs they left the embryos to grow another two days, which does not adversely affect pregnancy rates. The embryologists were then asked to repeat the exercise and choose the best embryos to transfer. They found that there was not a correlation between the best embryos chosen by the embryologists on day three and those that they chose on day five. This is significant since these embryologists are the experts in this field and the choice of which embryos to transfer is in their hands. Since it is standard to transfer the embryos on day 3, unless there is a good reason not to, it is perfectly possible that it is very hard to make that choice on that day and all eggs should be left to incubate and develop until day 5.
Another piece of work that was presented at another meeting of the ASRM investigated the influence and effect on pregnancy rates of moving or not moving the incubating fertilized eggs in the laboratory. It is generally accepted to check the embryos on the second day after fertilization, since at this stage we can see the normal progression of the embryonic development as the egg divides and goes through the stages called cleavage and then compaction. If the development is abnormal, then the eggs can be discarded as they will not develop properly and will not result in a pregnancy.
But each time that the embryo is checked it needs to be removed from the incubator and placed under the microscope. This movement may adversely affect the fertilized eggs, and this was what the paper wanted to examine. They left the embryos and did not check them thus possibly transferring fertilized eggs that were abnormal but having the advantage of having been moved less. They found better pregnancy rates when they forwent the check on the second day than when they performed this check. This suggests that moving the eggs less gives better results than checking them several times during the incubation period. More on this next week.
Rabbi Gideon Weitzman
The Puah Institute is based in Jerusalem and helps couples from all over the world who are experiencing fertility problems. Puah offers free counseling in five languages, halachic supervision, and educational programs. Offices in Jerusalem, New York, Los Angeles and Paris. Contact: (02) 651-5050 (Isr). http://www.puahonline.org
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