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Life without artificial cold is hard to imagine in the developed world.
But it all started 200 years ago with some giant ice cubes
Abha Maheshwari Consultant Reproductive Medicine & Surgery
NHS GRAMPIAN
.
Future of IVF – Frozen better than Fresh ?
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What is in-vitro Fertiliztion (IVF)?
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Fertilisation to Embryo
Day 1 Day 2
Day 3 Day 5
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Fate of Embryos
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To achieve ...........
IVF league table
Healthy mum & a healthy baby
Long term health
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How do we get eggs?
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OHSS- A price we have to pay!
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Safety- singleton pregnancies
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Obstetric/ perinatal outcomes
Outcome Overall effect (RR, 95%CI)
APH 2.49 (2.30-2.69)
Congenital anomalies 1.67(1.33-2.09)
Hypertension 1.49 (1.39-1.59)
PPROM 1.16 (1.07-1.26)
Caesarean Section 1.56(1.51-1.60)
Birth weight < 2500gm 1.65(1.56-1.75))
Birth weight<1500gm 1.93 (1.72-2.17)
Perinatal mortality 1.87(1.48-2.37)
Delivery at < 37 weeks 1.54 (1.47-1.62)
Delivery at < 32 weeks 1.68 (1.48-1.91)
Transfer to NICU 1.58 (1.42-1.77)
Gestational diabetes 1.48 (1.33-1.66)
Induction of Labour 1.18 (1.10-1.28)
Small for Gestation age 1.39 (1.27-1.53)
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Long term costs to NHS
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USA data (< 35 years old)
Year Live birth/ started cycle implantation rate
2013 40.1% 39.5%
2012 40.6% 37.4%
2011 40.1% 36%
2010 41.7% 36.9%
2009 41.4% 35.6%
2008 41.3% 34.1%
2007 39.9% 32.6%
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IVF is not good!
IVF is here to stay!
Something need to change!
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Endometrium and
implantation
Evans et al., 2014 Hum Reprod Update
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Why could success rates be better?
Ovarian
stimulation
Embryo
transfer
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Outcome RR (95% CI)
Small Gestational Age 0.45 (0.30,0.66)
Birth Weight <2500gm 0.69 (0.62,0.76)
Delivery at <37 Weeks 0.84 (0.78,0.90)
APH 0.67 (0.55,0.81)
Perinatal Mortality 0.68(0.48,0.96)
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Lower risk of ectopic
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Clinical pregnancy rates –
Frozen embryo transfer
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Graduation Gifts for future
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WIN-WIN-WIN situation
Frozen embryo transfer
Healthier pregnancies
Better pregnancy
rates
OHSS free clinics
Planned weekend work load
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Unknowns
• Which patients to freeze – all?
• When embryos are not good?
• Is it clinically effective?
• Is it cost effective?
• Is it acceptable?
• Recent concerns about LGA babies
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Evidence from HFEA data
Fertil Steril . Maheshwari A, et al. 2016
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FREEZE ALL
FRESH
EMBRYO
TRANSFER
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To determine if a policy of freezing created embryos,
followed by thawed frozen embryo transfer is a more
clinically effective, safer and cost effective way to
provide in-vitro fertilization when compared with the
current practice of transferring fresh embryos.
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Primary Outcome
• Healthy baby rate:
– Term
– Singleton
– Live birth
– Appropriate weight for gestation
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Secondary Outcomes• Complication of IVF treatment
– OHSS
• Complications in pregnancy
– Miscarriage
– Pre-eclampsia
– Antepartum haemorrhage
– Multiple pregnancy
– Low birth weight
– Preterm delivery
– Small for gestational age
– Congenital anomaly
– Perinatal mortality
• Clinical effectiveness
– Live birth rate
– Pregnancy rate
• Effectiveness of the process of
freezing embryos
– Failure of embryos to survive after
thawing
• Health economic outcome
– Costs to the health service
– Modelled long-term costs (broader
societal costs)
• Evaluation of emotional state
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Participating Centres
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Future recruiting centres:
- King’s College Hospital
- Nurture, Nottingham
- Jessop Wing, Sheffield
Recruitment Target:
1086 Couples
Current recruiting centres:
- Aberdeen Maternity Hospital - Homerton Hospital
- Guy’s & St Thomas’ - Hammersmith Hospital
- Liverpool Women’s - St Mary’s, Manchester
- Princess Anne, Southampton - Birmingham Women’s
- St Bartholomew’s Hospital
- Oxford Fertility
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It does not end with E-Freeze
• 90% consenting for long term follow up
• Cumulative live birth rate
• Follow up of children born 1,5,10.... years
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International Collaboration