Sweden
Define the prognosis of the patient Morphological scoring of embryos - early cleavage - time-lapse Metabolomics - NIR PGS-microarray Optimize the endomtrium Excellent cryopreservation techniques
Follow-up of IVF treatments in Sweden
Sweden
The National Board of Health runs validated registers for deliveries, IVF treatments, hospital admissions, cancer etc
Results showed after IVF 27 % multiples vs 1 %; more preterm babies after IVF 30 % vs 5 %, < 2500 g 27 % vs 5 %,perinatal mortality 1,9 % vs 1,1 %
Conclusion: Multiple pregnancy, not the IVF technique per se, is the risk factor, after IVF
Hale Waihona Puke M.Wikland, T. Hillensjö, M. Wood, G. Westlander, J. Olofsson
Lab.director T Hardarson
Aims of modern ART
Sweden
A healthy child - one at a time Safe treatment for the patient High compliance, well tolerated Cost-effective
Sweden
Elective single-embryo transfer – the Nordic Experience
Torbjörn Hillensjö, MD, PhD Fertility Center, Carlanderska Hospital and
Göteborg University, Göteborg, Sweden
74 transfers with elective one embryo transfer resulted in 30 % PR/ET. The cumulative PR after frozen embryo transfer was 47 %
Vilska, Tiitinen, Hydén-Granskog, Hovatta. HR 1999,14:2392
5680 IVF children compared to 11360 controls. Contact with all habilitation centers in Sweden Increased risk for cerebral palsy (3,7- fold), developmental delay (4-fold) and need for habilitation (1,7-fold)
Strömberg, Dahlquist, Ericson, Finnström, Köster, Stjernqvist (continued)
Sweden
” children born after IVF have an increased risk of neurological problems, especially cerebral palsy”………..the risks are related to twin pregnancy, low birthweight and prematurity”
Sweden
History
Sweden
The team in 1982 at
Sahlgrenska University Hospital
First IVF child in Scandinavia 26/9, 1982
Fertility Center Scandinavia
Sweden
Clinicians:
Deliveries and children born after in-vitro fertilisation in Sweden 1982-95: a retrospective cohort study
The Lancet 1999 Vol 354 pp 1579-1585
All IVF children born between 1982-95 (n=5856) were compared with other children (N=1505724) born 1982-95 and comparisons were made after stratification for maternal age, parity, year of birth and multiple pregnancies
It can be recommended to transfer only one embryo”
New Swedish law in 2003:
Sweden
.. ”as a rule only one embryo should be transferred..”
.. ”in exceptional cases two embryos may be transferred, if the risk of twin pregnancy is neglegible..”
128 (38,8 %) 142 (42,9 %) 0,30
1 (0,8%)
47 (33,1 %) < 0,001
Thurin et al NEJM 2004
Conclusion Nordic randomized study
Sweden
” In women under 36 years of age, transferring one fresh and then, if needed, one frozen-and-twawed embryo dramatically reduces the rate of multiple births while achiving a rate of live births that is not substantilly lower than the rate that is achievable with a double-embryo transfer”
Impact of elective single embryo transfer on the twin pregnancy rate. Tiitinen et al HR 2003,18:1449-53
Sweden
Finnish experience
Nordic randomized study on single-embryo transfer
New England Journal of Medicine 2004, 351:23922402
Nordic randomized study..
Sweden
Patients < 36 years (mean 30) and first or second IVF treatment were asked to participate
Sweden
” Elective Single-Embryo Transfer versus DoubleEmbryo Transfer in in Vitro Fertilization”
Thurin, Hausken, Hillensjö, Jablonowska, Pinborg, Strandell, Bergh
661 patients could be randomized to single and double embryo transfer
Inclusion criterion: at least 2 good quality embryo, where one could be frozen
Nordic randomized study- main results. ITT
Evaluation by crosslinking of registers. Almost all cases (> 99 %) can be traced and analysed
Bergh, Ericson, Hillensjö, Nygren, Wennerholm 1999
Sweden
Sweden and the other Nordic countries
Sweden
Göteborg Sweden
The ship Götheborg leaving for China 2005
Sweden
The ship Götheborg on its way to Guangzhou 2005
Swedish national IVF data: trends 1991-2011
Sweden
2003
Swedish national IVF data: trends 2000-2011
Sweden
Improved chances of birth per transferred embryo
Outline of lecture
Sweden
Follow-up of births and childrens health Experience of SET in the Nordic countries Follow-up of Swedish results after changing to eSET Implantation rate – how to improve?