Commentary: Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss
The process of conception and implantation of an embryo is very complex, and we likely only know a small fraction of the science behind this. Many couples that struggle with infertility have tubal patency and a reasonable sperm count, suggesting that for many of these patients conception of an embryo may be happening. However, these couples may well have a problem with implantation of that embryo into the endometrium (uterine cavity). The embryo then would pass away and be shed with the next menstruation, unbeknownst to the woman.
During the IVF process, we know that conception has occurred in a "test tube". Physicians then instill this embryo into the uterine cavity, and over half the time the embryo does not implant. Thus, IVF may not help at all for those patients with implantation problems.
This is even more apparent for those couples struggling with recurrent pregnancy loss. In these couples, conception and implantation of the embryo in the uterine cavity have occurred. However, at some point in the early phase of pregnancy, the pregnancy is lost. So why would IVF physicians believe that they can help with this problem? After all, couples conceiving through IVF as well as couples conceiving with NaProTechnology both depend on a good implantation of the embryo and continuing growth of that pregnancy in the uterus.
The answer: pre-implantation genetic diagnosis (PGD). With this process, IVF physicians examine embryos from the IVF process with different genetic techniques - in an attempt to select those embryos which may be the healthiest and most likely to implant, and to exclude those embryos which may not implant as well, or which may have certain identifiable diseases (cystic fibrosis, down syndrome, etc.). So - if IVF physicians can select the healthiest embryos, and only transfer these to the uterine cavity, theoretically this would optimize pregnancy and live birth rates and minimize miscarriage rate.
There have been a number of smaller studies looking at this. Some do suggest a reduction in miscarriage rates using the IVF/PGD process. However - there is very little published research comparing the IVF/PGD process directly with recurrent miscarriage couples conceiving on their own (or with NaProTechnology). The study below does examine this. This was published in 2015 in Fertility and Sterility, a well-known infertility journal. While it did find some reduction in the miscarriage rate with the IVF/PGD strategy - the ultimate outcome - live birth of a baby - was better (and much cheaper!) in those couples who conceived through natural intercourse. We could also speculate that the difference would be even greater for those couples using NaProTechnology to assist them in their conception efforts.
In summary - although more study is needed in this area - it has not been shown that IVF/PGD can increase the live birth rate in couples with recurrent pregnancy loss above that achieved by spontaneous intercourse. NaProTechnology certainly has the potential to increase this live birth rate even further.
Cost-effectiveness analysis of preimplantation genetic screening and in vitro fertilization versus expectant management in patients with unexplained recurrent pregnancy loss.
Murugappan G, Ohno MS, Lathi RB.
Fertil Steril. 2015 May;103(5):1215-20. doi: 10.1016/j.fertnstert.2015.02.012. Epub 2015 Mar 13.