Can SART Improve the LBR/transfer

Dr. Timothy Hickman discusses SART’s progress in IVF, including improvements in live birth rates and the shift to single embryo transfers for safer, high-quality outcomes.

Well, hello, I'm Timothy Hickman. I'm the immediate past president of SART, and it's a pleasure to be here this morning to see you all. What I was asked to speak on is actually not what we're seeing on the screen here.

It was actually, can SARTs improve the live birth rate per embryo transfer? So I didn't see this until I got here. I thought, well, that's actually not what I'm speaking on. So it'll be a little different than maybe what you anticipated.

So thinking about that question, you have to kind of go through and think about what SART is. So the mission of SART is to help families be built in safe and high quality IVF and ART. To answer that question, I think we also have to step back.

So come with me, if you will, back to 1985. 1985 was a very different time than it is now. Evidence-based medicine was only about 10% to 15% of what was being practiced in the United States.

There was a group called AFS, American Fertility Society at the time. And there was a group that decided, hey, we're doing this new IVF stuff that's just happened in England in 78, in the US in 82. Let's form a special interest group called SART.

Alan Decherney was the first president. I just saw him walking by. So here we are coming full circle.

Alan Decherney was our first president. And places around the country started to do IVF. Success rates, unfortunately, were quite low, typically single digits.

And sometimes there were places that were kind of reporting things a little differently. So there was an exposé that came out on 60 Minutes. You all remember how popular that show used to be that showed some people not actually telling exactly what their live birth rates were.

There was a big groundswell, a public groundswell. And a law was passed in 1992 called the Wyden Act for Ron Wyden. He was in the House at the time out of Oregon.

Now he's a senator. And that required us to all report our data to the CDC. Well, that was an unfunded mandate.

And people were kind of thinking, oh, this is an onerous task. We're not really that interested in doing that. But it has turned out to be a huge blessing for us in many, many ways.

So as you can see in our field, we have very, very clear metrics. You either get pregnant or you don't get pregnant. You either get pregnant and have a baby.

You get pregnant and have a miscarriage. So it makes it much, much easier than, for example, like if you're an orthopedic surgeon and you break your arm and you go to Dr. A that's going to set it one way and Dr. B that'll set it a different way. It's a little hard to tell what the probability and success rates of those type of procedures are compared to our field.

So it adds up perfectly to analyze data. Well, that started out where we would gather the data. Initially, when it was gathered, it was all put together.

So the individual centers were not monitored. It was just all in one group. And then we compared kind of the national average to see where things were.

Eventually, we got to clinic-specific data and published our first report in 1998. Well, let's even go to the early 2000s. Very different type of practice back then.

It was very common to have very high-order multiples, right? So for those less than 35 that had a live birth, it was not common to have a 30 to 40% high-order multiple rate, or at least a twinning rate or above. That we would obviously consider totally unacceptable now. The number of embryos transferred, typically three to four per patient at any age.

Again, we would not do that now. I guess one thing that we could say, things have changed drastically in that way. Now, we're happy to say that last year when we reported, the last report of the year, 2021, 86% of all cycles done in SART clinics in the United States, single embryo transfer.

That's huge, a huge change. The twinning rate down to 5% now. So a big, big change, big, big health change.

Recently in the Gray Journal, which is the American Journal for Obstetrics and Gynecology, they call it the Gray Journal and OB-GYN, there was a nice article written. The senior author was Jim Toner. Many of you know Jim, he was one of our past presidents.

In that article, it talked about what they call the vanishing twin. Now, if you're an OB, you realize, oh, well, sometimes twins start out and one of the twins is reabsorbed and you end up delivering one child. But what they were talking about there is how we've had this drastic change in going from transferring four embryos to now one embryo, the vanishing twin.

So going down to 5%, naturally occurring twins are about 2% of the general population. So we're almost down to that point. They equate that change to four different principles.

Those principles are, that have changed in the field. One is extended culture, being able to grow the embryos all the way up to the blastocyst stage. Two was being able to freeze embryos well and use them in a high-profile way so that you can, if you freeze them, you'll have a very good chance that they will survive and succeed. So vitrification.