Is EmbryoGlue really an “Add-On”?
Happy New Year Everyone! I hope your 2020 is starting off with optimism and revitalization. A new year is such a great opportunity to celebrate victories (big and small!) and to lay out the strategy to achieve our goals. Here at Denver Fertility, we are wrapping up a spectacular first year in our new embryology laboratory. Our annual success ratesare rolling out and they are clearly confirming the exceptional results that we have been witnessing month in, month out. We are so proud to be providing exceptional IVF services while simultaneously driving down the cost of fertility treatment in our region.This statement is fundamental to our mission. We are not cutting corners! Through technological advancements and efficiencies, we can provide world-class care while reducing the financial burdens faced by our patients.
This year, I am excited to begin a series of laboratory related blog posts that will highlight several of the key aspects of our state-of-the-art embryology program. Each of these critical building blocks fit seamlessly together to aid our embryologists in the conception and care of your embryos. We will touch upon many different topics (such as embryo development, the fight against airborne pollutants, and the benefits of genetic testing) but, to kick this series off, I want focus on the end of the embryo’s journey in our laboratory… the embryo transfer.
The embryo transfer is an exciting moment for everyone involved! While great care is put into every step of the IVF process, this climactic event is held in special regard. So much effort has been put forth to reach the limitless potential that is concentrated in a healthy blastocyst. A smooth transfer procedure puts the embryo into the uterus, but the biology of embryo implantation is essential to achieving the anticipated pregnancy. With this biology in mind, it is in the moments leading up to transfer where EmbryoGlue plays its role. EmbryoGlue is a solution of nutrients and macromolecules (most notably hyaluronan) which holds the embryo immediately prior to the transfer and aids the embryo through the implantation process after the embryo has been placed in the uterus.
Whether or not you have heard of EmbryoGlue, the first thing you have to admit is that it has an extremely clever name. Who doesn’t want to make that embryo stick?! However, the name is just the beginning of theingenuity1. If you have heard of EmbryoGlue, you likely know that it is often presented to patients on an individual basis, included on a menu-like list of IVF treatment “add-ons” which can quickly raise the cost of an already expensive IVF cycle. This à-la-cart pricing strategy was recently called out in an ethics review2published in IVF’s leading peer-reviewed journal. The authors conclude what should have been an obvious truth; new treatment options must be demonstrated to be effective prior to being sold to patients.
Now, the authors casually include EmbryoGlue among their list of dubious examples but EmbryoGlue has, by far, the longest history of all the mentioned treatment options. I would also argue that EmbryoGlue has absolutely met the threshold of effectiveness and has certainly shown beneficial in our laboratory. Prior to release in 2003, there was already a significant body of research behind the development of the product 3, 4, 5and, over the past 17 years, the benefit has been confirmed and published by labs around the world 6,7. Furthermore, a 2014 collection of the published data shows a 7% increase in pregnancy rates with EmbryoGlue 8. Prof. David Gardner, one of the leading minds in the field of embryology, has recently put out a webinar summarizing the 20 years since he first published the benefits hyaluronan. Thus, if EmbryoGlue is the most established “add-on” around, why is it still an “add-on”? One truth is, EmbryoGlue marketed as an add-on allows some clinics to charge additional premium on top of an already expensive IVF cycle.
Based on the data available to us, why limit this benefit only to patients able to spend more money? Why not provide EmbryoGlue to every patient? Today’s top embryologists are striving for 1% improvements in success rates. 7% is nothing to ignore!This is the reason Denver Fertility provides EmbryoGlue at every transfer.
We don’t want to upsell our patients. If something is good for every patient, then we will provide it to every patient. Through thoughtful diligence, we have designed an efficient, effective laboratory to take care of your embryos. Thank you for partnering with Denver Fertility to find the best strategy to reach your goals.
References
- Glazar, B (2015) EmbryoGlue® Implantation Promoting Medium with Proven and Documented Success Increasing Live Birth rates. Vitrolife Whitepaper.
- Wilkinson, J et al. (2019)Do à la carte menus serve infertility patients? The ethics and regulation of in vitro fertility add-ons. Fertility and Sterility. Volume 112, Issue 6, 973-977
- Zorn TM et al. (1995) Biosynthesis of glycosaminoglycans in the endometrium during the initial stages of pregnancy of the mouse. Cell Mol Biol 41:97-106
- Gardner DK et al. (1999) Fetal development after transfer is increased by replacing protein with the glycosaminoglycan hyaluronan for mouse embryo culture and transfer. Hum Reprod 14:575-2580
- Stojkovic M et al. (2002) Effects of high concentrations of hyaluronan in culture medium on development and survival rates of fresh and frozen-thawed bovine embryos produced in vitro. Reprod 124:141-53
- Urman et al. (2008) Effect of hyaluronan-enriched transfer medium on implantation and pregnancy rates after day 3 and day 5 embryo transfer: a prospective randomized study. Fert Steril 90(3):604-12
- Bontekoe S et al. (2014) Cochrane Database Syst Rev. Feb 25;(2):CD007421
- Hashimoto S et al. (2014) EmbryoGlue improves pregnancy and implantation rates: Results from a Metaanalysis on almost 10,000 embryo transfers. Reprod BioMed Online. 28(Suppl 1):S7-S8.
