so i need your opinion. we are obviously headed to vegas to ivf again and this time we feel like we're going to try everything to optimize success because we know we're not an easy case. so we just sat down to fill out our consent forms (which are about 40 pages long and have to be notarized...so all you guys out there that just get pregnant on a whim...be grateful...this sucks). well, on the last page there is a consent to sign up for a certain test that pretty much only our clinic does (they founded it) and it helps to pick out the embryos that are most likely to produce viable pregnancies. here is a quick synopsis of the test from SIRM itself:
The Embryo Marker Expression Test (EMET)
By measuring the concentration of a genetic marker known as sHLA-G (soluble human leukocyte antigen-G), which is released into the media in which early embryos are growing after fertilization, it is now possible to identify those embryos most likely to produce a pregnancy. This Embryo Marker Expression Test (EMET) is performed 46 hours after the egg retrieval to identify EMET-positive, or “competent” embryos. It has been determined, based upon the performance of EMET in more than 500 women undergoing IVF at SIRM, that the transfer of even a single EMET-positive embryo in women under 39 (provided that they had normal uterine linings and, when needed, were treated for immunologic implantation problems) results in better than a 60% chance of a viable pregnancy. Comparable results in women 39-43 years was above 40% . The transfer of more than one EMET-positive embryo at a time resulted in a great increase in the multiple pregnancy rate without significantly improving the overall pregnancy rate.
We conclude that measurement of sHLA-G in the media surrounding 2-day-old embryos in order to select competent embryos allows for a reduction in the number of embryos transferred on day 3, thereby minimizing the risk of high-order multiple pregnancies (triplets or greater) while optimizing IVF success.
This discovery is changing the way IVF is performed by bringing IVF practitioners much closer to the long-awaited objective of “one embryo, one healthy baby.”
Perhaps equally important is that now, by measuring sHLA-G (and perhaps similar molecular markers, as yet unidentified) produced by early embryos, we can establish a rational basis by which we can customize protocols used for ovarian stimulation to better meet the needs of separate categories of patients and so measurably improve egg/embryo quality and IVF success rates. Just as one size of any garment will not fit everyone, so no single regimen of ovarian stimulation is adequate for all patients. The use of biochemical and genetic markers of “embryo competency” such as sHLA-G could also provide researchers as well as the pharmaceutical industry with a method that would help in the development of new and more efficacious fertility drugs that produce fewer side effects with reduced risk to patients.
It is hoped that the proof that such advances can improve IVF outcome—and reduce risk as well as virtually eliminate high-order multiple pregnancies—will prompt health insurance companies to revisit the issue of universal infertility coverage. Until then, the size of the pocket book still determines the ability to go from infertility to family.
The above sections on GES, blastocyst transfer, and EMET provide an overview of the means by which the embryos most likely to implant are selected and nurtured at SIRM. How these elements are mixed and matched varies according to individual circumstances. Although it is not possible to generalize how they would be used, the following situations are examples of what might occur before embryo transfer. In the case of embryos scoring 70 or higher, we might advise culturing them to blastocyst stage; but at other times we would add one or two poorer-scoring embryos to a 70+ one and transfer on day 3 post-egg retrieval. If there are only a few embryos and all score below 70, we might transfer several at once in the hope that one might implant; but if there are many embryos scoring below 70, we might culture them 2 to 3 days longer to test if they will go to blastocyst stage. Presently EMET is available to all women doing IVF at SIRM. EMET, once requested by a woman/couple, is performed on all divided embryos on day 2 (i.e., one day prior to establishing the final GES score and transferring embryos). Thus, the EMET result influences which embryos are chosen, usually overriding the GES parameters. Each case must be evaluated individually. This is an example how a merger of the “art” and the “science” of IVF can profoundly benefit the woman and her partner.
so if you had time to read all that. would you do it.?? it's not a test that is used by most RE's but it sounds so good, and the best part...it's only $420 to do and has no real detrimental effect on the embies. but sometimes if it sounds too good to be true, then i usually is. what do you think???