In Germany, the pregnancy rate pro embryo transfer is so unsatisfactory (IVF=22.6% : ICSI=23.5%) that we must really ask ourselves, if we can take the responsibility and treat couples who long for a child. The question is justified when we compare the German rates to those elsewhere, where in some cases pregnancy rates of 80% and more are achieved pro embryo transfer. Then we have to remember, that at the moment couples have to pay up to 10.000 EUR out of their own pocket for ICSI treatment , and this without optimal treatment. The reasons lie in the legal requirements for embryo protection in Germany and Switzerland. The legal guidelines in both countries are responsible for the dilemma and programmed failure. In these countries, no more than 3 embryos can be cultivated legally.

 

Today we are convinced that the quality of the transferred embryo is the crucial factor for the success of IVF/ISCI treatment.

 

Embryo quality can only be judged by growth speed and morphology in each embryo stage. In other countries, outside Germany and Switzerland, routine embryo selection is practised. That indicates that from all the cultivated embryos over 3-6 days, only the best developed and morphologic, most inconspicuous embryos are selected and transferred . The most preferred stage is after 5-6 days of culture when the blastocyst has expanded.

 

Every selection art is prohibited in Germany and Switzerland. Maximal 3 chosen pre nuclear stadium, are allowed to develop into embryos, no matter how good or bad they have developed. A culture that is more than 2 days old is pointless because selection is not allowed at any time.

 

Only about 40% of all fertilized egg cells reach the expanding blastocyst stadium. If this stadium is reached after cultivation for 5-6 days in sequential medium, and then transferred, a success rate over 50% can be achieved. This applies also when only 2 embryos are transferred. Consequently, the multiple pregnancy rate after IVF/ICSI can be reduced significantly.

 

This is not possible in the German and Swiss IVF/ICSI groups.

 

 

Oer the last few years, the drifting pregnancy rates between Germany, Switzerland and other countries outside their borders, are due to the fact that the other countries are allowed to cultivate in sequential medium for longer periods, and then select the best embryos. In the future, we will have to live with pregnancy rates under 30% in Germany and Switzerland, because we don’t have the possibility of choosing the expanding blastocysts from the pool of developing embryos.