Friday, 29 January 2016

Early Embryo Viability Assessment (Eeva)?

Disclaimer: I'm not a scientist, not a person with any kind of actual clue. Just a patient who likes to google.

My clinic offers an "Eeva test" (Early embryo viability assessment) for the rather staggering cost of $1500. Apparently this tool takes snapshots of embryo growth every 5 minutes and then turns all that data into an algorithm that can assist embryologists in their selection of embryos for transfer.
At every meeting it has been mentioned as an option for my cycle. And of course I only want to do this once and if $1500 can improve my chances, maybe I should go for it. A bit like insurance? 
LONG post continues after cut....
Tl;dr, I'm not convinced, and I'm not spending $1500 for Eeva. But I would be very very interested to hear what others think.

 
So at my IVF orientation, I asked if there have been clinical studies that show that using Eeva leads to better outcomes. The orientation nurse couldn't answer me, but offered to put me in touch with an embryologist.
I got home and googled Eeva. That brought me to eevatest.com. Eventually (clicking through to the 'healthcare professionals' part of the website, which I only found after contacting eevatest on facebook asking for more information) you can see that there has been a "prospective multi-center study" that the makers of Eeva, Auxogyn, used in order to obtain FDA approval of the test (so that it can be used in the USA). Great. What did the study show? Well, that is less clear. And interestingly, there is no mention of the study's author, or where it was published or a link to the research. As far as this non-scientist can tell from reviewing the information on eevatest.com, Eeva helps embryologists more accurately predict, on day 3, which embryos will survive to day 5 blastocyst stage. Hmm. More googling required.

More googling led me here, http://www.auxogyn.com/press-release/oral-presentations-on-eeva-test-at-asrm2014/ -- an announcement that at a 2014 reproductive medicine conference, there would be presentations about the results of clinical studies by...two "Auxogyn clinic partners". Auxogyn consultants presenting about how great an Auxogyn product is? Interesting.
Again, I'm no scientist. But it seems to me that instead of using $1500 video technology to see if an embryo is going to make it to Day 5, one might instead just, I dunno, wait until Day 5? Here's the key sentence from the article: "The adjunctive Eeva Test day 3 implantation rate appears equivalent to published day 5 blastocyst rates."


This article is a bit more interesting, as there was a statistically significant difference in implantation outcomes in a double-blinded study of 205 patients. The study showed that embryos which Eeva graded as 'high' were more likely to implant than those graded 'low'. Notably absent from the study is the embryologist's assessment: would they, based on morphology alone, have agreed with Eeva? I mean, they were going to transfer an embryo, the one they determined was 'best' based on their assessment of morphology. Did they transfer the embryo identified by Eeva? Because all this study shows is that good embryos do better than bad embryos...and this is not something terribly surprising. Does using Eeva help? Still don't know.

There are more studies, but they are harder to find. Clicking on Auxogyn's 'research and publications' tab just routed me in a loop back to eevatest.com. I had to use google's cashe feature to get to the actual list of publications: http://webcache.googleusercontent.com/search?q=cache:-Lnrn3xezdAJ:www.auxogyn.com/clinical-innovation/reproductive-science-publications/+&cd=1&hl=en&ct=clnk&gl=ca

There are some really interesting titles of articles here. Unfortunately many of the most interesting-to-me are not available online, and I don't feel like hanging out at some university health library this weekend. But I was able to find the article that eevatest.com seems to be so proud of: http://www.fertstert.org/article/S0015-0282%2813%2900517-7/fulltext. This study's author is also an Auxogyn consultant, and several others are employees and/or equity holders of Auxogyn. This study's results seem to be similar to the first described above, that is, that Eeva can assist in determining which embryos at Day 3 would be likely to develop into blastocysts at Day 5. The authors state,

It is widely accepted that morphological grading is accompanied by significant intra- and interoperator variability, which can impact IVF success rates. Here we have built a generalized prediction algorithm based on multiclinic data and demonstrated that the automated prediction information can be added to embryologists' morphological evaluations to improve their interoperator variability. Combining the noninvasive, automated Eeva measurements with traditional morphology is therefore likely to provide embryologists with more consistent and objective data that may make embryo assessment on D3 more standardized, reproducible, and successful.
Interesting for clinics and for embryologists. But I'm just not personally worried about whether the grading of my particular embryos can be reproduced, because I'm really hoping to only do this once...

It's at about this time that my eyes started to glaze over. Too much science for one day.

But I do have one remaining question: if Eeva truly and significantly improved results, and the clinic owns Eeva, and the clinic lives and dies by its success rates, why wouldn't the clinic just use Eeva for every patient? 
If you have thoughts, particularly if you have a science background, I would LOVE to hear your thoughts on this.

Edited to add: I googled just a bit more after initially publishing this post, I found this rather relevant article on Scientific American: http://www.scientificamerican.com/article/new-test-lets-women-pick-their-best-ivf-embryo/

2 comments:

  1. Hi there...I know nothing about Eeva but I used to work at an IVF clinic and have lots of queer friends going through IVF. Are you part of closed FB group Queer Mamas*? I will post this there... Sending you all good thoughts in your family building journey!

    Maya

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    1. Hi! My very first comment...yay someone actually reads my blog! Thank you for writing!
      I have joined Queer Mamas* and it is so fantastic to see the amazing range of diverse and wonderful families. A great resource for sure! If/when I actually conceive I'm sure I will have a ton of questions for everyone over there.

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