Posts Tagged ‘IVF’

For unexplained infertility-IUI with drugs or IVF, which is best?

Monday, August 30th, 2010

Conventional treatment for couples experiencing unexplained infertility has usually consisted of three cycles of clomiphene (CC) with IUI, followed by three cycles of gonadotropins (FSH) with IUI and then IVF if those conservative measures did not work.

A study in the August 2010 issue of Fertility & Sterility looks at the time it took to establish a pregnancy that led to a live birth and cost-effectiveness of either conventional treatment with three cycles of clomiphene citrate CC/IUI, three cycles of gonadotropins FSH/IUI, and up to six cycles of IVF or an accelerated treatment that omitted the three cycles of FSH/IUI.

An increased rate of pregnancy was observed in the accelerated arm compared with the conventional arm. Median time to pregnancy was 8 and 11 months in the accelerated and conventional arms, respectively. Per cycle pregnancy rates for CC/IUI, FSH/IUI, and IVF were 7.6%, 9.8%, and 30.7%, respectively. Average charges per delivery were lower in the accelerated arm compared to conventional treatment. The observed incremental difference was a savings of $2,624 per couple for accelerated treatment.

In my experience many couples are bypassing the option of FSH/IUI, not only because of the increased time and expense to success, but also because IVF provides more control over high-order multiple pregnancies as we transfer fewer embryos.

Arthur L. Wisot, M. D.

Does IVF increase the chance of identical (monozygotic) twins?

Tuesday, July 20th, 2010

It does, at least according to a study in the July 2010 issue of Fertility & Sterility.

The authors surveyed 4976 clinical pregnancies from one large IVF center and found ninety-eight cases of monozygotic twins (MZTs) were diagnosed after first-trimester ultrasound evaluation (2% incidence). In naturally conceived pregnancies the incidence is about 0.25-0.5%. 

The incidence in women transfering embryos from their own eggs was 1.7% but was 3.3% with donor eggs; however, younger women (<35 years old) using their own eggs displayed a similar rate (3.1%) to women using donor eggs.

Eighty MZTs occurred after fresh day-5 transfer; only 14 followed fresh day-3 transfer (2.6% vs. 1.2%). The MZT incidence in day-3 transfers without assisted hatching was not different from those with hatching (1.3% vs. 1.1%). In addition, MZT incidence did not differ significantly whether or not ICSI was performed (2.4% vs. 2.0%). Four MZTs occurred after frozen-thawed embryo transfer (0.8% incidence).

The good news is that ninety-five percent of all placental arrangements were confirmed as having two amniotic sacs on obstetric ultrasounds, making them safer pregnancies than when both babies are in the same amniotic sac.

The take-home message is that this is a good reason for young women and those using eggs from a young donor to seriously consider elective single embryo transfer (eSET) so if a set of identical twins does occur and the other embryo implants one does not have to deal with a triplet pregnancy.

IVF or IUI for Women Over 40?

Monday, June 7th, 2010

Selection of a treatment method for women over 40 whose main limitiation in conceiving is their age can be difficult. If they are in the "unexplained infertility" group with open tubes, no significant gynecologic problems and a partner with normal sperm parameters the common choices are to try injectable fertility drugs (COH) with artificial insemination (IUI) or in vitro fertilization (IVF). A recent study in Fertility & Sterility compared groups of women aged 38-39 with a group over 40.

The women who were 38–39 years old had an overall live birth rate of 6.1% per cycle, with no live births occurring after the second cycle, and women  over 40 years old had an overall live birth rate of 2.0% per cycle, with all births occurring in the first cycle. These data suggest that the efficacy of COH/IUI cycles significantly decreases with age, but women aged 38–39 years had reasonable success during the first two cycles. However, for women aged over 40 years, no benefit after a single cycle of COH/IUI was observed. Women over 40 years should be considered for in vitro fertilization as the first choice or after one failed COH/IUI cycle.

All we need from a sperm is its DNA.

Tuesday, March 30th, 2010

And its appearance is not a reflection of the DNA. That's what I've been telling couples when the male has severe abnormalities in his semen parameters. This especially applies to the appearance of the sperm (teratozoospermia), the strict morphology. Now a study in the March 2010 issue of Fertility & Sterility confirms the accuracy of my statement.

They looked at couples going through cycles of IVF with ICSI and correlated their outcomes with the degree of abnormality in the measurement of sperm appearance, the strict morphology. Fertilization rates were high (74%–77%), and clinical pregnancy rates ranged from 60% (subgroup with 0% normal sperm) to 56% (subgroup with ≥7% normal forms). The highest pregnancy and live birth rates were actually observed in eggs fertilized with sperm from specimens with the most severe teratozoospermia. The percentage of high-quality blastocysts was significantly greater in the severely teratozoospermic patients compared with patients with ≥5% normal sperm (37% vs. 28%). This is likely because in the lower morphology subgroups, female factors are less prevalent and the primary infertility problem is male factor.

So, according to this study,  those couples needing IVF with ICSI for severe teratozoospermia can rest assured that they do not have to worry that this abnormaility will adversly affect the outcome of their IVF cycles.

Monozygotic twinning not increased in blastocyst embryo transfer over cleavage stage transfer

Tuesday, March 16th, 2010

One of the discussions we may have with patients prior to a blastocyst transfer is the supposed increased chance of an embryo at the blastocyst stage splitting and becoming an identical twin pregnancy.

In this study in the February 2010 issue of Fertility and Sterility, the authors monitored almost 2000 IVF cycles and found in this group of single-embryo transfers there was no statisically significant difference observed in the probability of monozygotic twinning between the cleavage-stage (Day 3) and the blastocyst group (Day 5).  The odds of an identical twin pregnancy was 2.6% in the cleavage-stage group (8/308) and 1.8% (5/271) in the blastocyst group The odds ratio for the incidence of monozygotic twinning after Day-5 embryo transfer was calculated to be 0.71 compared to the Day 3.

Despite the stage of the embryos at the time of transfer, one must be mindful of the almost 2% chance of monozygotic twins when selecting the number of embryos to transfer.

Does preimplantation genetic screening (PGS) improve IVF success rates in women over 35?

Friday, March 5th, 2010

Some fertility centers promote preimplantation genetic screening as a way of improving IVF success rates in women over 35 (defining advanced maternal age).

Now a study in the January 2010 edition of Fertility & Sterility shows that PGS does not significantly improve implantation, pregnancy or live birth rates. In this randomized control study from Belgium, the clinical implantation rate per embryo transferred was compared between the PGS group (analysis of chromosomes 13, 16, 18, 21, 22, X, and Y by FISH) and the control group without PGS.

No differences were observed between the PGS group and the control group for the clinical implantation rate, the ongoing pregnancy rate at 12 weeks and the live born rate per embryo transferred.  A normal chromosome component was observed in only 30.3% of the embryos screened by PGS.

In this randomized controlled trial, the results did not confirm the hypothesis that PGS by FISH in 3-Day embryos results in improved reproductive outcome in patients with "advanced maternal age.".

In the future newer techniques of chromosome analysis such as comparative genomic hybridization (CGH) which can analyze all chromosome pairs and the ability to analyze blastocyst cells, freeze the embryos and transfer only chromosomally normal embryos may result in better outcomes and the need to transfer fewer embryos and reduce high-order multiple pregnancies as well.

The Success Prime IVF Program

Thursday, February 4th, 2010

We are proud to announce the launch of the Success Prime IVF Program, an IVF money back guarantee for best-case patients. The elements of the Success Prime IVF Program are very simple. If we determine that you are an eligible, or prime candidate, and if you do not get pregnant with embryos from either a fresh or frozen embryo IVF cycle, you will receive a refund of the Global Fee of $11,650 standard IVF or $13,350 for IVF with egg donation.

At Reproductive Partners we want to encourage patients to do everything possible to enhance the chance of a successful outcome. We have designed the Success Prime IVF Program to recognize those who take vital steps in preparing for pregnancy.

Among other characteristics, prime candidates using their own eggs must be under the age of 34, have a BMI under 30 and both partners must be non-smokers for at least six months. If the patient is using an egg donor, the egg donor must meet all the requirements of a prime candidate.

The IVF success rate data at RPMG shows couples and donors who meet these prime candidate characteristics often succeed in their first cycle.

For complete program details, please see the Success Prime IVF Program page.
 

Announcing the Elective Single Embryo Transfer (eSET) Encouragement Program

Tuesday, December 1st, 2009

Reproductive Partners Medical Group has created the Elective Single Embryo Transfer (eSET) Encouragement Program to provide a financial incentive for patients with good embryo quality and a good prognosis for success to consider reducing the chance of twins by transferring a single embryo.

Reducing the number of multiple pregnancies, even twin pregnancies, is one of the biggest issues in advanced reproductive technology today. Couples with fertility problems often assume that they can double their chances for a healthy baby by transferring two embryos instead of just one. But, data published in the New England Journal of Medicine shows that what they're really doing is increasing their odds of having multiples, which is riskier for the mother and babies alike.

Pregnancies involving multiples, including twins, come with a greater risk of gestational diabetes, bleeding and preeclampsia for the mother, and cerebral palsy, birth defects, developmental delays and death for the babies. Twins usually survive, but incur higher medical expenses in the first five years of life.

Yet, despite the risks involved in transferring multiple embryos, couples must weigh this decision against both the chance of a failed cycle and the costs incurred by starting another fresh or frozen embryo cycle. For patients who qualify, the eSET Encouragement Program reduces the economic rationale for transferring more than one embryo.

For more information please visit our Elective Single Embryo Transfer (eSET) Encouragement Program page.

LA Times article promotes single embryo transfer

Friday, October 30th, 2009

An article in the October 29th edition of the Los Angeles Times, “1 in vitro embryo may be best” reports on data from the New England Journal of Medicine that shows by transferring more than one embryo doctors are increasing the odds of having twins, creating a riskier pregnancy for both mother and baby.

Increased risks of twins over a single IVF baby include a greater chance of prematurity, cerebral palsy, birth defects, developmental delays and death for the babies, and gestational diabetes, bleeding and preeclampsia for the mother.

Researchers from Sweden expanded the results from a 2004 study showed a difference of 43% live birth from two embryo transfer; 39% from a  single embryo transfer. That difference was not statistically significant. One third of the patients in the double-embryo group had twins or triplets, compared with only 1% in the single-embryo group.

At Reproductive Partners we have been encouraging single embryo blastocyst transfer in appropriate couples who have a good prognosis for success and excellent embryo quality. The biggest barrier to acceptance of this concept seems to be financial. In the U.S., most couples pay for IVF out-of-pocket, where in many European countries the procedure is covered by national health insurance. So a couple with a failed cycle not only has to deal with teh disappointment of not succeeding, they are faced with paying for another fresh or a frozen cycle.

Girl Crazy: Women Who Suffer from Gender Disappointment

Tuesday, October 20th, 2009

IMG

Reproductive Partners was cited in an article in the November 2009 issue of ELLE magazine, “Girl Crazy: Women Who Suffer from Gender Disappointment.” The article profiles women whose lives are disrupted because they have not been able to have the girl child that they are craving. According to the author, they resort to a variety of techniques to try to achieve their elusive dream from folk remedies to IVF with preimplantation genetic screening (PGS), also know as preimplantation genetic diagnosis (PDG) for chromosomes. The focus of the article was the degree of emotional impairment from which these women suffer rather than the procedure itself. The article profiles a physician whose practice is devoted to IVF/PGS for gender selection, although the technique is widely available, including at Reproductive Partners.

The article states, “Physicians at other clinics, including California’s topranked Reproductive Partners Medical Group, use PGD as a screening tool to identify embryos with defects, and—if pressed— will reveal the sex of embryos in conjunction with other findings. ‘We would transfer embryos of one sex or another if that is the patient’s preference,’ says Arthur Wisot, its executive director and a clinical professor of reproductive medicine at UCLA. ‘We would do it if they seem like reasonable people and no one is hurt by it. But we certainly don’t advertise it and promote it the way Steinberg does. The people he services are more on the fringe, and he’s just playing to their neuroses.’”

 Actually Reproductive Partners offers IVF/PGS for family balancing and we do not need to be “pressed” to reveal the sex of embryos. It is just not the only focus of our practice. We mostly employ this technology to detect embryos with chromosomal abnormalities, when appropriate, and diseases caused by known gene abnormalities carried by one or both parents. In fact, the most recent recommendation from the American Society for Reproductive Medicine has reduced the number of reasons for doing PGS for chromosomes because of evidence that it does not improve live birth rates in patients with advanced maternal age, previous implantation failure, recurrent pregnancy loss and even those who have recurrent pregnancy loss from chromosomal abnormalities.