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Archive for April, 2010

Using an IVF Database To Influence Real Outcomes

By John Moschella, Ms Eld

April 29th, 2010 at 6:00 pm

For many years, embryologists have talked about the benefits of having real time data available at their fingertips. Although several companies have developed comprehensive systems, none are widely used. The question is why aren’t they used by more clinics? The answer is both simple and simplistic. First, the cost of both hardware and the database itself can be prohibitive for most IVF clinics. Second, the manpower needed for data entry is labor intensive. Third, use of such systems requires diligent compliance by all members of IVF team, including nurses and physicians. So why then should be address this subject again? In 2004, East Coast Fertility began using Embryostats, a cost effective database application with streamlined data entry. This state of the art database focuses on critical reporting. After all, bells and whistles mean nothing if you can’t access a useable report. With legitimate reports available in just seconds, we have been able to identify positive and negative trends quickly and effect changes that directly influence patient outcomes.

We have identified

  • Problems with medications
  • Differences among embryologists and physicians performing transfers
  • Methods of reducing the learning curve for newly trained embryologists
  • New procedures and protocols (co-culture, oocyte freezing) based on pregnancy statistics
  • Different treatment regimens for specific age groups
  • Dangerous trends such as incubator variability, problems with air quality, media variability and toxicity of contact materials.

For physicians who question its usefulness, how many times have you wondered why pregnancy rates dropped, only to have them mysteriously recover the following month? How many different variables could have been responsible? Have you ever found out why this happened? Finally, how different would your SART statistics look if only you could have identified the problem sooner? Our physicians no longer ask these questions. They have learned from firsthand experience, the benefits of a true database application. So the answer really is simple. Although differences exist among IVF centers, the one desire we all share, is to improve outcomes for our patients. Using an IVF database application can go along way to achieving this goal.

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Through The Eyes of an Embryologist

By admin

April 28th, 2010 at 6:00 pm

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As an embryologist, most of my day is spent in the laboratory performing microscopic analysis and handling gametes, zygotes and embryos.  Although I don’t interact with patients as frequently as the physicians, nurses, medical assistants or receptionist do, I have had my share of experiences with patients. My most recent experience is a memorable one in which a little miracle was created in the midst of an unforeseen tragedy. This miracle involves a young, married couple from my hometown of Jamaica, Queens. This couple, who I will refer to as Tammy and Tony, tried unsuccessfully for several years to conceive on their own. In the fall of ‘09 Tammy and Tony became IVF patients of East Coast Fertility.

I met Tony on the day that he arrived to have a diagnostic semen analysis. I remember him as a man of great stature and presence who, upon entrance into the collection room, became visibly nervous and timid.  After assuring him that everything will be ok, the collection protocol was explained. The sample he produced was analyzed and found to be suboptimal. Consequently, his sample was cryopreserved as a backup for future use.

Several weeks later, Tony-a 33 year old NYC bus driver- was fatally wounded while moonlighting as a music video producer for a local neighborhood artist. Surprisingly, despite the loss of her significant other, Tammy decided to continue with her treatment.  On the day of retrieval, the cryopreserved sperm of the deceased spouse was thawed and used for the insemination of Tammy’s eggs.

I met Tammy, a petite woman with a very pleasant demeanor, on the day of embryo transfer.  I vividly remember being amazed by her ability to remain calm and strong while a distraught mother-in-law sat by her bedside.

Tammy is now three months pregnant and expecting her first child in the fall. Although Tammy will never be able to get back the life that she lost, she will be able to bring a part of her loved one into the world. It is very humbling and gratifying to know that we contributed to this extension of life.

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Seeing Infertility As One of Life’s Detours

By Pam Madsen

April 28th, 2010 at 5:00 am

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I have been writing, advocating and sharing my heart, my family, and what there is of my wisdom and experience with the fertility community for close to 21 years now. It was not how I intended to my spend my life – it was not on my list of childhood dreams for my future. I was going to be a kindergarten teacher – and I was one for six years. I taught at P.S. 26 in a rough section of the Bronx. I loved cooking with my class, putting on plays – and the easel in my classroom was always busy. I loved teaching my children through the arts and bringing reading, writing, and arithmetic to them through the world around them. it was how I was going to spend my life – and being a teacher fit really well with my life plan of marrying young, and having a big family. Well, I married young anyway!

I didn’t expect infertility – and it almost derailed me. But instead of being derailed – my experience with infertility became an incredible life detour for me that I would never have wished for – and would now never would give back. In so many ways – my experience of infertility created who I am today. Sometimes, the curve balls that life throws at us is what makes our lives truly interesting. The fact of the matter is, that for me – as much as I loved teaching – it was not a challenge for me. It was simply a quiet life – that gave me a lot of time. When I think back on those days – it is hard to remember what it is that I did with all of that time! And yet I am sure that I must have felt "busy". I know that I felt busy because when I did encounter infertility and I was asked to volunteer for a fertility support group called "RESOLVE NYC" – at first I declined because I didn’t know where I would find the time to do it.

But it was by finding the time – and volunteering that I changed my life. If I didn’t say yes all those years ago – I would not have found my life’s purpose. I know that I am not alone here – I know that so many people who have dedicated their lives to a mission often do so after an experience with adversity.

When you hear people share why they went on a certain career path – or even why they led a revolution – it is often because they had a moment in life that was so earth shaking, that it defined their life’s purpose in some way that would not have been without that big bang life experience that set them back on their ass in a way that was mind blowing.

That was how it was with me and infertility. The inability to have a child so shook me down to the core of my being -that it changed me forever. Last week I wrote a entry on the power of positive thinking and how we can take our experiences and our pain – and change it into something powerful for our lives and for others. Boy, was I slammed. I had people write to me that I didn’t understand the pain of infertility (after all I was "successful"), and that I was telling people that if they had a positive attitude that they would have a baby – and of course the reverse as well – if they were angry and upset that they were causing their own infertility. Of course I wasn’t saying any of those things. But it was a good reminder of the anger that so many of us feel during infertility – and I certainly remember at one point or another during my own infertility experience -that nobody could say anything to me that would make me feel better.

But eventually – I figured out – that learning how to cope with the detours that life had thrown at me – was a tremendous gift of it’s own kind. It was through the pain of infertility that I became a leader in the community and turned my negative into a positive. It was a life’s detour that shaped the following 20 years of my life. Infertility became an incredible teacher for me – it was my own life coach – and as I learned to deal with disappointments and challenges – I also learned to expand my heart in ways that I think that I never would have if I was not touched by this disease. I learned how to pick myself up after very difficult experiences that put me down for days in the pits of unbearable sadness. I learned to find my own sense of resilience and a belief in my own future – and that belief kept me going to find my own resolution.

Now my story is not your story – it is my story. You may not think that infertility is a great life teacher – but for me it was. You perhaps cannot imagine what it would be like to travel to another country to adopt a child – or to find treatment that you cannot get at home. But if you do – what I can promise you is that it will change you and be a life’s detour that will fill you in ways that you cannot know. Or perhaps your detour may be triplets – or finally figuring out that being a family of two is what works the best for you and your partner.

But what I do believe is that no matter what your outcome is – infertility will change your life in a way that you will never expect and at some point you will see that it has brought with it some gifts that you never would have had if infertility had not come knocking on your door. I do believe that there will be some kind of life shift that is beautiful and perhaps cannot be seen while you are in the midst of the pain.

What we need to be able to do, in my opinion to cope with all of it – to grow like wild flowers in the mud – is to be able to some how reach for life’s detours instead of being derailed by the curve balls. It is a way of living one’s life – a way of being. One of my guides during difficult times – and a teacher for me in turning my life into a positive place when I was stuck in a place of fear and sadness is Pema Chodron. I highly recommend picking up the books "The Places That Scare You – A Guide to Fearlessness in DIfficult Times" and "When Things Fall Apart". These books helped me become a woman that didn’t lay down when I was punched by life ( or at least not for very long).

For me – I has taken life’s detours – and I have been amazed at the journey and the beauty that has greeted me in the most unexpected places. So – does infertility suck? You bet. But keep your eyes open for what else it will bring you besides disappointment, anger, fear and pain. You might be surprised at the parting gifts if you just allow your self to look around as life throws at you it’s detours. As the late, great Gilda Radner said with a smile – "It’s always something"!

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The Sixth Annual East Coast Fertility Family Reunion!

By admin

April 26th, 2010 at 1:52 pm

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Was your ECF baby born in 2008, 2009 or 2010? If so – we would love to celebrate your family with you – and see all of our precious alumni!

So join us at The Mid-Island Y JCC from 12pm to 2pm on May 19th for a lovely lunch (there will be lots of kid friendly food) and lots of hugs!

Please RSVP to Lindsay at lmontello@eastcoastfertility.com or 516 939 – 2229 x5509

The Mid- Island Y JCC
45 Manetto Hill Road
Plainview, NY 11803

Related Links

  • Video from last year’s reunion:

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The Wyden Bill Doesn’t Support Patients

By David Kreiner, MD

April 24th, 2010 at 6:00 pm

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Unlike most other fields in medicine, IVF success rates have been subject to public reporting since the passage of the Wyden Bill in 1992. The intent of the Centers for Disease Control and Prevention (CDC) report and the Society of Reproductive Technology (SART) report was to help infertility patients by informing them of the relative success of different IVF programs. Unfortunately, what sometimes creates the best IVF statistical outcomes in pregnancy rates is not always what is in the best interest of the mother, child, family and society.

Now that prospective patients are comparing pregnancy rates between fertility programs there is a competitive pressure on these programs to produce the best reportable rates. This means that patients with lower odds of success are less likely to be offered IVF retrievals and are diverted to IUIs or donor egg cycles.

The Wyden Bill results in competitive pressure to transfer more embryos to increase the pregnancy rate as reported. Despite the fact that there is evidence that a program can achieve similar live birth rates by transferring a single embryo each time, the Wyden Bill creates a disincentive to do so. It is no surprise that the clinics with the highest success rates have also had the highest triplet rates.

Live birth rates are reported per fresh cycle… those from subsequent frozen embryo transfers are reported separately. But again, success rates are reported per transfer, motivating programs to transfer multiple embryos to enhance their success rates. If live birth rates were reported per fresh IVF stimulation and retrieval… including those conceived from subsequent frozen embryo transfers, then programs would be likely to provide the less risky option of single embryo transfer to patients.

The risks of prematurity and pregnancy complications are far higher in multiple pregnancies than in single pregnancies. Financial and emotional costs to families and society are enormous. Multiple pregnancies result in longer hospitalizations, neonatal ICU (NICU) admissions, complications resulting in disabled children and occasionally death. They often do not have a happy ending, including increasing the incidence of divorce.

At East Coast Fertility, our Single Embryo Transfer program covers the financial cost for transferring one embryo at a time. For the fee of one IVF cycle, we offer free cryopreservation, embryo storage and unlimited frozen embryo transfers until a patient achieves a live birth. We also offer MicroIVF (minimal stimulation IVF) which is at least half the price of full stim IVF and about the same cost as a typical IUI cycle. Since minimal stimulation does not result in as many eggs, other programs are uncomfortable offering this treatment because it would lower their reported pregnancy rates.

If we are going to report IVF pregnancy rates as required by the Wyden Bill, let’s put all programs on the same playing field… enforce the number of embryos to be transferred and promote minimal stimulation IVF as safer and more efficient than IUI.

The Wyden Bill, without the teeth to regulate such things as the number of embryos transferred and reporting success per stimulation and retrieval and not by isolated embryo transfer, does more harm than good.

Let’s support efforts to reduce the number of embryos transferred by removing the added costs to the patient of cryo-preservation, storage and subsequent frozen embryo transfers and by absorbing them ourselves as a profession. This will go a long way in eliminating multiple birth pregnancies, and will do the right thing for the patients, their families and for society.

As Ghandi said “Be the change that you want to see.”

Let’s not just talk about it.

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Welcome to the new site

By David Kreiner, MD

April 22nd, 2010 at 6:00 pm

Welcome to opening day at not only The Fertility Daily – but East Coast Fertility’s (ECF) newly redesigned website. All of us at ECF are excited to bring this new site and blog to you. Our goal at ECF is to reach more people every day struggling with infertility – and help them remove the road blocks to building their families.

We hope that this blog – and the newly improved ECF website with all of its improved and extensive content will become a good resource not only for fertility patients, but for the media and students as well.

There are “Ask the Expert” and Journey to the Crib Videos, message boards and of course this new blog.

It is my hope that the interactive parts of our site will allow for a dialogue between patients and the staff here. We want both our prospective patients and our current patients to feel they have access to us and to the information they are looking for. We hope that this new website with its blog will provide support, information – and frankly some comfort for our patient community.

ECF knows that making decisions regarding medical care and considering the financial burden of fertility treatments can be overwhelming for many couples. That’s why we have expanded the content around different procedures and financial options. With our premium content, it is our hope that we will be educating the patients and turning them into their own advocates.

It is my personal hope that through this blog – that you will get to know the East Coast Fertility team so much better. So come and visit us every day – and connect not only with our incredible staff of doctors, nurses, embryologists, alternative medicine practitioners, our patient advocate – but with other patients as well.

Together, we hope to provide you with the resources, avenues and support that will help you make the right decision for you on your family building journey.

All the best –
David Kreiner, MD

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