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Archive for the ‘free cryopreservation program’ tag

Infertility Podcast Series: Journey to the Crib: Chapter 28: No More “Jon and Kate” Casualties

By David Kreiner, MD

August 23rd, 2013 at 5:12 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Eight: No More “Jon and Kate” Casualties. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=136

No More “Jon and Kate” Casualties

 

A few years ago when I wrote this chapter, the Jon and Kate makes eight story was still hot in the press.  It brought to the national limelight the potentially tragic risk of the high order multiple pregnancy for women undergoing fertility therapy.  It is one I was all too familiar with from my early days in the field, during the mid-1980′s when the success with IVF was poor and we consequently ran into occasional high order multiple pregnancies with transfer of four or more embryos or with the alternative gonadotropin injection treatment with intrauterine insemination (IUI).

 

Today, IVF is an efficient process that, combined with the ability to cryopreserve excess embryos, allows us to avoid almost all high order multiple pregnancies.  In fact the IVF triplet pregnancy rate for Long Island IVF docs has been under 1% for several years now.  There has not been a quadruplet pregnancy in over 20 years.  Such a claim cannot be made for gonadotropin injection/IUI therapy where as many eggs that ovulate may implant.

 

You may ask then why would we provide a service that is both less successful and more risky and was the reason Jon and Kate made eight.

 

Not surprisingly, the impetus for this unfortunate treatment choice is financial.  Insurance companies, looking to minimize their cost, refuse to cover fertility treatment unless they are forced to do so.  In New York State, there is a law that requires insurance companies based in NY State that cover companies with over 50 employees that is not an HMO to cover IUI.  The insurance companies battled in Albany to prevent a mandate to cover IVF as has been passed in New Jersey, Massachusetts and Illinois among a few others.  As a result, many patients are covered for IUI but not IVF.  This short-sighted policy ignores the costs that the insurance companies, and ultimately society, incurs as a result of high order multiple pregnancies, hospital and long-term care for the babies.

 

The answer is simple.  Encourage patients to practice safer, more effective fertility.  This can be accomplished with insurance coverage for IVF, wider use of minimal stimulation IVF especially the younger patients who have had great success with it and minimizing the number of embryos transferred. 

 

At Long Island IVF we encourage single embryo transfer by eliminating the cost of cryopreservation and embryo storage for one year for patients who transfer one fresh embryo.  In addition, we offer those patients up to three frozen embryo transfers for the price of one within a year of their retrieval or until they have a live birth.

 

It is my sincere wish that the government can step in to enforce a policy that will never again allow for the possibility of another Jon and Kate debacle.

 

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Was this helpful in answering your questions about multiple pregnancies, IVF, IUI, and Micro-IVF?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

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Infertility Podcast Series: Journey to the Crib: Chapter 3: What Are My Odds?

By David Kreiner MD

February 26th, 2013 at 4:59 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Three: What Are My Odds? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=24

 

What are my odds?

 

This chapter is dedicated to informing patients regarding the potential for success with fertility therapy.  Success, in particular with IVF has been increasing significantly over the years as physicians and embryologists became more experienced.   The tools we use are more accurate and effective today and the protocols, media and laboratory conditions are all far superior to that which was standard not so many years ago.

 

This improved efficiency of the process has allowed physicians to transfer fewer embryos thereby avoiding the higher risk multiple pregnancies that IVF was known for in the 1990’s.  Still pressure exists to transfer multiple embryos to minimize expenses for the patient and maximize success rates for the IVF programs.  I have instituted a single embryo transfer incentive (SET) program at Long Island IVF eliminating the cost of cryopreservation and storage for a year for patients transferring a single embryo.  These patients are also offered three frozen embryo transfers within a year of their retrieval for the cost of one in an effort to eliminate the financial motivation some patients express to put “all their eggs in one basket”.  Experience tells us that the take home baby rate for patients transferring a single embryo at the fresh transfer is equal to that for patients transferring multiple embryos when including the frozen embryo transfers. For information on the SET program, go to: http://bit.ly/WpzCvv

 

Since the merger of East Coast Fertility and Long Island IVF, we have seen clinical IVF pregnancy rates at 66% (35/53) for women <35, 60% (18/30) for women 35-37, 54.1% (20/37) for women 38-40 and 8/28 (28.6%) for women 41-42 from Oct 1- Dec 31, 2011.  MicroIVF has been running better than 40% for women <35.

 

Different factors are discussed that can affect pregnancy rates at different programs.  The use of Embryo Glue and co-culture at Long Island IVF are discussed as laboratory adjunctive treatments that appear to improve our success rates.

 

For the most recent success rates, speak to your Long Island IVF physician or visit our website at http://bit.ly/XYZrSC

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Please share your thoughts about this podcast or ask any questions of Dr. Kreiner here.

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Infertility Podcast Series: Journey to the Crib: Chapter 33: Fertility Treatment During This Economic Downturn

By David Kreiner, MD

November 8th, 2012 at 6:19 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers the final chapter, Chapter Thirty-Three: Fertility Treatment During This Economic Downturn. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=149 

 Fertility Treatment During This Economic Downturn 

Financial hardships have increased fertility challenges for many couples attempting to build their families.  In regions where patients do not have insurance coverage for their IVF procedures it is unlikely that they proceed with the treatment that is necessary for them to be able to complete their families. 

In places that do provide coverage for IVF, such as Massachusetts, 5% of all babies born are as a result of IVF.  Elsewhere in the U.S., IVF accounts for only 1% of births suggesting that the financial cost of IVF denies access for approximately 80% of couples in need.

The problem of the cost of IVF is compounded by the fact that patients are driven to transfer multiple embryos to limit the cost and avoid additional fees from cryopreservation, embryo storage and frozen embryo transfers.  These multiple transfers increase the risks of multiple pregnancy and preterm delivery with subsequent complications to the babies from preterm birth. 

We, at Long Island IVF, attempt to make IVF more accessible and safer by offering income based grants, free cryopreservation, storage and discounted frozen embryo transfers to patients electively transferring single embryos.  We have also offered free IVF cycles through best video/essay contests to a few needy patients over the past few years. 

It is our sincere wish and hope that a bill that is presently in front of Congress offering a tax credit to patients going through IVF is passed thereby making IVF that much more affordable to our patients in need. 

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Was this helpful in answering your questions about fertility treatment during this economic downturn? Are you aware of the pending proposed Family Act, which would offer a tax credit to infertile women wishing to undergo infertility treatment (similar to the current adoption credit for those wanting to pursue adoption)? Have you urged your legislators to support this important legislation?

 Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

 

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Infertility Podcast Series: Journey to the Crib: Chapter 30: The Gift of Life and Its Price

By David Kreiner MD

October 5th, 2012 at 1:24 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty: The Gift of Life and Its Price. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=141

 The Gift of Life and Its Price

 IVF has been responsible for over 1 million babies born worldwide who otherwise without the benefit of IVF may never have been.  This gift of life comes with a steep price tag that according to a newspaper article in the New York Times in 2009 was $1 Billion per year for the cost of premature IVF babies.

 According to the CDC reported in the same NY Times issue, thousands of premature babies would be prevented resulting in a $1.1 Billion savings if elective single embryo transfer (SET) was performed on good prognosis patients. 

 The argument often given by a patient who wants to transfer multiple embryos is that to do SET would lessen their chances and to go for additional frozen embryo transfers is costly.

 In fact, if one considers the combined success rate of the fresh and frozen embryo transfers that are available from a single stimulation and retrieval, the success rate is at least as high if not higher in the cases of fresh single embryo transfers. 

At Long Island IVF, in an effort to eliminate the financial motivation for multiple embryo transfers, we offer free cryopreservation and embryo storage for a year to our single embryo transfer patients.  In addition, we offer them three (3) frozen embryo transfers for the price of one for up to a year after their retrieval.

IVF offered with single embryo transfer is safer, less costly and probably the most effective fertility treatment available for good prognosis patients.                     

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Was this helpful in answering your questions about single embryo transfers?  Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

 

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Infertility Podcast Series: Journey to the Crib: Chapter 28: No More “Jon and Kate” Casualties

By David Kreiner MD

September 20th, 2012 at 5:03 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Eight: No More “Jon and Kate” Casualties. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=136

 No More “Jon and Kate” Casualties

 Two years ago when I wrote this chapter, the Jon and Kate makes eight story was still hot in the press.  It brought to the national limelight the potentially tragic risk of the high order multiple pregnancy for women undergoing fertility therapy.  It is one I was all too familiar with from my early days in the field, during the mid-1980′s when the success with IVF was poor and we consequently ran into occasional high order multiple pregnancies with transfer of four or more embryos or with the alternative gonadotropin injection treatment with intrauterine insemination (IUI). 

Today, IVF is an efficient process that, combined with the ability to cryopreserve excess embryos, allows us to avoid almost all high order multiple pregnancies.  In fact the IVF triplet pregnancy rate for Long Island IVF docs has been under 1% for several years now.  There has not been a quadruplet pregnancy in over 20 years.  Such a claim cannot be made for gonadotropin injection/IUI therapy where as many eggs that ovulate may implant. 

You may ask then why would we provide a service that is both less successful and more risky and was the reason Jon and Kate made eight. 

Not surprisingly, the impetus for this unfortunate treatment choice is financial.  Insurance companies, looking to minimize their cost,  refuse to cover fertility treatment unless they are forced to do so.  In New York State, there is a law that requires insurance companies based in NY State that cover companies with over 50 employees that is not an HMO to cover IUI.  The insurance companies battled in Albany to prevent a mandate to cover IVF as has been passed in New Jersey, Massachusetts and Illinois among a few others.  As a result, many patients are covered for IUI but not IVF.  This short-sighted policy ignores the costs that the insurance companies, and ultimately society, incurs as a result of high order multiple pregnancies, hospital and long-term care for the babies. 

The answer is simple.  Encourage patients to practice safer more effective fertility.  This can be accomplished with insurance coverage for IVF, wider use of minimal stimulation IVF especially the younger patients who have had great success with it and minimizing the number of embryos transferred.  

At Long Island IVF we encourage single embryo transfer by eliminating the cost of cryopreservation and embryo storage for one year for patients who transfer one fresh embryo.  In addition, we offer those patients up to three frozen embryo transfers for the price of one within a year of their retrieval or until they have a live birth. 

It is my sincere wish that the government can step in to enforce a policy that will never again allow for the possibility of another Jon and Kate debacle. 

* * * * * * **  * * * *

Was this helpful in answering your questions about multiple pregnancies, IVF, IUI, and Micro-IVF?  Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

 

no comments

Cryopreservation: A Look into the IVF Freezer

By Tracey Minella and David Kreiner MD

December 13th, 2011 at 2:41 pm

Remember the Good Humor man? You’d hear that sound from blocks away and bolt out the door barefoot, shrieking “STAAAPPP!” arms flailing, and being joined by the rest of the block like rats to the Pied Piper.

Remember the way the white square door with the chunky silver hinge on the back swung open and all that cold, smoky fog billowed out into the humid air?

Remember the frozen magic inside?

Well, Long Island IVF and East Coast Fertility have magic freezers, too. Full of dreams. Full of potential. Full of embryos that may one day turn out to be rugrats running after the ice cream man.

In fact, Long Island IVF’s freezer once held the frozen embryo that turned out to be Long Island’s first cryo baby! Let’s revisit an earlier post by Dr. Kreiner which lets us take a peek inside the freezer of Long Island’s first successful cryopreservation program:

In 1985, my mentors, Drs. Howard W. Jones Jr. and his wife Georgeanna Seegar Jones, the two pioneers of in-vitro fertilization in the USA and the entire western hemisphere, proposed the potential benefits of cryopreserving or freezing embryos following an IVF cycle. They predicted that cryopreserving embryos for future transfers would increase the overall success rate of IVF and make the procedure more efficient and cost effective. They also suggested that it would reduce the overall risks of IVF. For example, one fresh IVF cycle might yield many embryos which can be used in future frozen embryo transfer cycles, if necessary. This helps to limit the exposure to certain risks confronted only in a fresh IVF cycle such as the use of injectable stimulation hormones, the egg retrieval operation, and general anesthesia.

At East Coast Fertility, we are realizing the Jones’ dream of safer, more efficient and cost effective IVF. By utilizing the ability to cryopreserve embryos in 2007, 61.5% (118/192) of patients under 35 were successful in having a live birth as a result of only one egg stimulation and retrieval cycle! In addition, because of our outstanding Embryology Laboratory, we are usually able to transfer as few as 1 or 2 high quality embryos per cycle and avoid risky triplet pregnancies. In fact, since 2002, the only triplet pregnancies we have experienced have resulted from the successful implantation of two embryos, one of which goes on to split into identical twins (this is rare!). By cryopreserving embryos in certain high-risk circumstances, we are able to vastly reduce the risk of ovarian hyperstimulation syndrome requiring hospitalization. At East Coast Fertility, safety of our patients comes first. Fortunately, our success with frozen embryo transfers is equivalent to that of fresh embryo transfers, so that pregnancy rates are not compromised in the name of safety, nor are the babies.

Today, as reported in the Daily Science: “The results are good news as an increasing number of children, estimated to be 25% of assisted reproductive technology (ART) babies worldwide, are now born after freezing or vitrification” (a process similar to freezing that prevents the formation of ice crystals).

The study, led by Dr Ulla-Britt Wennerholm, an obstetrician at the Institute for Clinical Sciences, Sahlgrenska Academy (Goteborg, Sweden), reviewed the evidence from 21 controlled studies that reported on prenatal or child outcomes after freezing or vitrification.

She found that embryos that had been frozen shortly after they started to divide (early stage cleavage embryos) had a better, or at least as good, obstetric outcome (measured as preterm birth and low birth weight) as children born from fresh cycles of IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection). There were comparable malformation rates between the fresh and frozen cycles. There were limited data available for freezing of blastocysts (embryos that have developed for about five days) and for vitrification of early cleavage stage embryos, blastocysts and eggs.

Slow freezing of embryos has been used for 25 years and data concerning infant outcome seems reassuring with even higher birthweights and lower rates of preterm and low birthweights than children born after fresh IVF/ICSI. For the newly introduced technique of vitrification of blastocysts and oocytes, very limited data have been reported on obstetric and neonatal outcomes. This emphasises the urgent need for properly controlled follow-up studies of neonatal outcomes and a careful assessment of evidence currently available before these techniques are added to daily routines. In addition, long-term follow-up studies are needed for all cryopreservation techniques,’ concluded Dr Wennerholm.

The use of frozen embryos has become a common standard of care in most IVF Programs. At East Coast Fertility, [now merging with Long Island IVF], we are able to keep multiple pregnancy rates down – by only transferring one or two embryos at a time – while allowing patients to hold on to the additional embryos that they may have created during the fresh cycle. It is like creating an insurance plan for patients. We developed a unique financial incentive program using the technology of cryopreservation to encourage patients to transfer only one healthy embryo at a time.

In order to ensure the best outcome for mother and child – these special pricing plans take the burden off the patient to pay for the additional transfers and the cryopreservation process. We have eliminated the cost of cryopreservation, storage and embryo transfer for patients in the single embryo transfer program. Thus, patients no longer have that financial pressure to put all their eggs in one basket! We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

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Did you know before today that Long Island IVF is the home of Long Island’s first cryo baby?

Or that East Coast Fertility’s Director, Dr. Kreiner, and Long Island IVF’s Co-Directors, Drs. Kenigsberg and Brenner were running the show together at Long Island IVF way back then when cryo first came to Long Island…back when most of you reading this were very little kids?

Stay tuned as we bring you more interesting history about these IVF pioneers now that they’re all together again.

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