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Archive for the ‘free cryopreservation’ tag

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

By David Kreiner MD

November 9th, 2013 at 11:56 am

 

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 30: The Gift of Life and Its Price

By David Kreiner, MD

September 3rd, 2013 at 7:41 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 29: Why the Wyden Bill Does Not Support Fertility Patients

By David Kreiner MD

August 28th, 2013 at 2:18 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-Nine: Why the Wyden Bill Does Not Support Fertility Patients. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=138

Why “The Wyden Bill” Does Not Support Infertility Patients

 

IVF results subjected to government audit were mandated to be reported with the passage of the “Wyden bill”.   The intent of the CDC and national reproductive society (SART) was to assist infertility patients by informing them of the relative success of all IVF programs in the country. 

 

Unfortunately, what sometimes creates the best statistical results is not always in the best interest of the mother, child, family and society.  Now that prospective parents are comparing pregnancy rates between programs there is a competitive pressure on these programs to reports the best possible rates.   Sounds good…unfortunately it doesn’t always work out that way for the following reasons.

 

Patients with diminished ovarian reserve, who are older or for any number of reasons have a reduced chance for success, have a hard time convincing some programs to let them go for a retrieval.  In 2008, we reported our success, 15% with patients who stimulated with three or fewer follicles.  Sounds low and in fact many of these patients were turned away by other IVF programs in our area.  However, for those families created as a result of their IVF, these “miracle” babies are a treasure that they otherwise… if not for our program giving them their chance… would never have been born.

 

Another unfortunate circumstance of featuring live birth rate per transfer as the gold standard for comparison is that it pressures programs to transfer multiple embryos thereby increasing the number of high risk multiple pregnancies created.  This is not just a burden placed on the patient for their own medical and social reasons but these multiple pregnancies add additional financial costs that are covered by society by increasing costs of health insurance as well as the cost of raising an increased number of handicapped children.

 

William Petok, the Chair of the American Fertility Association’s Education Committee reported on the alternative Single-Embryo Transfer (SET) “Single Embryo Transfer:  Why Not Put All of Your Eggs in One Basket?”.  He stated in November 2008, that although multiple rather than single-embryo transfer for IVF is less expensive in the short run, the risk of costly complications is much greater.  Universal adaptation of SET cost patients an extra $100 million to achieve the same pregnancy rates as multiple transfers, but this approach would save a total of $1 billion in healthcare costs.

 

We have offered SET since 2006 with the incentive of free cryopreservation, storage for a year and now a three for one deal for the frozen embryo transfers within the year in an effort to drive patients to the safer SET alternative. 

 

If we are going to report pregnancy rates with IVF as is required by the Wyden Bill, let us put all programs on the same playing field by enforcing the number of embryos to be transferred and even promoting minimal stimulation IVF for good prognosis patients.  The Wyden Bill without the teeth to regulate such things as the number of embryos transferred and reporting success per embryo transfer does more harm than good.  Let us promote safer alternatives and report in terms of live birth rate per stimulation and retrieval, including frozen embryo transfers, so that there is a better understanding of the success of a cycle without increasing risks and costs from multiples.

 

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Was this helpful in answering your questions about the Wyden Bill, IVF success rates and reporting requirements, and SET?

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 22: Cryopreservation of Embryos

By David Kreiner MD

August 16th, 2012 at 5:44 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-Two: Cryopreservation of Embryos. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=119 

Cryopreservation of Embryos 

In 1985, my mentors, Drs. Howard W. Jones Jr and his wife Georgeanna Seegar Jones, the two pioneers of In Vitro Fertilization (IVF) in the Western Hemisphere, proposed the potential benefits of cryopreserving embryos for future transfers.  They predicted that doing so would increase the overall success rate of IVF and make the procedure safer, more efficient and cost effective.  

One fresh IVF cycle might yield enough embryos so that in addition to performing a fresh embryo transfer in the same cycle as the stimulation and retrieval that additional embryos may be preserved for use in future cycles.  This helps to limit the exposure to certain risks confronted in a fresh cycle such as the use of injectable stimulation hormones, the egg retrieval and general anesthesia.  It also allows patients to minimize their risk for a multiple pregnancy since embryos can be divided for multiple transfers. 

At Long Island IVF, we are realizing the Jones’ dream of safer, more efficient and cost- effective IVF, as well as increasing the overall success of IVF.  

Today, an estimated 25% of all assisted reproductive technology babies worldwide are now born after freezing.  Studies performed in Sweden revealed that babies born after being frozen had at least as good obstetric outcome and malformation rates as with fresh IVF.  Slow freezing of embryos has been utilized for 25 years and data concerning infant outcome appear reassuring relative to fresh IVF.  

I personally have pushed to promote the concept of removing the financial pressure to put all your eggs in one basket by eliminating the cost of cryopreservation and storage for those patients transferring a single embryo.  Furthermore, such a patient may go through three frozen embryo transfers to conceive for the price of one at our program.  We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

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Was this helpful in answering your questions about cryopreservation of embryos?

 Are you aware that Long Island IVF is giving away a free basic Micro-IVF cycle, valued at $3,900.00? Check out the contest here: http://bit.ly/LHbmQR HURRY…it ends on August 26, 2012!!

 

 

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Infertility Podcast Series: Journey to the Crib: Chapter 21: Things You Should Know About Your Embryo Transfer

By David Kreiner MD

August 9th, 2012 at 4:57 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-One: Things You Should Know About Your Embryo Transfer. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.eastcoastfertility.com/?p=116 

Things You Should Know About  Your Embryo Transfer 

As many embryos as you transfer may implant.  There is also about a one per cent chance an embryo can spontaneously split resulting in identical twins.  For young patients with high quality embryos, the implantation rate is high enough that transfer of one embryo offers a 50% pregnancy rate or better and transfers of two a slightly higher pregnancy rate but a twin rate of 40%.  For this reason it is recommended that patients under 35 with a high quality embryo transfer one embryo to minimize their chance of having a higher risk multiple pregnancy. 

At Long Island IVF, we offer the Single Embryo Transfer (SET) Program to minimize the cost implications of freezing the excess embryos by eliminating the fee to cryopreserve and store these embryos for up to a year.  We also offer for SET participating patients, three frozen embryo transfers for the price of one. 

Embryos are typically transferred three to five days after retrieval. The longer duration allows the embryos to develop further giving embryologists an opportunity to judge better which embryos have the best pregnancy potential.  Otherwise, a day five transfer does not improve an embryo’s chance to implant.  Many embryos fail to develop further after the third day and therefore are not ideal for transfer on day five.  The embryologist will decide whether delaying transfer improves a woman’s pregnancy potential based on the number and grade of the embryos, the woman’s age, and her history. 

The embryo transfer procedure, which we studied in the late 1990′s and presented at the ASRM in 2000 includes first passing a thin very pliable tube (trial catheter) through the cervix under ultrasound guidance.  Occasionally, a suture has been placed in the cervix during retrieval so as to not cause any uterine contractions at the time of transfer.  This suture can then be used to manipulate the cervix to straighten the cervical canal for easier atraumatic passage of the trial catheter.  The inner part of the trial catheter is removed leaving the trial open at its distal end.  The embryologist loads the embryo/s in the transfer catheter which is fed through the trial catheter noting on ultrasound when the transfer catheter has reached the center of the uterine cavity.  The embryos contained in a microdroplet are then gently expressed with visualization of an air bubble usually adjacent to the microdroplet noted on the ultrasound.  The catheter is then examined by the embryologist to insure that the embryo/s did not stick to the wall of the catheter. If it does we repeat the procedure.

Results of our study of this transfer procedure, I called the two-step transfer method, showed shockingly higher implantation rates compared to transfers with different catheters, with a one-step approach, without ultrasound, and with a tenaculum at the time of transfer instead of the suture.  

In the 27 years I am performing IVF, this advance in the embryo transfer stands out as one of the top three most significant advances in IVF along with the radical improvement in media preparation and the ultrasound-guided transvaginal follicular aspiration. 

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Was this helpful in answering your questions about embryo transfers?

 Are you aware that Long Island IVF is giving away a free basic Micro-IVF cycle, valued at $3,900.00? Check out the contest here: http://bit.ly/LHbmQR 

Please share your thoughts about this podcast here. And ask any questions.

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Is Micro-IVF the Answer?

By David Kreiner MD

December 19th, 2011 at 9:08 pm


You’ve already crossed the bridge from “We’re going to get pregnant!” to “We need help…” But this other side looks filled with more obstacles, including expensive and risky fertility medications.

How far do you have to go just to have a baby?

Micro IVF (sometimes called MiniIVF) may be your answer.

The primary point of MicroIVF: fewer fertility drugs, less cost.

Plus you get additional benefits: decreased chances of ovarian hyperstimulation syndrome and of multiple pregnancy.

Additionally, East Coast Fertility and Long Island IVF patients who choose MicroIVF can increase their savings if they also use our Single Embryo Transfer Program — embryo freezing, storage, and future frozen embryo transfers are free.

Why go Micro?

I learned long ago that pregnancies of twins, triplets, and more can bring heartache to what should be a joyous journey for fertility patients. So the ECF team has dedicated our practice to the achievement of safe, healthy pregnancies.

IUI or IVF?

Intrauterine insemination (IUI) is often considered the first order of business for many infertility patients.

Sometimes called “artificial insemination,” the usual protocol — oral and injectable fertility medications to induce superovulation (of more than one egg in a cycle), followed by insemination via exam room procedure — is believed to be simpler and, therefore, less costly than IVF.

That’s just not true any longer.

The facts now are that success rates can be far better for IVF than for IUI, depending on the individual’s or couple’s cause of infertility. Many women undergo several IUIs before achieving conception.

Some infertility causes — pelvic adhesions/scarring, blocked fallopian tubes, endometriosis, and severe male factor issues — will not respond to IUI but are treatable with IVF.

Even patients who would otherwise try IUI to get pregnant will find that choosing MicroIVF can result in cost savings and greater safety:

Micro IVF fee (current as of Dec 2011): $3900

ICSI (if required): $1000

Anesthesia (as requested): $550

IUI with hormone injections: $3500 to $4500

Is MicroIVF right for you?

Each patient’s case is considered carefully and individually. The following are conditions that might respond best to MicroIVF:

Young healthy women with PCOS or who otherwise produce many follicles

Women with pelvic adhesions or scarring, blocked fallopian tubes, or endometriosis

Couples with severe male factor infertility

MicroIVF really is a case of a little treatment going a long way! With it, you can access the world’s most successful assisted reproductive technology at far less cost.

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Has this blog post changed your mind about the course of treatment you are taking (or planned to take)? Did you know about Micro-IVF and Single Embryo transfers prior to this post?

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IVF Today: One Baby at a Time

By Tracey Minella and David Kreiner MD

August 26th, 2011 at 12:00 am

Single embryo transfers. What a concept!

Back when I was doing IVF in the mid-90’s, transferring FOUR embryos was the norm! Sometimes even more, depending on the patient’s history! After a few failed IVFs, I did a GIFT/ET in 1994 with 4 eggs for the GIFT plus a 3ET. Technically, I could have been the “Septomom”, though prior history didn’t make that seem possible. I did get pregnant that cycle but later miscarried that twin pregnancy.

Also back then, my best friend was doing IVF at a clinic upstate. She had elected on medical advice to reduce a triplet pregnancy to a twin pregnancy, but miscarried after the selective reduction. A few years later, she got pregnant with triplets again. She did not reduce and, despite many complications, has healthy 12 year old triplets now.

It’s refreshing to see that technology at some of the finest fertility clinics now enables couples to choose single embryo transfers (SETs) and avoid the expense and potential complications a high order, high risk multiple pregnancy brings.

Dr. Kreiner of East Coast Fertility believes so strongly in the success rates and safety of SETs that his practice offers an amazing financial incentive to patients undergoing traditional IVF. Read on for details:

I entered the field of IVF in 1985 when the pregnancy rate at the Jones Institute, the most successful program in the country, was 15 percent. This rate was achieved by transferring six embryos at a time. As a consequence, we experienced many high order multiple pregnancies. Unfortunately, these were often complicated and did not always end well. Aside from pregnancy and neonatal complications, many of the marriages also suffered.

Thankfully, today IVF is so much more successful and we can attain pregnancies in greater than 60 percent of retrievals for women under 40. These rates are accomplished while transferring one, two, or at most three embryos at a time. Cryopreservation, or freezing embryos, has also improved our pregnancy rates per retrieval giving us multiple opportunities to get a patient to conceive from a single IVF stimulation and retrieval.

In an effort to encourage safer single embryo transfer and avoid risky multiple pregnancies, we introduced a program in 2007 at East Coast Fertility for patients who transferred one embryo at a time. For these patients we offered free cryopreservation, storage and frozen embryo transfers until a live baby was born.

Still, patients don’t commonly choose single embryo transfer.

From our experience, similar to others’, there was no significant difference in pregnancy rates between patients who chose to transfer one embryo vs. those who chose to transfer two embryos. There was a trend, however, towards higher rates for the two-embryo transfer group that was practically eliminated when frozen embryo transfers were added. These groups were age matched with no difference except for a 40 percent twin rate and one triplet in the two-embryo transfer group compared to the single-embryo transfer group in which no twins were created.

It is hoped that these results will encourage a higher percentage of good prognosis patients to transfer a single embryo, which is the safer option.

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Would incentives and stats like those above make you consider SET for yourself? Why or why not?

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