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Archive for the ‘jon and kate plus 8’ 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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Donor Eggs or Their Own: Are Older Celebrities Lying?

By David Kreiner, MD

September 22nd, 2011 at 3:25 pm

The Fertility news is constantly highlighted in sensational headlines, such as “49 year old woman conceives with own egg through IVF”. In the past, readers have been entertained with “Octomom”, “a woman pregnant with a supposed dozen”, “Jon and Kate plus eight” and “a 62 year old mother through IVF” not to mention the numerous over 45 and sometimes over 50 year old celebrities having babies supposedly with their own eggs.

Reading these “news” stories one may get the impression that Fertility is a thriving business bearing little resemblance to the medical specialty of reproductive endocrinology requiring seven years of post medical school training.

The medical pioneers Drs. Steptoe and Edwards in the UK and Drs. Howard and Georgeanna Jones Jr. in the US envisioned a world in which couples inflicted with the curse of an inability to procreate, would, with the benefit of this technology that they developed, give these couples the ability to build their own families.

They were excited that as the technology improved and became more efficient and the cryopreservation of embryos became routinely available that risky multiple pregnancies could be eliminated. They believed that insurance companies would pay for an IVF benefit that had a high success rate and could deliver healthy singleton pregnancies with far greater confidence than any alternative treatment especially intrauterine inseminations (IUI).

They were unhappy that in the early years when IVF was inefficient, many embryos needed to be transferred in order to give a patient a reasonable chance for success. This resulted in multiple pregnancies, many of which delivered prematurely requiring expensive neonatal intensive care and unfortunately many did not end well. Today, we have control over this with IVF by transferring one embryo at a time but not with IUI.

They also did not believe that women should be subjected to the medications, blood work and retrieval process without a fair chance for a successful outcome.

The idea of subjecting a 49 year old woman to IVF for what may be a 1% chance of conception with a greater than 50% chance of miscarriage is not medically reasonable. Women of this age have a 70 to 80% chance for conception through egg donation.

This is how the 50 something celebrities are getting pregnant.

They are not using their own eggs. Misleading the public with news stories that feature these older pregnant celebrities gives patients the misconception that they too can create their families at the same age using their own eggs.

We have recently performed IVF on two perimenopausal patients with FSH levels over 50 at age 45 after days of counseling regarding the extreme low odds of pregnancy and a live birth. In both cases, they felt they needed to give it one shot before moving on to egg donation.

They had one follicle each and both resulted in pregnancies with a gestational sac seen on ultrasound. One has since miscarried and will now move on to egg donation where her odds of having a live baby jump from less than 5% to 60% per attempt. The other remains pregnant and is miraculously the exception to the rule.

IVF is a medical procedure that is part of a proud tradition of reproductive endocrinology. It is a medical treatment that can cure one of the cruelest maladies known to man, the inability to have a child.

This problem is featured in the bible with several references including from the woman’s perspective with Hanna weeping for a baby of her own. The Old Testament proclaims the commandment to procreate. This is part of the human condition.

Does it not make sense then that insurance companies provide the financial coverage to allow IVF, a treatment that can be controlled by transferring one embryo at a time to result in a singleton pregnancy? Regulations to prevent costly dangerous multiple pregnancies and the performance of IVF in patients with unreasonably low odds of success need to be instituted.

Financial programs that make it no more expensive to patients to transfer one embryo at a time such as our Single Embryo Transfer program at East Coast Fertility need to be the news highlight of the day not the 49 year old who conceived on her sixth try.

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Do YOU think any of the older celebrity moms… who claim or imply that their children are not conceived through donor egg programs… are being untruthful?

Do you think their right to privacy is more important than the disservice such lies do to the public’s misconception about how old women can be and still conceive with their own eggs?

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