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Infertility Podcast Series: Journey to the Crib: Chapter 27: A Dozen Embryos, Who Will Stop This Madness?

By David Kreiner MD

August 12th, 2013 at 9:44 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-Seven: A Dozen Embryos, Who Will Stop This Madness? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=133

A Dozen Embryos, Who Will Stop This Madness?

When I wrote this chapter, the news of the day was that an IVF clinic had transferred 12 embryos.  In fact, it was learned weeks later that this was a hoax.  However, in the wake of Octomom, where 8 embryos were transferred, I felt there was still an important lesson to be learned especially since insurance companies often insist that a patient try multiple cycles of intrauterine insemination (IUI) before covering IVF… if they cover it at all. 

 

In fact, gonadotropin hormones in conjunction with IUI offers a 35% risk of multiple pregnancy including a 5% risk of triplets or more.  After obtaining six fetuses after one such cycle, I became very wary of offering gonadotropin IUI cycles to my patients.

 

Yet, this is what our insurance companies are covering rather than the safer IVF where only 1 or 2 embryos can be transferred at a time.

 

When we do an IUI, as many eggs that ovulate can implant resulting in a high risk multiple pregnancy.  I believe that it is not until we discourage the use of gonadotropins without IVF by offering a regulated covered alternative will we eliminate these risky multiples.

 

Until then, all of us including society, the government, insurance companies and employers are to blame for letting these dangerous multiple pregnancies occur.

 

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Was this helpful in answering your questions about multiple pregnancy risks in IUIs and 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 15 Intrauterine Insemination

By David Kreiner MD

June 3rd, 2013 at 8:52 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Fifteen: Intrauterine Insemination. You, the listener, are invited to ask questions and make comments and Dr. Kreiner will respond.  You can access the podcast here: http://podcast.longislandivf.com/?p=98

 Intrauterine Insemination

Intrauterine Insemination, or IUI, involves preparing the sperm usually by a washing procedure removing prostaglandins and debris that would otherwise cause severe cramping when the sperm is introduced into the uterine cavity.  Since clomid, an anti-estrogen, can thicken the cervical mucus and create a cervical barrier to the sperm, IUI is a valuable adjuvant to clomid therapy.

The disadvantage of IUI is that as many eggs as you ovulate can fertilize and implant.  In cases where multiple eggs are developed in ovarian hyperstimulation therapy like clomid and FSH (bravelle, menopur, gonal F, Follistim) the risk of multiple pregnancy occurring is enhanced.  The increase in pregnancy rate from this therapy as well as the increased risks associated with IUIs needs to be compared with the relatively superior success rate from In Vitro Fertilization where a single embryo transfer may be performed and excess embryos cryopreserved for a subsequent cycle.  If costs of the treatments are a consideration, such reduced-cost procedures like Minimal Stimulation IVF or Micro-IVF may prove to be a cost effective alternative to IUI when insurance does not cover the IUIs.

Interestingly, not all insurance companies have caught on to this issue of a higher risk of multiple pregnancy with IUI associated with clomid or FSH.  Some require patients to go through a minimum number of IUIs prior to covering the more effective and safer IVF.

Ironically, a multiple pregnancy will cost the insurance company far more than if they had covered IVF.

Worth repeating from the last podcast on clomid therapy: For those patients without insurance coverage, Micro-IVF, minimal stimulation IVF (utilizing Clomid), costs approximately the same as three Clomid/IUI cycles but offers women under 35 years of age a better than 40% pregnancy rate and as such may be a more cost effective alternative.

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Was this helpful in answering your questions about Intrauterine Insemination?

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

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Long Island IVF Podcast: Journey to the Crib Ch.1: Welcome

By David Kreiner MD

February 11th, 2013 at 10:24 pm

Welcome to the Journey To the Crib Podcast.  We will have a blog discussion each week with each chapter.  You, the viewer, are invited to ask questions and make comments. You can access the podcast for this Chapter 1 here: http://podcast.longislandivf.com/?p=16

The first chapter introduces the reader to the writer, me, and my early experiences in the field of reproductive endocrinology, infertility and IVF.  This was during the early years of IVF and I was a new doctor driven by a passion for fertility; the science, the surgery and the new technology of in vitro fertilization.

I dedicated the book to my parents who were still alive when it was published.  They taught me the importance of family as it was the most precious commodity they owned.  My father recently passed but he was excited and proud of the work his son did even if he suggested making more revisions to my original drafts than I wanted to hear.  My mother, who suffered a ruptured cerebral aneurysm twenty five years ago and as a result has significant cognitive issues, remains my biggest fan.

It was with great anticipation that I sent to my mentor, Dr. Howard W. Jones Jr., this first chapter as much of it describes my impressions of him and his wife, Georgeanna Seegar Jones, the American pioneers in In vitro fertilization.  Today, he is 101 years old and remains the sharpest individual I have ever met.  I am proud to say that he was touched and impressed with my memories as I recorded them.

If you have not had the opportunity to hear him speak, please do yourself a favor and listen to any one of many videos recorded of him.  “Dr. Howard” describes how he initiated his efforts to develop the first IVF program in the U.S. on http://vimeo.com/asrm/howardjones .

I have a YouTube video discussing this pioneering couple at: http://www.youtube.com/watch?v=b790aiFLzJI&feature=related

If you have time, Dr. Howard gives an exceptional speech on the future of fertility on http://vimeo.com/17418251 .  He starts speaking about 19 minutes into the video.

The reproductive endocrinologist who had the greatest impact on my career was Dr. Zev Rosenwaks.  I unfortunately did not sufficiently credit him with the huge influence he had on my career and in shaping the physician that I have become.  As Zev was a fellow of both Joneses at Johns Hopkins and I was a fellow of his, it is this family of Reproductive Endocrinology from which my career was born.  There is not a thing that I do in practice today that cannot be traced back to Zev or Drs. Howard and Georgeanna or to any of the other fertility giants that were in Norfolk in those days including Suheil Muasher, Mason Andrews, Annibal Acosta, Gary Hodgen, Sergio Oehninger and Richard Scott.

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Do you have any questions about this podcast? Dr. Kreiner would be happy to answer them. Please tune in weekly as we continue to cover Dr. Kreiner’s  book, Journey to the Crib, chapter by chapter. Back by popular demand.

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