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Archive for the ‘Micro-IVF’ tag

How Long Island IVF Was Born: A Historical Retrospective Journey of 25 Years

By David Kreiner MD

April 8th, 2013 at 6:39 pm

Today, a woman I delivered into this world in 1982 came to me to help her conceive.   At the time, I was a resident in obstetrics and gynecology, a four year program that preceded my fellowship training in reproductive endocrinology and infertility (REI).

Seeing her triggered memories from then and how it happened that I am here today at Long Island IVF.  As an ob-gyn resident, my goal was to become an IVF expert and was the reason I came to Stony Brook to train with Dr. Zev Rosenwaks.  However, in 1983, he left to become the Director of IVF at the Jones Institute in Norfolk, Virginia, the American clinic that pioneered IVF.  Stony Brook then was without an REI specialist.

I attempted to learn as much I could through reading the latest studies which were directed primarily by Dr. Gary Hodgen at the National Institute of Health.  Of particular interest to me was a study performed 30 years ago that won the National Fertility Prize on what was termed, “Ovarian Stimulation in Medical Hypophysectomized Primates”.  The author of the study, a protégé of Gary Hodgen, was a young reproductive fellow, Dr. Daniel Kenigsberg.

Isn’t it ironic that as one expert left Stony Brook, the future of IVF on Long Island was formed by replacing Zev Rosenwaks with Daniel Kenigsberg?

Kenigsberg’s historic study became the foundation on which modern day IVF is practiced today.  In fact, Dr. Kenigsberg was the first to demonstrate the ability to stimulate ovaries using exogenous FSH (Follicle Stimulating Hormone) without the pituitary stimulation of both FSH and Luteinizing Hormone (LH).  Today infertility specialists throughout the world characteristically employ “the Kenigsberg switch” to turn off the pituitary when stimulating ovaries in preparation for IVF.

In 1985, motivated by the research success of Dr. Kenigsberg, my new mentor, I submitted research of my own on endometriosis that became a finalist for the National Fertility Prize.  Three years later, after my IVF training at the Jones Institute, I returned to start Long Island IVF with Dr. Kenigsberg where together we brought Long Island its first IVF baby, first baby from a cryopreserved embryo, and first donor egg baby.

Today… along with all of the Long Island IVF physicians, embryologists, nurses, and staff… we both look forward to celebrating our 25th anniversary of successfully assisting over 5000 Long Island couples with their family building needs.

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If we’ve been a part of your family-building journey, we thank you for your faith and trust in us and would love to hear and see what you and your little miracles have been up to.

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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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Long Island IVF’s Personal Financial Counselor and Payment Options

By Tracey Minella

February 17th, 2013 at 4:45 pm

credit: stuart miles/freedigitalphotos.net

For many couples, understanding their infertility diagnosis and treatment options is challenging.  But that can pale in comparison to navigating the financial maze of infertility insurance and payment options for self-pay patients.

Imagine finding out on the day before your retrieval that the IVF cycle you thought was covered, actually isn’t? Fortunately, Long Island IVF can help you avoid such nightmares.

At Long Island IVF, every patient is assigned a “Personal Financial Counselor” that stays with you every step of the way… from the first day you walk through our doors until you’re returned to the care of your OB/GYN. This knowledgeable specialist is a valuable part of your personal treatment team during your time with us.

Your Personal Financial Counselor will act as the liaison between you and your insurance company and help ensure that you know the maximum benefits you may be entitled to for your infertility treatment. She can help explain your coverage, including pre-authorizations, co-pays, doctor referral requirements, and exclusions, if any, before your treatment begins.

Having a Personal Financial Counselor means there will be one specific and knowledgeable person who has your financial back on this journey…freeing you from the frustration of having to explain your whole situation over and over to whoever happens to pick up the phone whenever you call with a question.

Your Personal Financial Counselor can explain monetary or treatment-specific limitations in your policy right upfront when you become a new patient, so you can factor them in when discussing your treatment plan with your doctor. For example, if your plan covers IVF but has a monetary limit, it might affect how many IUIs you’ll want to do before moving on to IVF.

Your Personal Financial Counselor can also advise you about Long Island IVF’s many payment options. There are several different “Self Pay Case Rates” or programs offering bundled services for virtually every treatment protocol, http://bit.ly/Z2uTCj.

Long Island IVF also offers two different grant programs to help patients afford IVF treatment: the “IVF Grant” program http://bit.ly/YjVeKR and the New York State Department of Health, or “DOH Grant” program http://bit.ly/YjVnOD.  You can also reduce your costs if Micro-IVF is appropriate for you http://bit.ly/12ZjvaD.

Another financial option available to Long Island IVF patients is the “IVF Refund Program”. http://bit.ly/ZfqDmC. Also known as the “IVF Financial Share Program”, this program includes up to three (3) fresh IVF and up to three (3) Frozen Embryo Transfer cycles until a live birth is achieved. If you do not give birth, you receive 70% of your fees for the Program refunded to you. For more information about this program, which is administered through In Vitro Sciences, speak to your Personal Financial Counselor or call In Vitro Sciences directly at (877) 678-1999 to see if you meet the clinical and age criteria.

Don’t let your fear or confusion over the financial issues paralyze you from moving forward with your treatment. Let your Personal Financial Counselor explain and help you maximize any medical benefits, or direct you to the best available Long Island IVF  case rate program, grant, or financial refund program possible.

Having a Personal Financial Counselor will allow you to focus only on your medical treatment… and reducing stress can only benefit your treatment outcome.

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What is the single biggest obstacle impacting your infertility treatment plan?

Photo credit: http://www.freedigitalphotos.net/images/Other_Health_and_Bea_g278-Health_Insurance_Approved_Stamp_p96067.html

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How Far Would You…Literally… Go To Have a Baby?

By Tracey Minella

January 31st, 2013 at 9:04 pm

image courtesy of Ambro/freedigital photos.net

If you ask an infertile couple what they’d be willing to do to have a baby, they’d probably say “Anything”. What would they be willing to spend? “Every last dime”. What would they sacrifice? “Whatever they need to”.

How far would they be willing to go to have a baby? “The ends of the earth”.

No, I don’t mean that philosophically. I mean it literally.

How far would you be willing to physically travel on your infertility journey?

If you live in a very rural or remote area, you have no choice but to travel extensively just to get to the nearest infertility clinic. Maybe it’s an hour or two in each direction. Many days per week, when cycling. And that’s just to access the nearest reproductive endocrinologist, not necessarily the best one.

Did location factor in to your decision for an R.E.? Did you choose the closest? Are you willing to travel farther for a clinic with the best reputation and success rates? If so, how far would you be willing to go? An hour? Two?

And on a related note, would you… or have you…relocated to another state to pursue IVF?

If the state you live in is not one of the 15 states that mandates some level of infertility coverage, and you do not have private medical insurance for infertility treatment, would you move to a state that does in order to pursue treatment? Here is a list of the states which do mandate some level of infertility coverage: http://bit.ly/Vmh6n2.

This list, provided by RESOLVE, is an invaluable asset for anyone willing to consider relocating, especially due to a job transfer or new employment opportunity. There are many variables, conditions, limitations, and exclusions on the coverage. Some states cover diagnostic testing only, others will allow certain treatments but exclude IVF, and some cover IVF but limit the number of cycles. Massachusetts has a very generous mandate which would certainly tempt infertile couples to consider relocating under the right circumstances. But it’s important to do your research since, even in Massachusetts, employers who self-insure are exempt.

Long Island IVF has treated patients who have traveled here from distant states and other countries, attracted by success rates and/or programs like our Micro-IVF and Donor Egg programs.

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Would you…or have you… traveled far, or even relocated to another state to pursue your dream of having a baby?

 

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=10032766

 

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Is Your Biological Clock Running Out?

By David Kreiner MD

December 4th, 2012 at 8:25 pm

Tears start to course down the cheeks of my patient, her immediate response to the message I just conveyed to her. Minutes before, with great angst anticipating the depressing effect my words will have on her, I proceeded to explain how her FSH was slightly elevated and her antral follicle count was a disappointing 3-6 follicles. I was careful to say that though this is a screen that correlates with a woman’s fertility, sometimes a woman may be more fertile than suspected based on the hormone tests and ovarian ultrasound. I also said that even when the tests accurately show diminishing ovarian reserve (follicle number), we are often successful in achieving a pregnancy and obtaining a baby through in vitro fertilization especially when age is not a significant factor.

These encounters I have with patients are more frequent than they should be. Unfortunately, many women delay seeking help in their efforts to conceive until their age has become significant both because they have fewer healthy genetically normal eggs and because their ability to respond to fertility drugs with numerous mature eggs is depressed. Women often do not realize that fertility drops as they age starting in their 20s but at an increasing rate in their 30s and to a point that may often be barely treatable in their 40s.

A common reason women delay seeking help is the trend in society to have children at an older age. In the 1960’s it was much less common that women would go to college and seek a career as is typical of women today. The delayed childbearing increases the exposure of women to more sexual partners and a consequent increased risk of developing pelvic inflammatory disease with resulting fallopian tube adhesions. When patients have endometriosis, delaying pregnancy allows the endometriosis to develop further and cause damage to a woman’s ovaries and fallopian tubes. They are more likely to develop diminished ovarian reserve at a younger age due to the destruction of normal ovarian tissue by the endometriosis. Even more important is that aging results in natural depletion of the number of follicles and eggs with an increase in the percentage of these residual eggs that are unhealthy and/or genetically abnormal.

Diminished ovarian reserve is associated with decreased inhibin levels which decreases the negative feedback on the pituitary gland. FSH produced by the pituitary is elevated in response to the diminished ovarian reserve and inhibin levels unless a woman has a cyst producing high estradiol levels which also lowers FSH. This is why we assess estradiol levels at the same time as FSH. Anti-Mullerian Hormone (AMH) can be tested throughout a woman’s menstrual cycle and levels correlate with ovarian reserve. Early follicular ultrasound can be performed to evaluate a woman’s antral follicle count. The antral follicle count also correlates with ovarian reserve.

By screening women annually with hormone tests and ultrasounds a physician may assess whether a woman is at high risk of developing diminished ovarian reserve in the subsequent year. Alerting a woman to her individual fertility status would allow women to adjust their family planning to fit their individual needs.

Aggressive fertility therapy may be the best option when it appears that one is running out of time. Ovulation induction with intrauterine insemination, MicroIVF and IVF are all considerations that speed up the process and allow a patient to take advantage of her residual fertility.

With fertility screening of day 3 estradiol and FSH, AMH and early follicular ultrasound antral follicle counts, the biological clock may still be ticking but at least one may keep an eye on it and know what time it is and act accordingly.

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Do you wish you started trying to conceive earlier than you did? Do you wish you saw a reproductive endocrinologist sooner? Do you have any advice for others?

 

Photo credit: Peter Kratochvil http://www.publicdomainpictures.net/view-image.php?image=14919&picture=your-are-late

 

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A Patient’s Story

By Jessica Upham

October 16th, 2012 at 4:37 pm

credit: victor habbick/freedigital photos.net

For no special reason, it felt like the right time to unearth and again share a beautiful essay received from a patient in 2011, in response to the free micro-IVF contest that year. For those who missed it or want to re-read it, here is Jessica’s essay:

Bobby’d be the Best Big Brother

A few months ago I ran into an old childhood friend while grocery shopping with my little miracle. We reminisced about how much fun we would have playing together with all of our dolls. She mentioned a specific day when she got angry with me for “always wanting to be the mommy”. I could remember that day clearly…she asked “why do YOU always get all the dolls? Why are YOU always the mommy?” My reply was simple, “Well, because I really want to be the mommy & I think I’ll be really good at it”. Boy, some things never change!

Even then I knew I wanted children, although I never knew just how badly I wanted to be a mother until I met my amazing husband. Everything came so naturally with us. In a way, each day was new, yet, at the same time I felt like he had been part of me for my whole life. We had a short courtship…wedding planning was a cinch…the honeymoon was bliss…the first year was a fairy tale. We did everything right…we followed the rules – first comes LOVE (o.k. check), then comes MARRIAGE (o.k. got it)… now where the heck is that baby carriage already?

We made the decision on a plane, returning home from our 1 year anniversary trip (where on the third day we knew that yet another month has passed without the news we were hoping for), to make an appointment with my GYN. After a year of trying the “good old fashioned way” we knew we might need a little help. It was an easy decision to make…but it was a hard decision to accept. Easy because I already knew I would do anything for my children (even if they don’t exist yet). Hard because I had grown accustomed to the “breeziness” of our relationship. How would this affect our love?

It seemed like every other day I was asked, “So when are you gonna have a baby?” For the first year I’d laugh it off and say “Oh trust me, we’re trying – OH BOY are we trying.”, then give a little wink- wink, nudge- nudge…laugh on the outside, cry on the inside (and in the parking lot, and in the car, and in my husband’s arms). It’s a natural question, but for someone who is having trouble trying to conceive, it can be very intrusive. It also gets harder as the months would pass to think of new “clever ways” to change the subject.

After a few procedures (2 HSGs and one laparoscopic surgery) to determine what we were really up against, we picked a specialist that we stayed with for 1 full year. We did quite a number of I.U.I.’s without success. I thought that all the negative pregnancy tests were hard before – but it did not compare to getting the same old results after all of that work and all of those injections. After a year we began to loose hope and decided it was time for a break. But I couldn’t sit still for long.

Armed with my laptop I began to research all of the specialists in our area. Almost instantly I found East Coast Fertility (now merged with Long Island IVF)…and for some reason through all of my searching, I just kept going back to them. Reading more, learning more, gaining more confidence…something told me that THEY would be the ones to help us begin our family. I spoke with my husband and we set up our consultation. It did not take long for us to make our decision. It was time to move on to IVF and we were going forward with East Coast Fertility.

From our initial orientation and all of the wonderful staff, we knew this was where we needed to be…but it still didn’t ease our nerves the day that BIG BOX arrived.

I remember walking slowly to the door and taking a deep breath as I signed the driver’s electronic tablet to accept this “special delivery”. I laid everything out on the kitchen table and had what can only be described as “momentary stress amnesia”. OH MY GOODNESS…how much of this do I inject? OH NO, where are my Menopur Q caps? What needs to be refrigerated? I forgot EVERYTHING! One phone call and I was back on track and ready to go.

On Friday, May 1st 2009, we had our eggs retrieved. I laughed with my husband as he snapped pictures of me in my gown and hat before going in to the operating room (thanks babe!). I love him so much for being so strong… I think sometimes people lose sight of the fact that just because it’s the woman that’s getting the injections, this is just as hard for the amazing men in our lives as well. We got the call the following day that we had 5 fertilized eggs. “Our babies are there waiting for us” I told him.

Monday, May 4th 2009 was our transfer day…this time I wasn’t the only one in a gown and hat…he held my hand so tightly the entire time. I didn’t turn away from his eyes for the whole procedure. We just smiled and kept telling each other how lucky we were and how much we loved each other. They implanted 3 embryos and before we left I got a picture of all three. They also let me go home with our dish…or as I like to call it “his first apartment”. We started a new tradition that day. Every morning before my husband left for work from then until today I get 4 kisses 1 for me and 1 for each embryo. Earlier I mentioned having questioned how IVF would affect our love…well it only makes the strong – STRONGER.

Friday, May 15th 2009 – We tried to start the day as if it were any other day – as if either one of us could forget that later today we’d find out we might be pregnant. I was at work when I got a voicemail from Dr. Pena. I could tell by the tone of his voice that he had the news we were hoping for. Still, when I dialed him back I held my breath for what seemed like forever. Our entire long hard journey flashed before my eyes. When he said I was pregnant, our future immediately wiped away all of the past. Now flashing before my eyes, like a big bright neon light was the word FAMILY…FAMILY…FAMILY! We did it! We are going to be a family! I have my husband’s reaction to the news on video. We watch it every now and then and relive that life changing moment.

Every day since then has been amazing! I LOVED being pregnant! Boy, was I ever proud of that belly of mine! We found out we were having one healthy boy; there was no question that we would carry on the family name.

January 9th 2010 we gave birth to Robert Ellis Upham III (his friends call him Bobby!). At 12:21 AM I first looked into the eyes of my son. I kissed his little “gooey” head and introduced myself – but he already knew me (we go way back). Before they took him from my chest to clean him up I whispered in his ear, “Baby, I am so proud of you. Welcome to the world. We waited so long to meet you. I promise I will love you forever and ever, and I promise I will NEVER skip pages when I read to you”.

He is now almost 16 months old. He has mommy’s eyes and daddy’s chin. He has the most infectious laugh. He loves to dance and he has 11 teeth. I can’t get enough of him. He has a great sense of humor and knows just how to make me smile. I need him just as much as he needs me. I can’t think of what my life would be like without him. I still marvel at just how amazing it is to be his mommy- I still can’t believe he came out of me!

I am so grateful for what I already have. I thank my lucky stars every day! Infertility hurts, be it your 1st attempt or be it secondary infertility – pain is pain, heartbreak is heartbreak. The desire to be a mother doesn’t always end after you’ve had your 1st, often…it becomes stronger.

Winning a free Micro IVF would mean so much to my family. Thinking about the possibility of expanding our love, giving Bobby a sibling, carrying and loving another child who is SO VERY wanted, is overwhelming! As I look into my son’s eyes, tears come to mine….he would be the best big brother any kid could ever ask for!

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Anyone else want to share their story? We’d  love to hear yours.

 

 

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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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Long Island IVF Doctor Surprises Recipient with a Free Micro-IVF Cycle

By Tracey Minella

October 4th, 2012 at 9:58 pm

At long last, we have the video footage of the moment when Long Island IVF’s Dr. Joseph Pena surprised our 2012 Extreme Family Building Makeover recipient with a FREE Micro-IVF cycle back on September 4, 2012!*

It was the pre-dawn hours on the rainy morning of September 4, 2012. It was the day most of Long Island’s children were going back-to-school, but this was before even the most punctual parent would have been awake and getting the troops ready. It was still dark!

We chose this day to surprise our recipient because it’s often a day when infertile couples are particularly sad… since many do not have a child to send to school yet. It’s another day that is focused on families and children. Backpacks and lunch boxes. Mommies bonding at the bus stop.

But in the background, in the silence, many an infertile woman is heading past the school buses on her way to the fertility clinic for morning monitoring… if she is lucky enough to be able to afford treatment. This is our day to bring happiness to one woman who needs but doesn’t have infertility coverage. Our day to give back. It is a day that offers hope where things may have seemed hopeless.

Even in the dark. Even in the rain. There was light.

Please enjoy Jessica’s big moment, shared with her consent and captured on tape forever, in this video: http://www.youtube.com/watch?v=aye03_6DXLk&feature=player_embedded Jessica also provided the photo for use in this post.

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Feel free to wish Jessica your best as she moves forward with her journey. We were so moved by the stories of all of our entrants. We hope that those of you who did not win in your first year of entering will… like Jessica did… try again in the future.

*As stated in the contest rules, this contest was in no way sponsored, endorsed, or administered by, or associated with Facebook.  All entrants or participants completely released Facebook for any claims. Participants disclosed their entry information to LIIVF, not Facebook. Participants could not enter on LIIVF’s Facebook (since this was not a Facebook Contest). Winner was notified in person as indicated in the Sept. 4, 2012 video herein and after being notified in person, the winner was announced on this blog on Sept. 4, 2012; winner was not notified on Facebook.

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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

September 28th, 2012 at 6:22 am

 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 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. 

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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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