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Archive for the ‘Minimal Stimulation IVF’ tag

ASRM Retrospective 30 Years Later

By David Kreiner MD

October 17th, 2013 at 1:48 pm

image courtesy of renjith krishnan/freedigital photos.net

 

Flying into Boston this week it occurred to me that this was the 30 year anniversary of the first ASRM meeting I ever attended.  In 1983, the American Fertility Society “AFS” meeting (as it was called then) was held in San Francisco and I attended as a third year ob-gyn resident. I was in awe attending this huge conference of about 3-5,000 held at the Hyatt Hotel as I recall.


Though I was required to man the Ovcon 35 birth control pill exhibit (since Ovcon’s manufacturer was paying my way), I was drawn to the microsurgery and in vitro fertilization exhibits and presentations.  

In the ballroom, the presenters presided over a few thousand of us eager to hear about the most recent successes in IVF.  Already, Norfolk had achieved dozens of births through this new scientific process which brought gynecological surgeons (laparoscopists) together with embryo biologists, endocrinologists, andrologists and numerous nurses, technicians and office staff.  For me, hearing Dr. Howard Jones, American IVF pioneer, and others speak about their experiences with this life creating technique was exhilarating.

Years later, as a Jones Institute reproductive endocrinology fellow, I would hear Dr. Howard proclaim that a chain is only as strong as its weakest link.  IVF required every link to maintain its integrity for the process to work.

In 1985, I presented my own paper at the AFS meeting in Phoenix, Arizona.  My wife and two sons joined me.  My presentation on endometrial immunofluorescence in front of hundreds of experts and specialists in the field remains one of the strongest memories in my life.

Today, the ASRM must be held in mega convention centers like the one in Boston where it could accommodate tens of thousands of attendees.  One presentation estimated the number of IVF births worldwide at over five million. Interestingly, per capita, the US performs one fifth the number of IVFs as Europe–where IVF is much more accessible and typically covered by government insurance.

Today, success in the US is better than fifty per cent for most people, thereby making single embryo transfer (“SET”) for good prognosis patients a viable option to avoid the risk of multiple pregnancy. Minimal stimulation IVF (“Micro-IVF”) is a viable alternative for many patients, offering a lower cost and lower risk option.  Egg freezing offers a means of fertility preservation, especially valuable to women anticipating cancer therapy.  Pre-embryo genetic screening (“PGS”) is an option that allows patients to screen for and eliminate genetically undesirable embryos that may otherwise lead to miscarriage or termination.

Looking back at the past thirty years, I am amazed at the progress and achievements made by my colleagues in IVF and happy that I was able to participate in this most rewarding field that has brought so much joy to millions of people.

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photo credit: renjith krishnan http://www.freedigitalphotos.net/images/agree-terms.php?id=10058384

 

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Infertility Podcast Series: Journey to the Crib: Chapter 16 Micro-IVF

By David Kreiner MD

June 10th, 2013 at 9:46 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Sixteen: Micro-IVF. You, the listener, are invited to ask questions and make comments.  Dr. Kreiner will answer them. You can access the podcast here: http://podcast.longislandivf.com/?p=101

Micro-IVF

Micro-IVF, also known as Mini-IVF, is a minimal stimulation IVF that differs from routine IVF only in the ovarian stimulation hormones that are used.  We typically stimulate with clomid 100mg for the first five days followed by 75 units of FSH hormones for two days.  We monitor, retrieve the eggs, fertilize the eggs in the lab and perform the embryo transfer in the same exact way as we do with all other IVF patients. 

In 2006, a friend and colleague of mine, Suheil Muasher, who completed the Jones Institute fellowship two years before me, introduced the idea of Micro-IVF to me.  My initial reaction was not unlike most other reproductive endocrinologists who question “Why offer an IVF alternative that has a lower success rate?”  Well, as they say, the proof is in the pudding. And it doesn’t hurt that the pudding costs less with ingredients that have less of an effect on the body.

Since October 2011, when East Coast Fertility merged with Long Island IVF, we have had a better than 50% pregnancy rate for our patients under 35 years of age utilizing Micro-IVF.  That the cost is $3900 and the exposure to fertility drugs is minimal makes this an astounding success rate.

Furthermore, our patients who transfer just one embryo with the fresh transfer qualify for the Long Island IVF Single Embryo Transfer program and as a result are entitled to cryopreserving and storing up to one year any excess embryos for free. 

With such great results, I recommend Micro-IVF as a safer and superior alternative to FSH/IUI and sometimes even Clomid/IUI cycles especially in our younger age patients.

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Was this helpful in answering your questions about Micro-IVF?

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

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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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Infertility Podcast Series: Journey to the Crib: Chapter 16 Micro-IVF

By David Kreiner MD

July 5th, 2012 at 9:39 am

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Sixteen: Micro-IVF. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.eastcoastfertility.com/?p=101 

Micro-IVF 

Micro-IVF, also known as Mini-IVF, is a minimal stimulation IVF that differs from routine IVF only in the ovarian stimulation hormones that are used.  We typically stimulate with clomid 100mg for the first five days followed by 75 units of FSH hormones for two days.  We monitor, retrieve the eggs, fertilize the eggs in the lab and perform the embryo transfer in the same exact way as we do with all other IVF patients.  

In 2006, a friend and colleague of mine, Suheil Muasher, who completed the Jones Institute fellowship two years before me, introduced the idea of Micro-IVF to me.  My initial reaction was not unlike most other reproductive endocrinologists who question “Why offer an IVF alternative that has a lower success rate?”  Well, as they say, the proof is in the pudding. And it doesn’t hurt that the pudding costs less with ingredients that have less of an effect on the body. 

Since October, when East Coast Fertility merged with Long Island IVF, we have had a better than 50% pregnancy rate for our patients under 35 years of age utilizing Micro-IVF.  That the cost is $3900 and the exposure to fertility drugs is minimal makes this an astounding success rate. 

Furthermore, our patients who transfer just one embryo with the fresh transfer qualify for the Long Island IVF Single Embryo Transfer program and as a result are entitled to cryopreserving and storing up to one year any excess embryos for free.  

With such great results, I recommend Micro-IVF as a safer and superior alternative to FSH/IUI and sometimes even Clomid/IUI cycles especially in our younger age patients. 

* * * * * * **  * * * *

Was this helpful in answering your questions about Micro-IVF? 

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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Over 40, High FSH, and Infertile

By admin

February 16th, 2012 at 5:44 pm

Time flies when you’re having fun. Time also flies when you’re not really “having fun”, but are just busy plodding through life’s challenges. And then one day you turn around and ask yourself “Where did the time go?”…especially when you’re TTC.

Long Island IVF’s Dr. Kreiner offers the following advice:

You have that dreaded infertility diagnosis, “Over 40 with High FSH Levels.” And there’s no cure or magic herb that will turn back the hands of time. You’re desperate so you are willing to try it all anyway, including acupuncture and some internet recommendations such as DHEA (dehydroepiendosterone).

You hear that you can lower your FSH with DHEA or estrogen. The fact is, however, elevated FSH levels do not cause a problem with conceiving. They are merely a marker of diminishing ovarian reserve, a depletion of ovarian follicles and eggs that, combined with increasing age, mean you have very few genetically normal eggs available in your ovaries to achieve a healthy child.

Reproductive endocrinologists typically counsel “Over 40 with High FSH Levels” patients that their chance of successfully achieving a live birth using their own eggs is small and that by using a donated egg from a young, fertile woman they can increase their odds of giving birth to greater than 70 percent per donation. Unfortunately, this comes as a shocking disappointment to most women. It’s often a reason for them to drop out of a doctor’s practice or even quit trying to conceive.

So what do you do when faced with this situation? Your answer needs to be individualized, based on your emotional and financial resources, your motivation and your comfort with using a donated egg.

At our clinic, we try to come up with a strategy with our patients that includes counseling to begin the discussion about donor eggs, as opposed to trying with less chance for a successful outcome using a patient’s own eggs, or stopping therapy completely and adopting or living child-free.

Perhaps you will choose a low tech option such as insemination with or without hormonal therapy. Sometimes, the plan will be to blast ahead with the big guns using IVF with full stimulation or with less medication and cost using Micro IVF or Minimal Stimulation IVF. Some patients respond better to different stimulations such as sensitizing with estrace or even DHEA prior to stimulation, using a lupron flare or even using clomid in combination with gonadotropins. Unfortunately, it is hard to predict what will be the optimal stimulation for you until we give it a shot.

The bottom line? There’s no right or wrong choice for you. Remember, a family can look many different ways and still be a healthy, loving unit. Your physician, nurses and counselors are available to assist you and support you with whatever decision you make.

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=19718&picture=woman-with-glasses

 

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