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Archive for the ‘Multiple Births’ tag

Can Twins Be Born Years Apart?

By Tracey Minella

January 19th, 2012 at 2:14 pm


Unless you’re the Octomom, chances are that if you’ve done IVF, you may have frozen…or cryopreserved… a number of embryos above and beyond the number you elected to transfer back on your fresh IVF cycle. If you were lucky enough to have an excess, that is. (Alas, my first few IVFs back in the dark ages, never produced enough for cryo. But later cycles did.)

So, let’s assume you had a baby from that fresh cycle. You breathe a sigh of relief at your motherhood dream coming true and proceed to enjoy a few years of normalcy with your little miracle. So you’re out there doing the play date thing, having great birthday parties, doing Disney. Not to mention suffering–happily–  through Yo Gabba Gabba  as you catch yourself singing things like “Don’t bite your friends”…

All the while in the back of your brain there’s some security  knowing you’ve got “potential” children…literally frozen in time from when your eggs were younger than they are today. No guarantee, but some level of security nonetheless. They do cross your mind at times.

So the time comes to revisit the clinic with the hope of a successful cryo transfer. Imagine it works again.

The question: Are your two children “twins”?

Well, they were conceived at the same time, as fraternal twins would be. But one has been out living its life for a few years. A big head start. The other was tossed in the freezer. (Oh, I’m just kidding…) But the reality is that one… merely through the judgment call of an embryologist … was ever so carefully placed in a frozen state of existence. It’s potential for life on hold. For years.

So are they “twins”?

Is it defined at conception? Is it occupying the same uterus at the same time?

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What do you think?

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Fertility Over Martinis

By David Kreiner, MD

September 9th, 2010 at 7:41 am

Last week we had an in service on the IVF programs that are offered to patients at East Coast Fertility.  You know – any time you ask even the most devoted employees to stay after school – not everyone is thrilled by this. Especially after a long day of making babies! One staffer asked her friend why they needed to attend, the meeting was after all about something she knew about already; that is what makes ECF a wonderful place for patients to overcome their infertility and besides – it was cutting into "Dancing With The Stars".

"I heard that this restaurant is one of the best", her colleague and friend said.  "Besides, how often do we get to have a drink together".

At this point our fearless marketing director stood up by her easel, marker in hand and proceeded to attempt to elicit from the 18 members of the East Coast Fertility staff what words would they use to describe ECF.  She was aiming to help our staff communicate better with our patients about all of the different programs that ECF had to offer.

One of the nurses – clearly bored by the process sipped her martini and with a disparaging look at Pamela, the  marketing director impatiently blurted that ECF is successfully effective in performing IVF and got up to go to the rest room.  Clearly she felt that she didn’t need to know what she already thought that she knew!

Nurse Rosa proudly stated that ECF is about providing sympathetic care to our patients.  Christina, the popular front desk clerk offered "affordable".  At this point I could not hold back as my drive has been to make IVF safe, effective and accessible.  Our two new physicians, Dr. Eli Rybak, the orthodox rabbi practicing in our Brooklyn office and Dr. Jessica Mann, our South American woman chimed in together proclaiming that ECF accommodates the diversity common to New York and Long Island.

Pamela declared that the ECF’s mission was about delivering safe and effective IVF to as many people of varying ethnic and economic backgrounds.

How do our programs do this?  Are they consistent with our intended message to patients?

The first program discussed was our Micro IVF or Minimal stimulation IVF program.  

At $3900, this program is priced to make IVF affordable.  Since minimal gonadotropin stimulation hormones are used it is expected to have less affect on a woman’s body and be easier in that it requires less monitoring.  Cheaper and less risky appeals to many women who otherwise would not consider IVF as a viable option.  The pregnancy rate we have seen thus far in these cases varies from 20% to 50% depending on the patient with the greatest success experienced by our young PCOS patients and patients with a history of tubal ligation in the past.  I reminded everyone that Helen, a 32 year old patient from South Carolina was 7 weeks pregnant with a singleton pregnancy and she had severe endometriosis.

Our Single Embryo Transfer (SET) program was my attempt to eliminate financial cost as a reason for patients to transfer multiple embryos and thereby increase the likelihood  of causing risky multiple pregnancies.  Patients without insurance or other discounts who transfer one embryo at a time will not have to pay to cryopreserve excess embryos.  Frozen storage as well as frozen embryo transfers are free until a live baby is born or they have used up all their embryos.

This program is available for the MicroIVF and full stimulated IVF cases.  Data since the inception of this ECF SET program in 2007 shows that pregnancy rates for elective single embryo transfer lag fresh elective double embryo transfer by 6% but only 2% if you include the frozen embryo transfers.  These groups were age matched with no significant difference noted between single and double embryo transfers for any age except with regards to the incidence of multiple pregnancy.  There were no twins in the single embryo transfer group but about 30% twins and two cases of triplets in the elective double embryo transfer group.  Essentially, for the good prognosis patient, SET eliminates risky multiple pregnancies without jeopardizing pregnancy rates and without increasing cost.

Our egg freezing study was brought up by Dr. John, Director of embryology.  Half of the eggs retrieved are frozen prior to fertilization.  The other half undergo Insemination in the typical IVF fashion.  These embryos are incubated for 3 to 5 days and then placed in frozen storage.  The frozen eggs are thawed an hour after freezing and are inseminated.  These embryos are transferred 3 days after the study patients have undergone retrieval.  Study patients get free hormone medications, ICSI, coculture, embryo glue, assisted hatching, cryopreservation, frozen storage and free frozen embryo transfers.  The cycle costs them $6900.

He also mentioned our new PGD/PGS program to screen for chromosomal problems in the embryos.  Using a new technique called the Microchip Assay developed by Jacques Cohen at Reprogenetics, ECF is collaborating to offer patients this more accurate assay that tests all 23 pairs of chromosomes in the embryo.  Initial tests suggests that this test may diminish the risk of miscarriage and help select the most viable embryo to transfer.

We completed our discussion with a review of our grant programs.  We were selected by NY state to provide IVF under the DOH grant.  As it is supported by NY state the patient’s cost share is significantly reduced.  Unfortunately, these funds are limited so ECF sponsors it’s own grant program.  The ECF grant like the DOH grant is income based.  Patients pay between $6900 and $9900 for basic IVF.  The cost of medications are reduced and any additional procedures if needed are at half price.

In the end – our staff felt like it was important for all of us to truly understand why we did what we did for our patient community. We always think that we know what our mission is all about – but it was good to be reminded.  

The only remaining question was whether to order the tiramisu or the apple crumb.   

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