CALL US AT: (877) 838.BABY


Archive for the ‘Multiple pregnancy’ tag

To Single Embryo Transfer (or Not to)?: That is the Question

By Tracey Minella

February 11th, 2015 at 12:24 pm

 

Credit: stockimages/ freedigitalphotos.net


One of the hardest parts of undergoing in vitro fertilization is the difficult decision of how many embryos to transfer back…because each embryo transferred has the potential to implant and develop into a baby.

In the 1980s when IVF was new and success rates were understandably low, it was common to transfer as many as 6 embryos back. Even then, many women did not conceive. Others conceived multiple pregnancies. Still others conceived only one.

Happily, today the technology has been dramatically fine-tuned, resulting in much higher IVF success rates and, because fewer embryos are being transferred, fewer multiple pregnancies.

Some women can’t or don’t want to have a multiple pregnancy and are interested in a program that virtually eliminates the risk of more than a singleton pregnancy. Some of their reasons include possible health risks for the mother or babies, concerns over the higher costs of raising multiples, or the fear of being placed on bed rest and its potential financial impact.

On the other hand, because IVF can be expensive and often not covered by insurance, and because the couples attempting it may have already been trying to conceive for a long time with and without medical assistance and expense, it’s tempting to want to “put all your eggs in one basket”. These couples want to transfer a higher number of embryos back to maximize their chance of conceiving in that one cycle or because they can’t afford to do more cycles. Many couples think of the possibility of twins as a bonus. Two-for-one. Instant family. Dream come true.

But if the financial burden was lessened, and the odds of a live birth from transferring one embryo were nearly comparable to the odds for transferring more, would that make a difference to you? Would you opt for the statistically safer singleton pregnancy vs. the statistically riskier multiple pregnancy? Would you really prefer a multiple pregnancy or would you rather have a succession of singleton pregnancies, the way you originally planned before infertility entered your life?

Deep, emotionally-charged decision. No right answer. Just the right answer for you.

Some good news that may affect your decision is 20-year study of 92,000 patients from Denmark, Norway, Sweden, and Finland, recently published in the on-line Oxford Journal, Human Reproduction, on January 21, 2015. The Nordic study found that the health of children born from IVF has significantly improved and that the risks of pre-term or severely pre-term births have declined dramatically…and it’s primarily due to transferring just one embryo. In addition, the stillborn and infant death rate for singletons and twins born through IVF has declined. http://bit.ly/1Ejgg1o

For those interested, Long Island IVF has a well-established Elective Single Embryo Transfer Program with success rates comparable to traditional IVF in select patients. If you elect to transfer one embryo in your fresh cycle you get free cryopreservation of your embryos and free storage for six months or until a live birth occurs. As an additional incentive to motivate patients to make safer choices, we offer patients transferring a single embryo during their fresh stimulation cycle up to three frozen embryo transfers, within a year of their retrieval or until a live birth occurs, for the price of one. For more details and information on whether SET may be right for you, visit http://www.longislandivf.com/single_embryo_transfer.cfm or ask your LIIVF physician.

* * * * * * ** * * * * *

What did/would you consider when deciding how many embryos to transfer? Is the elective SET program something you did/would consider? Why or why not?

 

 

no comments

National Twins Days

By Tracey Minella

July 30th, 2014 at 10:22 pm

 

image courtesy of david castillo dominici/freedigitlaphotos.net


Twins. Gotta love ‘em.

For the majority of couples struggling with infertility, the idea of having two babies at once…especially in cases of a long, expensive treatment history… is a dream come true. Times two! For some, twins are a “two-fer” that helps “justify” the expense of IVF and IUIs. Twins are also a great way to quickly “catch up” in the total number of children department. After years of having none, suddenly you are the parents of two… instant “standard American family”. In fact, many call it quits after twins.

On the other hand, twins (or triplets) make others nervous. The fact is that a multiple pregnancy can be more complicated than a singleton. Many infertile couples have stressed enough over just getting pregnant and may prefer to avoid the additional worries a high risk multiple pregnancy sometimes presents. This fear, coupled with financial incentives, has driven the popularity of quality Single Embryo Transfer (SET) programs which may offer comparable success rates. For information on Long Island IVF’s SET Program success rates and incentives, click: http://www.longislandivf.com/single_embryo_transfer.cfm

But those lucky enough to have twins will agree that once they arrived safely, it’s mostly two times the pleasure and two times the fun.

This year, August 1-3 is the National Twins Days Festival. http://www.twinsdays.org/, which is billed as the largest annual gathering of twins in the world.

We are inviting all our parents of twins (or more) who are so inclined, to SHOW US YOUR TWINS! Upload your favorite photo to our Facebook page any time between August 1-3. We want to see all those cuties…the ones born this week, the ones who are leaving for college, and the ones in between!

Your success will give others hope. (But those who find viewing baby photos difficult will have advance notice to avoid viewing those posts on the page on those days.)

* * ** * * * * * * * * * * * * *

If you could control it, would you prefer having twins or one baby at a time?

 

no comments

Infertility Podcast Series: Journey to the Crib: Chapter 34: Fertility Treatment During This Economic Downturn

By David Kreiner MD

December 5th, 2013 at 7:57 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers the final chapter, Chapter Thirty-Four: Fertility Treatment During This Economic Downturn. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=149

Fertility Treatment During This Economic Downturn


Financial hardships have increased fertility challenges for many couples attempting to build their families.  In regions where patients do not have insurance coverage for their IVF procedures it is unlikely that they proceed with the treatment that is necessary for them to be able to complete their families.

In places that do provide coverage for IVF, such as Massachusetts, 5% of all babies born are as a result of IVF.  Elsewhere in the U.S., IVF accounts for only 1% of births suggesting that the financial cost of IVF denies access for approximately 80% of couples in need.

The problem of the cost of IVF is compounded by the fact that patients are driven to transfer multiple embryos to limit the cost and avoid additional fees from cryopreservation, embryo storage and frozen embryo transfers.  These multiple transfers increase the risks of multiple pregnancy and preterm delivery with subsequent complications to the babies from preterm birth.

We, at Long Island IVF, attempt to make IVF more accessible and safer by offering income based grants, free cryopreservation, storage and discounted frozen embryo transfers to patients electively transferring single embryos.  We have also offered free IVF cycles through best video/essay contests to a few needy patients over the past few years.

It is our sincere wish and hope that a bill that is presently in front of Congress offering a tax credit to patients going through IVF is passed thereby making IVF that much more affordable to our patients in need.

* * * * * * **  * * * *

Was this helpful in answering your questions about fertility treatment during this economic downturn? Are you aware of the pending proposed Family Act, which would offer a tax credit to infertile women wishing to undergo infertility treatment (similar to the current adoption credit for those wanting to pursue adoption)? Have you urged your legislators to support this important legislation?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

no comments

Infertility Podcast Series: Journey to the Crib: Chapter 32: Octomom

By David Kreiner MD

December 1st, 2013 at 8:26 am

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty-Two: Octomom. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=146


A year ago, the Medical Board of California revoked the license of Dr. Michael Kamrava, finding he “did not exercise sound judgment” in transferring 12 embryos to Nadya Suleman, who already had six children at home. The ruling, while not surprising, was illuminating, and it’s worth reflecting on the five things we learned from Octomom:

 

1.      Know How to Say “No”: There is a point where physicians have to make a judgment call. Pregnancies with triplets – let alone eight infants – put the mother at high risk of serious medical complications and put unborn children at risk for developmental disabilities. Physicians need to rely on their professional expertise and experience to know when to turn down a patient request no matter how vehemently it is made.

 

2.      Beware the Patient with Tunnel Vision: Often when a patient comes to a fertility doctor, unsuccessful pregnancy attempts have made her anxious and determined. She might want to get pregnant regardless of the risks that pregnancy may present.

3.      Less is More: In 1999, 35 percent of all transfers involved four or more embryos. In 2009, only 10 percent had four or more. And those high-number transfers are generally reserved for patients with significant fertility challenges. In contrast, Octomom already underwent multiple successful IVF (in vitro fertilization) procedures and had given birth to six children when she had her 12-embryo transfer.

 

4.      Know When to Deviate: While Dr. Kamrava’s deviation from guidelines was an extreme departure, deviations do occur for specific reasons, such as repeated IVF failure, age-related infertility and poor egg quality. It is important to know when implanting several embryos is appropriate.

5.      “Reduce” Risk: Dr. Kamrava complained that Octomom refused to undergo “selective reduction,” which would have reduced the number of embryos she carried to term. Here, again, is an argument for fewer transfers. Had he transferred fewer embryos, Octomom would not have had to face such a difficult decision.

 

* * * * * * **  * * * *

Was this helpful in answering your questions about what could have been done differently to prevent the Octomom case? How much weight do you give your doctor’s recommendation on the number of embryos to transfer?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

no comments

Infertility and National Prematurity Awareness Month

By Tracey Minella

November 19th, 2013 at 10:53 am

 

photo credit: praisaeng/freedigitalphotos.net

Infertility is a disease. Its course often follows a common progression. It often starts with the abandonment of what turns out to have been unnecessary birth control. It then progresses through a repeated series of monthly disappointments until charts, thermometers, and the “chore-mentality” move into the bedroom. ObGyn intervention becomes an RE referral. A battery of tests and invasive procedures follow. Sometimes there’s Clomid. Maybe even ovulation induction with IUIs. Possibly, there’s IVF.

It’s no wonder that most infertility patients are so caught up in the all-consuming grind of simply trying to get pregnant, that they don’t think past getting that positive pregnancy test. They don’t think that…after all that time and sacrifice…something could threaten that hard-earned pregnancy.

It’s National Prematurity Awareness Month. And there is no better time to focus on what you can do to reduce your chances of having a premature baby than before you become pregnant.

It’s not always known why babies are born prematurely, but according to the Mayo Clinic*, some risk factors can include:

  • Pregnancy with twins, triplets or other multiples
  • Problems with the uterus, cervix or placenta
  • Smoking cigarettes, drinking alcohol or using illicit drugs
  • Poor nutrition
  • Some infections, particularly of the amniotic fluid and lower genital tract
  • Some chronic conditions, such as high blood pressure and diabetes
  • Being underweight or overweight before pregnancy.

 

According to the CDC**, some of the symptoms or warning signs of pre-term labor include:

  • Contractions (the abdomen tightens like a fist) every 10 minutes or more often.
  • Change in vaginal discharge (leaking fluid or bleeding from the vagina).
  • Pelvic pressure—the feeling that the baby is pushing down.
  • Low, dull backache.
  • Cramps that feel like a menstrual period.

If you are doing IVF, one of the things you may want to consider to reduce your chances of prematurity is having a single embryo transfer (“SET”), if your doctor feels you are a good candidate. Doing so virtually eliminates your chance of a multiple pregnancy. In addition to the safety considerations for mother and baby, SET at Long Island IVF offers financial incentives, including free cryopreservation and reduced rates for subsequent frozen embryo transfers. Click here for more information about Long Island IVF’s Single Embryo Transfer Program. http://bit.ly/WpzCvv

As an IVF mom of two preemies myself, let me acknowledge that very often, babies arrive early for reasons beyond our control. Sadly, the outcomes are not always happy. But knowledge is power, so control what you can, watch for the signs, and listen to that little voice if you feel something is amiss. And remember that the vast majority of these hard-earned pregnancies do turn out just fine.

*http://mayocl.in/HWaNGz

** http://1.usa.gov/IdCytZ

* * * * * * * * * * * * * * * * *

Do you worry about prematurity? If so, would you consider SET to reduce the chance of a multiple pregnancy?

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=100141619 /praisaeng

 

no comments

Journey On: My Journey, My Advice

By Tracey Minella

January 3rd, 2013 at 2:38 pm

credit: tung photo/freedigitalphotos.net

I want to share my story today because I want to inspire you to go on when you think you can’t possibly do so any longer. I hope you will listen even though I personally know… and will always remember…how much it hurts to hear of someone else’s IVF success.

Fifteen years ago today,  my infertility journey took a turn down a new path. My daughter was born. Allow me to follow that with a big fat “Finally!”

She arrived six weeks early amid chaos in a delivery room crowded with NICU team members. I’d spent a week before Christmas in the hospital trying to stave off early labor and to get the hang of insulin injections for gestational diabetes. But there was no putting her off any longer. I won’t lie to you: my life truly began that day.

Nothing on the road to motherhood was easy for me, including the pregnancy itself. Some people are lucky to have IVF success right off the bat, but not me. But here’s one of the life lessons I learned from what felt like the world’s longest infertility journey ever: The longer the wait, the happier the ending.

The happiest “happy endings” come after struggle and loss. They come from a place of profound gratitude. From a place where hope barely hangs on. They often come after the heart-wrenching ups and downs of “No you can’t have it”…“Wait for it”… “It’s possible”…“It’s negative, again”…“Ok, we can do this”…” “See the heartbeats?”… “No, I’m so sorry”… “Let’s try this”… “Good news”… “You’re being admitted”…“There’s been a complication”…

But they do come:

“Congratulations. It’s a girl.”

If you’ve suffered long, may you find some consolation in the idea that you may be building a happier ending.

I usually share my story for new readers in January and June, on the anniversaries of the day I became a mother and the day I started working at Long Island IVF.

Oddly enough, I started working as a medical assistant at Long Island IVF on the day of my first pregnancy test after my 6th fresh IVF cycle. What the heck were we all thinking? It was a big gamble for the doctors… hiring not only a patient, but a very challenging one nearly ready to crawl out on the ledge. But it was a life-changing day for me on many levels.

I made it my purpose then to help others on their journeys. There is something to be said about “misery loves company.” As I drew their blood and they’d talk of quitting, I’d share my stories of perseverance in the face of my early 1990’s IVF challenges like hyperstimulation, poor fertilization, repeated failed implantation, ovarian torsion and its removal, high order multiple pregnancy, and pregnancy loss. I’d never push them to go on, but many chose to.

I help today’s patients through blogging. I pass along the latest information about advances in the field (like the PGS/PGD study we are currently recruiting patients for), share some stories, educate and entertain, and provide a laugh or a virtual shoulder to cry on. Some of the drug names have changed…and some of the needles have gotten smaller…but the emotions and most of the experiences are the same. Happily, the success rates are much higher.

As this New Year begins with possible thoughts of stopping your own infertility journey, please remember this when you’re weighing your options: Just because it doesn’t work out for you the first, second, third, fourth, or fifth time, it doesn’t necessarily mean it isn’t meant to be. We all may need financial and emotional breaks and we each take different roads along the way. Just realize that not succeeding quickly doesn’t necessarily mean you never will. I proved many people wrong.

I hope you all find your way over the worst bumps and turns in your own infertility road, sooner rather than later. In the meantime, you can vent here. Real life and online friendships have started here. Join us this year.

* * * * * * * * * * * *

Where are you along your infertility journey? Where do you find support?

 

 

photo credit: http://www.freedigitalphotos.net/images/search.php?search=crossroads&cat=

 

2 comments

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.                     

* * * * * * **  * * * *

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.

 

no comments

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. 

* * * * * * **  * * * *

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.

 

no comments


The Fertility Daily Blog by Long Island IVF
© Copyright 2010-2012