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Archive for the ‘Ovarian hyperstimulation syndrome’ tag

Micro-IVF vs. Full Stimulation IVF Study Shows Similar Clinical Outcomes

By Dr. David Kreiner and Tracey Minella

August 21st, 2013 at 7:48 pm

 

photo credit: stockbyte/freedigitalphotos.net

Long Island IVF is excited to offer a glimpse into its fifteen (15) month study of clinical outcomes comparing minimal stimulation IVF (Micro-IVF) and traditional full stimulation IVF.

The two IVF options differ by their stimulation protocols, costs and risks. The fee for basic Micro-IVF is $3900 without anesthesia and not including the medication. In Micro-IVF, patients typically take 100 mg. of Clomid for 5 days, followed by 75 IU of gonadotropin injections for 2-4 days, depending on follicle size as monitored by ultrasound. In full stimulation IVF, patients typically take a GnRH antagonist with doses from 150-600 IU of gonadotropin daily for several days, depending on follicle size as monitored by ultrasound. The amount of medication used, and consequently the number of eggs retrieved, is much greater with the full stimulation IVF.  As a result, generally success rates would be higher with the more aggressive stimulation.

In a retrospective data analysis of patients (<35 years of age) undergoing IVF between October 2011 and December 2012, this study by the physicians and embryologists of Long Island IVF sought to evaluate the effects of minimal stimulation IVF (Micro-IVF) on clinical outcomes. This data was presented at the American Society for Reproductive Medicine (ASRM), held in Boston, Massachusetts on October 17, 2013.

Average Number of Oocytes (Eggs)

Average Number of Embryos Transferred

Fetal Hearts per Embryo Transfer/ (Implantation Rate)

Clinical Pregnancy Rate per Embryo Transfer

Micro-IVF

3.5

1.7

28%

13/28=46%

Full Stim IVF

14.5

1.8

38%

117/215=54%

 

 

In the Micro-IVF cycles, the average number of oocytes (eggs) retrieved was far less than for the full stimulation IVF cycles and therefore there were far fewer embryos to select from for transfer.  As a result, there were most likely fewer high quality pregnancy potential embryos transferred from the Micro-IVF cycles and consequently that implanted (implantation rate).  This did not result in a considerably lower clinical pregnancy rate but there were far fewer twins relative to the group undergoing full stimulation IVF.

Aside from the lower cost, Micro-IVF offers a significantly lower incidence of ovarian hyperstimulation syndrome albeit for most without the advantage of additional cryopreserved embryos.   Even so, with a clinical pregnancy rate of 46% per embryo transfer, the study confirmed that Micro-IVF is often appropriate for younger patients. It can achieve a similar pregnancy rate using fresh embryos, is more cost-effective, and can reduce the risk of hyperstimulation.

 

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Do the results of this study make you more likely to consider Micro-IVF?

If you are interested in Micro-IVF, is it primarily because of the pregnancy rate, the lower risk of ovarian hyperstimulation syndrome, less medication, lower cost, or another reason?

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Don’t Jostle Your Ovaries

By Tracey Minella

February 10th, 2013 at 12:58 pm

It takes a strong woman to go through infertility treatment. And sometimes, in our headstrong, full-speed-ahead-with-blinders-on mode, we feel we’re unstoppable. Invincible, even. But we are not.

With some areas of Long Island blanketed in over two feet of snow, there is a potential danger to infertile women in treatment… snow shoveling. You are not invincible. Do not shovel snow if you are currently in a treatment cycle, have just completed a cycle, are in the two-week waiting period for results, or are pregnant. You must be gentle to and mindful of your ovaries.

When you take injectable medications for IVF (or ovulation induction) to stimulate your ovaries to produce multiple follicles… instead of the single monthly follicle you may otherwise have produced… one of the reasons the doctors monitor you so closely with blood work and sonograms is to reduce the risk of ovarian hyper-stimulation syndrome, or “OHSS”.

When you stimulate the ovaries, they temporarily swell a bit in response, which is expected. OHSS in its mild form can be uncomfortable, but usually resolves on its own. Fortunately, severe OHSS cases are incredibly rare. But in the 1-2% of those cases, patients may experience symptoms including rapid weight gain, abdominal pain, vomiting, and shortness of breath. Pregnancy hormones can worsen OHSS. So, it is important to report any of the above symptoms to your RE as soon as possible, before or after your retrieval or transfer (or IUI). For more info on OHSS, see http://mayocl.in/Xv5NsP

Most women know not to do anything that could be harmful to a developing baby, but they don’t often realize the potential risk certain activities can pose to their stimulated, or recently retrieved, ovaries. Play it safe. Don’t jostle your ovaries.

So put the snow shovel down, ladies. And, leave the vacuum alone while you’re at it, too.

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Have you ever done anything strenuous while stimulating? Have you ever experienced OHSS?

 

Photo credit: Peter Griffin @ http://www.publicdomainpictures.net/view-image.php?image=29815&picture=shovel-snow

 

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Micro-IVF May Be Your Answer—and You Could Win a Free Cycle!!!

By David Kreiner MD, and Tracey Minella

August 21st, 2012 at 9:22 pm

credit:duron123/ freedigitalphotos.net

What better time than now to have Dr. Kreiner explain what Micro-IVF is all about!

Why? Because there are 5 days left to enter to win a FREE MICRO-IVF CYCLE FROM LIIVF! After you read all about the many benefits of Micro-IVF, I’m sure you’ll be excited enough to want to enter to win our annual contest.

Here’s the link for the contest: http://bit.ly/LHbmQR

Dr. Kreiner of Long Island IVF explains the process and who can benefit from it:

You’ve already crossed the bridge from “We’re going to get pregnant!” to “We need help…” But this other side looks filled with more obstacles, including expensive and risky fertility medications.

How far do you have to go just to have a baby?

Micro-IVF (sometimes called mini-IVF) may be your answer.

The primary point of MicroIVF: fewer fertility drugs, less cost.

Plus you get additional benefits: decreased chances of ovarian hyperstimulation syndrome and of multiple pregnancies.

Additionally, Long Island IVF patients who choose MicroIVF can increase their savings if they also use our Single Embryo Transfer Program — embryo freezing, storage, and future frozen embryo transfers are free.

Why go Micro?

I learned long ago that pregnancies of twins, triplets, and more can bring heartache to what should be a joyous journey for fertility patients. So the LIIVF team has dedicated our practice to the achievement of safe, healthy pregnancies.

IUI or IVF?

Intrauterine insemination (IUI) is often considered the first order of business for many infertility patients.

Sometimes called “artificial insemination,” the usual protocol — oral and injectable fertility medications to induce superovulation (of more than one egg in a cycle), followed by insemination via exam room procedure — is believed to be simpler and, therefore, less costly than IVF.

That’s just not true any longer.

The facts now are that success rates can be far better for IVF than for IUI, depending on the individual’s or couple’s cause of infertility. Many women undergo several IUI’s before achieving conception.

Some infertility causes — pelvic adhesions/scarring, blocked fallopian tubes, endometriosis, and severe male factor issues — will not respond to IUI but are treatable with IVF.

Even patients who would otherwise try IUI to get pregnant will find that choosing Micro-IVF can result in cost savings and greater safety:

Micro-IVF fee (current as of August 2012): $3900

ICSI (if required): $2000

Anesthesia (as requested): $550

IUI with hormone injections: $3500 to $4500

Is Micro-IVF right for you? Each patient’s case is considered carefully and individually.

The following are conditions that might respond best to Micro-IVF:

Young healthy women with PCOS or who otherwise produce many follicles

Women with pelvic adhesions or scarring, blocked fallopian tubes, or endometriosis

Couples with severe male factor infertility

Micro-IVF really is a case of a little treatment going a long way! With it, you can access the world’s most successful assisted reproductive technology at far less cost.

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So, are you excited or interested in learning if you are a good candidate? Why not enter our contest before it ends this Sunday?

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Infertility Podcast Series: Journey to the Crib: Chapter 18 Medications for IVF Treatment

By David Kreiner MD

July 24th, 2012 at 3:29 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Eighteen: Medications for IVF Treatment. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.eastcoastfertility.com/?p=106 

 Medications for IVF Treatment 

Prior to Dr. Georgeanna Seegar Jones initiating gonadotropin therapy for IVF, success rates were a pitiful 1%.  Utilizing Follicle Stimulating hormone (FSH) and Leuteinizing Hormone (LH) to stimulate the ovaries and recruit a number of eggs improved pregnancy rates for IVF  to a more respectable 10% by 1980 in Norfolk, Virginia in what later became known as the Jones Institute for Reproductive Medicine at Eastern Virginia Medical School. 

Dr. Jones had pioneered the use of FSH and LH in the U.S. for ovulation induction in the 1960′s.  Today, nearly 50 years later, these hormones are used annually in hundreds of thousands of cycles and have resulted in over 5 million births by IVF alone with success rates for IVF at Long Island IVF for example greater than 50% live birth rate per fresh embryo transfer. 

Still, concern has been expressed regarding the safety of these hormones.  Multiple pregnancies, a common side effect of IVF in the 1980′s and 1990′s due to the inefficiency of the procedure necessitating multiple embryo transfer is seen in less than 25% of cases and rarely results in more than twins. 

The risk of cancer, which has been a concern raised by many over the years, is either minimal or nonexistent. 

Recently, the risk of ovarian hyperstimulation syndrome (OHSS) has been raised in the media with a sensationalized 10% incidence reported.  OHSS is a syndrome whereby a woman’s ovaries enlarge, fluid accumulates in the abdomen, sometimes in the soft tissues of the legs and occasionally around the lungs.  It rarely can cause clotting in the blood that increases the risk of a pulmonary embolus, a complication I have seen twice since 1985 (both women had babies and did fine afterwards). 

In fact most studies identify a 3% incidence of OHSS which due to recent prophylactic treatments is becoming less common with less severe symptoms.  At Long Island IVF, patients at increased risk identified by having an estradiol of greater than 3000 are prophylactically treated with a medication, cabergoline, which minimizes the OHSS.  Additionally, the final stage of maturation in these cases is triggered using lupron and a very low dose of hCG further minimizing the risk for OHSS.  In patients with the greatest risk for OHSS, all embryos are cryopreserved and the patient undergoes embryo transfer in a subsequent unstimulated cycle. 

As a result of these measures, OHSS has become a rare serious side effect of gonadotropin use in IVF at Long Island IVF while live baby rates have flourished. 

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Was this helpful in answering your questions about medications for IVF treatment? 

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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Micro-IVF Can Further Reduce Rare Risk of Ovarian Hyperstimulation Syndrome

By David Kreiner MD

July 17th, 2012 at 6:29 pm

Recent media attention* regarding the risk of ovarian hyperstimulation syndrome (OHSS) in in-vitro fertilization (IVF) cases– estimated by most sources at three percent (3%) for patients undergoing traditional IVF — has increased interest in minimal stimulation IVF, also known as Micro-IVF or Mini-IVF.  

Long Island IVF’s Micro-IVF program is five (5) years old and is registered with the Society of Assisted Reproductive Technology separately as East Coast Fertility under the medical directorship of Dr. David Kreiner and embryology directorship of Dr. John Moschella, who have a combined fifty years of IVF experience.

Since the merger of East Coast Fertility with Long Island IVF in October, 2011, the pregnancy rate for women under 35 years of age exceeds 50% per transfer with MicroIVF.  

Using clomid and two days of lowest dose gonadotropin hormones, this minimal stimulation has a 0% incidence of OHSS at Long Island IVF.  

Furthermore, a Micro-IVF procedure costs $3,900.00 plus the cost of the medications, and $500.00 for optional anesthesia.  

In tune with the safer minimal stimulation IVF, Long Island IVF also offers their Single Embryo Transfer (SET) Program to motivate patients to select the very safest procedure by avoiding the increased risk of multiple pregnancyassociated with a multiple embryo transfer.  Patients electing SET for traditional IVF or Micro-IVF pay nothing to freeze excess embryos and store them up to a year.

Certainly those concerned about OHSS, or those looking for a less costly alternative to traditional IVF should inquire about whether Micro-IVF–successfully performed by Long Island IVF’s doctors for five years—might be for them.

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Long Island IVF is holding its annual “Extreme Family-Building Makeover” contest to award a Free basic Micro-IVF cycle, valued at $3,900.00, to a woman without (or who has exhausted) infertility insurance coverage. You do not have to be a LIIVF patient or even a New York resident. Contest ends August 26, 2012. For details, rules, and to enter, click here: http://bit.ly/LHbmQR

Have you experienced severe OHSS during traditional IVF that required hospitalization? If so, did it stop you from pursuing traditional IVF again? Would you consider Micro-IVF?

*This letter was prompted in response to today’s New York Times article, entitled “High Doses of Hormones Faulted in Fertility Care”, by Jacqueline Mroz. See the full article here: http://nyti.ms/OJT4yu

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“What can I expect to feel like on fertility drugs? What are the side effects?” Part 2 (Injectable Gonadotropins)

By Joseph Peña, Md, Facog

August 5th, 2010 at 12:00 am

Side effects, risk, and complications of gonadotropins may include the following:

·         Ovarian hyperstimulation syndrome (OHSS)

o   OHSS occurs when the ovaries respond too well to the medication and produce too many eggs.  The ovaries rapidly swell to several times their size and leak fluid into the abdominal cavity.

o   If present, usually mild (10-30% of IVF cycles, less likely in intrauterine insemination (IUI) cycles) resulting in some discomfort (abdominal and pelvic bloating and discomfort) but almost always resolves without complications

o   Severe OHSS occurs ~1% of IVF cycles, increased in younger women, women with PCOS, and women who conceive.  Potential complications include:

§  Abdominal and chest fluid collections, blood clots, kidney problems, ovarian twisting

§  May occasionally require draining of fluid from the abdomen (paracentesis) to help alleviate symptoms (e.g. difficulty breathing, abdominal pain due to distention, decreased urine output)

§  May require hospitalization for close monitoring, but the condition is usually transient lasting about 1-2 weeks

o   The key is prevention.  A couple of options that may be considered in patients deemed to be at significant risk for OHSS (increased number of ovarian follicles on ultrasound, increased serum estradiol levels, PCOS) to decrease risk of manifesting severe OHSS include:

§  Cancelling IVF cycle (withholding hCG) and prevent ovulation

§  Cancelling embryo transfer with cryopreservation of the embryos for frozen embryo transfer in a subsequent menstrual cycle, in order to prevent conception during current cycle

·         Multiple pregnancy

o   Up to 20% risk of multiple pregnancy with use of gonadotropins in IUI cycles (majority are twins, but up 5% risk of triplets or greater), compared to baseline of 1-2% in the general population

o   Associated with increased risk of pregnancy loss, premature delivery, handicap due to the consequences of very premature delivery, pregnancy-induced hypertension, hemorrhage, and other maternal complications

·         Ectopic (tubal) pregnancies

o   Slightly increased risk from the 1-2% rate in the general population

o   Important for close monitoring in the early part of pregnancy to confirm that the pregnancy is located in the uterus

·         Adnexal torsion (ovarian twisting)

o   The enlarged, stimulated ovary can twist on itself, cutting off its own blood supply in < 1% of cycles

o   May require surgery to untwist or remove the ovary

·         Ovarian cancer?

o   Link between use of gonadotropins and the development of ovarian cancer is unknown and is the subject of ongoing research

Thus, while the use of the injectable gonadotropins is generally safe and the benefits outweigh the risks/side effects for many women undergoing fertility treatment, it is important that while taking any of these medications, it should be done under the close supervision of a physician who specializes in managing such treatment cycles.  And if one has any questions or concerns while taking any of these medications, it is best to consult one’s physician.

References:
-Clinical Gynecologic Endocrinology & Infertility.  Speroff.

-ASRM Patient’s Fact Sheet: Side Effects of Gonadotropins

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