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Archive for the ‘SART data’ tag

Infertility Podcast Series: Journey to the Crib: Chapter 29: Why the Wyden Bill Does Not Support Fertility Patients

By David Kreiner MD

November 3rd, 2013 at 11:20 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 4

By David Kreiner MD

March 4th, 2013 at 9:59 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Four: Where Do You Go? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=34

 

Where Do You Go?

 

I try to help the reader understand the published statistics offered online by SART, the national organization of IVF programs that provides a registry of IVF programs who submit their data for audit by SART.  Rates are offered with a numerator and a denominator with the critical goal of a live baby per retrieval or transfer being the most crucial statistic.

 

The benefits and disadvantages of large programs are discussed basically offering that larger programs tend to have more experienced and often skilled personnel albeit with more waiting time for monitoring.  Some programs may provide more personalized care, some more psychological or emotional support and some offer adjunctive therapies such as acupuncture and mind body programs.

 

I emphasize the importance of the embryology lab as well as the skill of the physician performing the embryo transfer.  The technique of the transfer is described including factors that I believe may affect success rates.

 

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Please share your thoughts about this podcast here.

no comments

Figuring out YOUR Odds of a Live Birth With IVF

By David Kreiner MD, and Tracey Minella

July 2nd, 2012 at 8:35 am

 

 

Statistics can be confusing. And when you’re on fertility meds and your hormones are raging, it can be hard to think clearly. So grab a cup of coffee and your thinking cap because you’re going to be interested in this post from Dr. Kreiner.

It’s about a recent study published in the New England Journal of Medicine that finally sheds light on a woman’s odds of having a live birth from IVF. The study examined data from SART (Society for Assisted Reproductive Technology), the primary organization that collects data, sets the guidelines, and helps maintain the standards for the practice of assisted reproductive technologies.

Dr. Kreiner reports:

NEJM Study Uses SART Data to Determine Cumulative Birth Rates for Individual Patients with In Vitro Fertilization

A new study published in the New England Journal of Medicine links data from the SART Clinic Outcome Reporting System to individual women who underwent cycles from 2004 to 2009.  In this way a cumulative live birth rate over the course of all their cycles could be determined.

The researchers reviewed data from 246,740 women, with 471,208 cycles and 140,859 live births, found that live-birth rates declined with increasing maternal age and increasing cycle number when patients’ own oocytes were used, but live-birth rates remained high in donor egg cycles. See Luke et al, Cumulative Birth Rates with Linked Assisted Reproductive Technology Cycles, N Engl J Med 2012; 366:2483-2491 June 28, 2012. http://www.nejm.org/doi/full/10.1056/NEJMoa1110238

By the third cycle, the conservative (patients who underwent fewer than three cycles were assumed not to get pregnant) and optimal estimates of live-birth rates (patients with fewer than three cycles were assumed to have a live birth) with autologous oocytes had declined from 63.3% and 74.6%, respectively, for women younger than 31 years of age to 18.6% and 27.8% for those 41 or 42 years of age and to 6.6% and 11.3% for those 43 years of age or older. When donor oocytes were used, the rates were higher than 60% and 80%, respectively, for all ages. Rates were higher with blastocyst embryos (day of transfer, 5 or 6) than with cleavage embryos (day of transfer, 2 or 3).

At the third cycle, the conservative and optimal estimates of cumulative live-birth rates were, respectively, 42.7% and 65.3% for transfer of cleavage embryos and 52.4% and 80.7% for transfer of blastocyst embryos when fresh autologous oocytes were used.

The study looks for the first time at a “cumulative live birth rate” for each patient going through three embryo transfers. They provide a range based on those patients who did not proceed with subsequent cycles assuming no pregnancy for lower end and live birth in upper end. They do not go into number of embryos transferred or multiple pregnancies.  This provides the best data we have available to answer the question of what the odds are that a patient will experience a successful live birth with IVF.  Understanding that the data is now a little dated and represents a national average, my expectation is that on the average we should see even somewhat better success.

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What did you think of the study? Any questions? Ask Dr. Kreiner right here.

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Infertility Podcast Series: Journey to the Crib: Chapter 4

By David Kreiner MD

April 12th, 2012 at 11:57 am

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Four. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://www.longislandivf.com/podcast/Chapter_4-WhereDoYouGo.mp3

 Where Do You Go?

 I try to help the reader understand the published statistics offered online by SART, the national organization of IVF programs that provides a registry of IVF programs who submit their data for audit by SART.  Rates are offered with a numerator and a denominator with the critical goal of a live baby per retrieval or transfer being the most crucial statistic.

 The benefits and disadvantages of large programs are discussed basically offering that larger programs tend to have more experienced and often skilled personnel albeit with more waiting time for monitoring.  Some programs may provide more personalized care, some more psychological or emotional support and some offer adjunctive therapies such as acupuncture and mind body programs.

 I emphasize the importance of the embryology lab as well as the skill of the physician performing the embryo transfer.  The technique of the transfer is described including factors that I believe may affect success rates.

 * * * * * * **  * * * *

Please share your thoughts about this podcast here.

no comments


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