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Archive for the ‘Single Embryo Transfer’ tag

Is Your Reproductive Endocrinologist or Fertility Practice On Top of Their Game?

By Tracey Minella

October 10th, 2013 at 7:22 pm

 

photo credit: jscreationzs/freedigitlaphotos.net

Did you research your reproductive endocrinologist’s background before your initial appointment or did you just trust the recommendation of a friend who had success with him? Has your investigation gone no further than a quick glance at those diplomas on the office wall?

Does it matter that your doctor graduated first in his class at Harvard Medical School in 1980 if he hasn’t kept abreast of the rapidly changing advances in the assisted reproductive technology (ART) field, or hasn’t surrounded himself with a team of top-rate embryologists? Or hasn’t conducted any research studies?

Certainly, education matters. But so does something else…continuing education.

Is your doctor on top of his or her game? Is he involved in ground-breaking research? Is she recognized as a leader in the field?

The biggest annual conference on Assisted Reproductive Technology is the Conjoint Meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine…more simply referred to as the ASRM… and it kicks off in Boston this Saturday. Fertility doctors, embryologists, IVF nurses, and others working in the field come from all over the world to attend the 5 day conference to learn the latest, cutting edge developments in reproductive technology.

The information to be presented at the ASRM each year is chosen by the committee based on research studies and abstracts submitted by fertility professionals across the globe. Having an abstract chosen for presentation at the ASRM is a great honor to a fertility practice.

Although Long Island IVF always sends several doctors and key support staff, this year is extra special… 

This year, not only one… but two… abstracts from Long Island IVF have been accepted for presentation at the ASRM.

The first abstract is titled: “Minimal Stimulation (Micro-IVF) Achieves Similar Clinical Outcomes in Patients Under 35 years of age compared to those undergoing conventional controlled ovarian hyperstimulation.” For more information about the Long Island IVF Micro-IVF Program see http://bit.ly/12ZjvaD or speak to your Long Island IVF doctor.

The second abstract is titled:  “eSET vs DET: Its Clinical Effectiveness in the Real World”. This abstract compared the effectiveness of Single Embryo Transfers (SET) against that of Double Embryo Transfers (DET). For more information about the Long Island IVF Single Embryo Transfer Program, including the financial incentives offered to SET program patients, see http://bit.ly/WpzCvv or speak to your Long Island IVF doctor.

Through these two ground-breaking studies, Long Island IVF has addressed two important issues for today’s infertility patients… lowering the costs of treatment and minimizing the chance of potentially risky multiple pregnancies…all while maintaining competitive pregnancy success rates.

If you have any questions, including whether you might be a candidate for either of these well-established Long Island IVF programs, please contact your Long Island IVF doctor.

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Have you participated in (or would you consider) the SET or Micro-IVF program? What would your primary reason be for doing so, or not doing so?

 

Photos credit: jscreationzs/ http://www.freedigitalphotos.net/images/agree-terms.php?id=10018651

 

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Infertility Podcast Series: Journey to the Crib: Chapter 30: The Gift of Life and Its Price

By David Kreiner, MD

September 3rd, 2013 at 7:41 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.                     

 

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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 29: Why the Wyden Bill Does Not Support Fertility Patients

By David Kreiner MD

August 28th, 2013 at 2:18 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-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 28: No More “Jon and Kate” Casualties

By David Kreiner, MD

August 23rd, 2013 at 5:12 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

 

A few 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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Where Have All The Baby Quads Gone?

By Tracey Minella

August 1st, 2013 at 8:13 pm

 

public domain image courtesy of pixgrove.com

Back in the 80’s and 90’s and even creeping into the new millennium, it wasn’t so unusual to see sets of triplets or quads around town. It was hard to miss those “stretch limo” strollers in the malls and parks, pushed by bleary-eyed but grateful parents, now “outed” as IVF’ers. Two of my good friends had sets of triplets in 1998 and 2000 and I conceived but lost my own set in 1995. It was just the way it was back then.

There was not much predictability in the early years of IVF. Because the revolutionary technology was new, IVF success rates were initially low (especially compared to Long Island IVF’s impressive rates today). http://bit.ly/XYZrSC. When I did IVF in 1993, I was given a 17% chance of success.

Standard protocol back then called for transferring four embryos. Challenging cases of repeated implantation failure occasionally transferred even more. So, when IVF did work, it often really, really worked…and women who did get pregnant often had high-order multiple pregnancies. As success rates rose… and the number of embryos transferred back remained the same… even more multiple pregnancies resulted.

Triplets or quads were a novelty in the early years of IVF when strangers would gawk and even be so bold as to approach the parents and ask if the babies were from IVF.  Later, we became desensitized and barely gave a second glance their way.

Then… when we weren’t looking… those high order multiples climbed out of their mega-strollers, stopped wearing matching outfits, grew up, and just blended into society. And now it seems the supply of replacements has dried up.

Where have all the baby quads gone?

Like an endangered species, high-order multiple birth children are heading toward extinction. Sure, there are still some such births… both naturally-occurring and through IVF… but thanks to advances in assisted reproductive technology, they are rare.

Today, IVF success rates are so good that standard protocol in many successful IVF programs calls for the transfer of only one or two embryos, virtually eliminating the chance of a high-risk triplet (or higher) pregnancy and its emotionally-devastating selective reduction considerations. Not only is this better for the health of the mother and the baby(ies), but it may be cost-efficient.

Transferring only one or two embryos at a time, a patient may be able to have two or three (or even more) pregnancies from one stimulated IVF cycle, depending on their response, age, and other factors. There are even greater financial incentives (including free cryopreservation and discounted FETs) if patients use Long Island IVF’s Single Embryo Transfer Program. http://bit.ly/WpzCvv.

So that beautiful set of quads I saw yesterday, in two double wide strollers, stretching the whole width of that mall traffic lane took me off-guard. I smiled and met the mother’s tired eyes.

Thankfully, I didn’t gawk.

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Have or would you consider the Single Embryo Transfer? Why or why not?

Do you have multiples?

 

Photo credit: http://www.pixgrove.com/2012/09/thoughtful-mothers-idea-of-identifying.html

Note: The quads pictured here are identical and not a product of IVF

 

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Infertility Podcast Series: Journey to the Crib: Chapter 22: Cryopreservation of Embryos

By David Kreiner, MD

July 15th, 2013 at 11:09 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-Two: Cryopreservation of Embryos. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=119

 Cryopreservation of Embryos

 In 1985, my mentors, Drs. Howard W. Jones Jr and his wife Georgeanna Seegar Jones, the two pioneers of In Vitro Fertilization (IVF) in the Western Hemisphere, proposed the potential benefits of cryopreserving embryos for future transfers.  They predicted that doing so would increase the overall success rate of IVF and make the procedure safer, more efficient and cost effective. 

One fresh IVF cycle might yield enough embryos so that in addition to performing a fresh embryo transfer in the same cycle as the stimulation and retrieval that additional embryos may be preserved for use in future cycles.  This helps to limit the exposure to certain risks confronted in a fresh cycle such as the use of injectable stimulation hormones, the egg retrieval and general anesthesia.  It also allows patients to minimize their risk for a multiple pregnancy since embryos can be divided for multiple transfers.

At Long Island IVF, we are realizing the Jones’ dream of safer, more efficient and cost- effective IVF, as well as increasing the overall success of IVF. 

Today, an estimated 25% of all assisted reproductive technology babies worldwide are now born after freezing.  Studies performed in Sweden revealed that babies born after being frozen had at least as good obstetric outcome and malformation rates as with fresh IVF.  Slow freezing of embryos has been utilized for 25 years and data concerning infant outcome appear reassuring relative to fresh IVF. 

I personally have pushed to promote the concept of removing the financial pressure to put all your eggs in one basket by eliminating the cost of cryopreservation and storage for those patients transferring a single embryo.  Furthermore, such a patient may go through three frozen embryo transfers to conceive for the price of one at our program.  We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

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Was this helpful in answering your questions about cryopreservation of embryos?

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 22: Cryopreservation of Embryos

By David Kreiner MD

July 8th, 2013 at 8:58 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-Two: Cryopreservation of Embryos. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=119

Cryopreservation of Embryos

In 1985, my mentors, Drs. Howard W. Jones Jr and his wife Georgeanna Seegar Jones, the two pioneers of In Vitro Fertilization (IVF) in the Western Hemisphere, proposed the potential benefits of cryopreserving embryos for future transfers.  They predicted that doing so would increase the overall success rate of IVF and make the procedure safer, more efficient and cost effective. 

 

One fresh IVF cycle might yield enough embryos so that in addition to performing a fresh embryo transfer in the same cycle as the stimulation and retrieval that additional embryos may be preserved for use in future cycles.  This helps to limit the exposure to certain risks confronted in a fresh cycle such as the use of injectable stimulation hormones, the egg retrieval and general anesthesia.  It also allows patients to minimize their risk for a multiple pregnancy since embryos can be divided for multiple transfers.

 

At Long Island IVF, we are realizing the Jones’ dream of safer, more efficient and cost- effective IVF, as well as increasing the overall success of IVF. 

 

Today, an estimated 25% of all assisted reproductive technology babies worldwide are now born after freezing.  Studies performed in Sweden revealed that babies born after being frozen had at least as good obstetric outcome and malformation rates as with fresh IVF.  Slow freezing of embryos has been utilized for 25 years and data concerning infant outcome appear reassuring relative to fresh IVF. 

 

I personally have pushed to promote the concept of removing the financial pressure to put all your eggs in one basket by eliminating the cost of cryopreservation and storage for those patients transferring a single embryo.  Furthermore, such a patient may go through three frozen embryo transfers to conceive for the price of one at our program.  We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

 

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Was this helpful in answering your questions about cryopreservation of embryos?

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

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Infertility Podcast Series: Journey to the Crib: Chapter 21: Things You Should Know About Your Embryo Transfer

By David Kreiner MD

July 1st, 2013 at 9:43 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-One: Things You Should Know About Your Embryo Transfer. You, the listener, are invited to ask questions and make comments.  Dr. Kreiner will answer himself. You can access the podcast here: http://podcast.longislandivf.com/?p=116

Things You Should Know About  Your Embryo Transfer

As many embryos as you transfer may implant.  There is also about a one per cent chance an embryo can spontaneously split resulting in identical twins.  For young patients with high quality embryos, the implantation rate is high enough that transfer of one embryo offers a 50% pregnancy rate or better and transfers of two a slightly higher pregnancy rate but a twin rate of 40%.  For this reason it is recommended that patients under 35 with a high quality embryo transfer one embryo to minimize their chance of having a higher risk multiple pregnancy.

At Long Island IVF, we offer the Single Embryo Transfer (SET) Program to minimize the cost implications of freezing the excess embryos by eliminating the fee to cryopreserve and store these embryos for up to a year.  We also offer for SET participating patients, three frozen embryo transfers for the price of one.

Embryos are typically transferred three to five days after retrieval. The longer duration allows the embryos to develop further giving embryologists an opportunity to judge better which embryos have the best pregnancy potential.  Otherwise, a day five transfer does not improve an embryo’s chance to implant.  Many embryos fail to develop further after the third day and therefore are not ideal for transfer on day five.  The embryologist will decide whether delaying transfer improves a woman’s pregnancy potential based on the number and grade of the embryos, the woman’s age, and her history.

The embryo transfer procedure, which we studied in the late 1990′s and presented at the ASRM in 2000 includes first passing a thin very pliable tube (trial catheter) through the cervix under ultrasound guidance.  Occasionally, a suture has been placed in the cervix during retrieval so as to not cause any uterine contractions at the time of transfer.  This suture can then be used to manipulate the cervix to straighten the cervical canal for easier atraumatic passage of the trial catheter.  The inner part of the trial catheter is removed leaving the trial open at its distal end.  The embryologist loads the embryo/s in the transfer catheter which is fed through the trial catheter noting on ultrasound when the transfer catheter has reached the center of the uterine cavity.  The embryo/s contained in a microdroplet are then gently expressed with visualization of an air bubble usually adjacent to the microdroplet noted on the ultrasound.  The catheter is then examined by the embryologist to insure that the embryo/s did not stick to the wall of the catheter.

If it does we repeat the procedure.

Results of our study of this transfer procedure, I called the two-step transfer method, showed shockingly higher implantation rates compared to transfers with different catheters, with a one-step approach, without ultrasound, and with a tenaculum at the time of transfer instead of the suture. 

In the 27+ years I am performing IVF, this advance in the embryo transfer stands out as one of the top three most significant advances in IVF along with the radical improvement in media preparation and the ultrasound-guided transvaginal follicular aspiration.

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Was this helpful in answering your questions about embryo transfers? Please share your thoughts about this podcast here. And ask any questions, which Dr. Kreiner will answer.

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“Windows of Implantation” and Recurrent IVF Implantation Failure

By Satu Kuokkanen, MD, PhD

June 27th, 2013 at 10:09 pm

Recurrent implantation failure is a devastating problem for infertile couples and a challenging clinical dilemma for physicians.  

It is hard for patients to accept an unsuccessful in vitro fertilization (IVF) cycle outcome and discontinue infertility therapy attempts when their physician reviews everything in their cycle as being fine… with normal follicle development, egg fertilization and embryo development as well as sonographically-appropriate endometrial thickness.  However, there are still factors beyond our visual scope that may not be quite perfect.

Human endometrium, which is the inner lining of the uterus, undergoes extensive changes under the influence of female hormones, estrogen and progesterone in each cycle.  These sequential endometrial events are critical in the preparation of the endometrium becoming receptive for a fertilized egg to implant.  Indeed, there is only a specific time during the cycle, called the “window of implantation”, when the endometrium is receptive for implantation.  

Extensive research has focused on identifying either morphological characteristics or molecular level markers of the endometrium to determine when the endometrium allows implantation of an embryo.  The hypothesis behind this research is that an endometrium lacking the required features and markers is considered abnormal and thus non-receptive for embryo implantation.  However, it has recently become clear that there are not only one or two such biological markers of endometrial receptivity, but instead a whole group (hundreds) of molecular signals that together describes receptive endometrium.

Interestingly, recent research has indicated that the window of implantation in some women with recurrent implantation failure has shifted from what has been traditionally considered the window of implantation.  

Dr. Carlos Simon (University of Valencia, Spain) presented his findings on this phenomenon at the Annual Meeting of the Society of Gynecological Investigation (SGI) in March this year. He described that the window of implantation for some women can be either earlier or later than the typical window of implantation.  Thus, if embryos are transferred when the endometrium is not fully prepared or when it has passed its peak receptivity, implantation cannot occur.  

When his research team determined the correct window of implantation for women with multiple past implantation failures and the embryo transfer was performed during their “personalized” window of implantation, these women had comparable pregnancy rates to the control women of their age group.  If these research results can be confirmed in larger patient groups, there will be therapeutic options available for some women with unexplained implantation failure. 

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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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