The IVF Process: One Step at a Time
It's Medical Monday, and as promised, one of our fertility nurses has written her version of step by step instructions on an IVF (in vitro fertilization) cycle. I say her version, because Kirsten's sense of humor and the emphasis that she places on certain words and phrases is all her own. Another nurse or doctor may have explained the process in a slightly different way, with each style having it's own merit. Kirsten's voice comes through on this wonderful piece and makes for lively and yes, almost fun, reading. After seven years here at RMACT, I undestand the IVF process better than I have before. Enjoy~ Lisa Rosenthal
Understanding an IVF Cycle
At Reproductive Medicine Associates of Connecticut (RMACT) we recognize how stressful it is for you, our patient, to undergo an IVF cycle. Unfortunately we can’t take the stress away completely. We can help you tackle this task with a clear head, a sound plan, and the comfort of knowing that you have a supportive team rooting for you every step of the way (that’s us!).
In this post I’m going to do my best to give you an overview of what to expect in a typical IVF cycle … think of it as a “zoomed out” picture. (Rest assured, your doctor, nurse, and navigator will help you “zoom in” on your specifics once you get started.)
Our first step is to gather information about you. We want to know how strong and well-functioning your ovaries and reproductive organs are and confirm that you are healthy and fit for pregnancy. We do this with a series of blood tests and ultrasounds. Depending on where you are in your menstrual cycle, it can take 4-6 weeks to complete this step.
Sometimes even this first step can get confusing - but don’t worry! While you are with us, you will be assigned a patient navigator who will assist you every step of the way. She will be your “go to” person. She will help you schedule appointments, and direct your questions when you don’t know who to direct them to. Navigators help you and navigators help us. We love them and you probably will too.
Once we have all of the necessary info, your doctor will decide if IVF is right for you, and if it is, she/he will customize a protocol. This is a fine tuned, carefully thought out “recipe” (medications and ultrasounds) that is very specific to YOU. You will follow this “recipe” for several weeks and we will carefully monitor you along the way.
Goals of IVF Treatment
Our first goal of treatment is to make sure that your naturally occurring hormones don’t interfere with the IVF medications that we are going to use to stimulate you to produce follicles (sacs containing eggs). We do this by starting everyone on birth control pills (in certain cases you may use medications called Aygestin or Lupron instead). Your nurse will ask you to contact them with your next menstrual cycle and she will instruct you on how to start pills or other medications.
While you are on birth control pills our finance team is hard at work. They have the tricky task of getting insurance companies to approve treatments and medications. They work very closely with you so that you understand what you will have to pay along the way, with no unexpected surprises. Once your finance coordinator is confident that both you and your insurance company are on board, they will give us the “green light” to order your mediations. Medications for IVF are ordered thru specialty pharmacies (you can’t just pick them up at your local CVS or Walgreens). If your insurance company is paying for your meds, they will tell us which pharmacy to use.
In the meantime, your assigned nurse will help you schedule an IVF teach class. This is a 2 hour class where a nurse will explain what medications you are taking, why you are taking them, and how to take them. For many of our patients, this is when the moving parts of the cycle start to “click,” and they feel that they have a clearer understanding of what to expect.
Once you have attended class and gotten your medications, we will instruct you to stop your birth control pills. (Our aim is to have you on pills for 1-2 weeks. Occasionally it can be longer.) A day or two after stopping birth control pills we will ask that you come in for a blood test and ultrasound. We are ensuring that everything is “quiet”. (In fact, you may hear us call this visit a “suppression” or “baseline” check.) We want to make sure that the lining of your uterus is thin, that your hormone levels are appropriately low, and that there aren’t any sneaky follicles or cysts growing on your ovaries. If all looks good we will instruct you to start your injections. If something is going on that we were not hoping for, then you will be instructed to stay on birth control pills or be give a new plan. This potentially could delay you by a week or two.
Most women need injections for 10-12 days. The exact amount of time varies from woman to woman, so don’t be alarmed if you need a little less or a little more time. It’s not a race … and please keep in mind – we don’t compare you to other women, so you shouldn’t either. Your ovaries will tell us how long they need.
During the time that you are giving yourself shots, we will instruct you to come for blood tests and scans regularly … typically every other day. As the follicles on your ovaries grow, we count and measure each one of them.
Count and measure, count and measure, count and measure, until TA DA! Your ovaries have their final say and you are ready for surgery (the retrieval) to collect the eggs.
On retrieval day you should expect to be in our Norwalk office for 2 to 3 hours. You will have anesthesia thru an IV that will make you sleep comfortably. The procedure typically takes 15 minutes and then we will monitor you for about an hour. Before you go home we will be able to tell you how many eggs were collected. At this point we won’t know much about them. We will tell you to go home, take a nap, and to start binge watching Downton Abbey (or the series of your choice). You may still feel crampy, bloated, or tired. Usually Tylenol is sufficient for your discomfort.
The day after you retrieval a nurse will call to check in with you, and tell you how many of your eggs fertilized. Two days later a doctor will call with an update, and two days after that you will either come in for your transfer (replacing an embryo or two back into your uterus) or get a call to let you know how many of your embryos were frozen for future use. If you have a transfer, we will schedule your pregnancy test 9 days later. If you freeze your embryos instead, we will ask that you call us when your period starts (usually two weeks later) so that we can schedule an FET (frozen embryo transfer).
For some women, the 9 days between the embryo transfer and the pregnancy test can be the most challenging part of the process. Many of you report that it feels strange to not be coming in to the office regularly (don’t worry – we’ll still call to check in on you). Some of you will be tempted to pee on a stick at home. Please don’t. Here’s why: The medications from your cycle may still be in your system. And, therefore you could have a positive test even if you aren’t pregnant. On the day of your pregnancy test we will ask that you come in first thing in the morning for a blood test. Approximately 4-5 hours later we will give you a call with your news. Regardless of the results, we will go over your next steps. We will tell you what meds you should continue, what you should stop, and what to expect over the next few days. If your result is positive, we will instruct you to repeat the levels 2 days later, and from there we will start booking your ultrasounds.
Occasionally the pregnancy test comes back positive, but your levels are lower than we expect. In these situations, we tread very carefully. You will be instructed to come back 2 days later for a repeat test to see if your numbers are rising appropriately. We are optimistic that they will, but very cautious. Unfortunately, most of these pregnancies will not continue normally.
Fertility Treatment Can Be Intense But Also Empowering
Fertility treatment isn’t a perfect science. And, sometimes we have to give you disappointing news along the way; your ovaries may not respond to medications the way that we had hoped, the number of eggs that we get in the operating room may be less than we expected, or your fertilized eggs may not grow to normal blastocysts. If this happens, we realize you may feel sad, disheartened, frustrated, or maybe even angry. Fortunately, this news rarely sneaks up on us and we will be communicating any concerns along the way. We also have a great team of wellness providers who are available to help you if you feel overwhelmed or need help making decisions and moving forward.
So, yes, IVF treatment can be intense, but it can also be empowering. Many women feel excited about being proactive and moving forward. We know that a lot of responsibility falls on our patients. We know that you will be rearranging your schedule like a Personal Admin, mixing medications like a Chemist, and administering injections like a Nurse. We will give you the tools and you will conquer it with confidence. We are your ultimate fans, and we will root you on as you tackle this journey. Good luck!
About IVF (in vitro fertilization)
Here at Reproductive Medicine Associates of Connecticut (RMACT), we have a wealth of experience. One of the reasons that I appreciate that so very much is that we can look at different ways to explain things. Our clinical staff, including our board certified reproductive endocrinologists, physicians assistant, specially trained fertility nurses, patient navigators, medical assistants, financial team and more; they all have a specific way of seeing the fertility treatment process and protocols.
Why is that important? Why does that matter? Because sometimes it is helpful to hear a different perspective. Sometimes hearing the same information from just a slightly different point of view, variation on language, a metaphor that makes more sense to you, can bring you to understanding that you can feel all the way to your toes.
So, something new for this blog, PathtoFertility; an ongoing series by our wonderful, talented team at RMACT. Below, find the information that we have on our website regarding IVF.
Next Monday, on Medical Monday, we will have a more step by step description of IVF (in vitro fertilization) from one of our talented fertility nurses. Don’t worry, I will remind you that it’s coming.
You will love it. It’s well written, with a sense of humor, which can be quite a relief in the middle of the seriousness of fertility treatment.
Something to look forward to~ Lisa Rosenthal
During the in vitro fertilization (IVF) process, eggs are removed from the woman’s body and combined with sperm in the laboratory to create embryos, which are then transferred into the woman’s uterus. Nearly 60% of IVF procedures in the United States are performed on women 35 and older.
Before undergoing IVF in Connecticut, you will be prescribed several medications to stimulate the development of multiple ovarian follicles containing eggs to be fertilized. We closely monitor this process using blood tests and ultrasound. Once the eggs have matured, they are retrieved through a simple procedure under ultrasound guidance. We then expose the retrieved eggs to sperm and transfer a limited number of the resulting embryos back into your uterus.
In Vitro Fertilization at RMA Connecticut Recognized for Scientific Excellence
The fertility doctors at RMACT are all board certified in Obstetrics & Gynecology and Reproductive Endocrinology. They are members of the American Society for Reproductive Medicine (ASRM), a voluntary, non-profit organization devoted to advancing knowledge and expertise in reproductive medicine and biology. They are also members of the Society for Assisted Reproductive Technology (SART), an organization of assisted reproductive technology providers affiliated with ASRM that has collected data and published annual reports of pregnancy success rates for fertility clinics in the U.S. and Canada since 1989.
In addition, RMACT is fully accredited by both the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Institute of Ultrasound in Medicine (AIUM).
Our Reproductive Endocrinology and Infertility Laboratory meets the highest standards and is certified by the College of American Pathologists (CAP) and the Clinical Laboratory Improvement Act (CLIA) for the State of Connecticut. As a result of its expertise and experience, RMACT is one of just 11 leading In Vitro Fertilization (IVF) centers nationwide chosen by In Vitro Sciences to participate in its Centers of Excellence program.
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Happy Birthday Louise Joy Brown, First IVF Baby
Louise Brown celebrated her 36th birthday on Friday, July 25, 2014. Her full name is Louise Joy Brown, although now she is married to Wesley Mullinder.
I’ve written before about Louise. She is, after all, the first in vitro fertilization (IVF) baby in the world. First test tube baby. You can read about it on Pathtofertility, on other blog dates to learn more about the first IVF baby in the news. Her parents led the way, as did her doctors, to a course of fertility treatment that has enabled over five million babies to come into the world.
Louise Brown went on to have her own children, with no need for medical assistance and certainly not needing IVF. Infertility, in her case, was not genetic. I wonder about the big sigh of relief from her parents when they discovered that Louise would not need the help that they did. Perhaps they would have just continued to be grateful that IVF was there for Louise had she needed it. How grateful the rest of the world is that IVF exists.
IVF Pregnancy Success
There’s always a first and for IVF pregnancy success stories, Louise Joy Brown is it.
We celebrate her birthday and her parents and her doctors. While everything might not have been perfect every step of the way, they took the brave steps none the less. In fact, it might be very well true that if we looked at the procedures and information available now, we would be aghast at the protocols followed and not followed with Louise’s conception.
I’m pretty sure that’s called Monday morning quarterbacking. It’s important to remember that there was no example to follow. No how to manual. That’s what they were creating together. Looking back is a great way to learn though. Informed consent was not delivered to Louise’s parents the way that it would be in a responsible and ethical IVF fertility program today. First time, there was no role model to follow. That’s what the combination of doctors and patients created. The first, perhaps not perfect, model of how to perform IVF on a woman who had no other way of becoming pregnant.
Flawed consent, flawed protocols or not, the medical team was impeccable as proved by their ivf pregnancy success, the birth of a healthy child. We applaud them for their willingness to create a practice that has been refined, discussed and labored over ever since, in the quest of making fertility treatment the most effective and ethical it can be.
Happy birthday to Louise Brown. First IVF baby in the world. We’re glad that you’re here.
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RMACT Ladies Night In Stories - When Is Enough, Enough?
We all feel release in different ways. Some of us cry. Some of us talk. Some of us write. A slightly different version of what is below appeared on our Ladies Night In Facebook page recently. I contacted the patient/writer (who I know personally), and asked her if I could share it here. She agreed, with the idea that perhaps it would shed some light or offer some comfort to someone else who is challenged by similar questions. Of course I'm keeping it anonymous. I will just say that it resonated with many women who are on that board. So while this is one woman's thoughts, it may very well echo thoughts that you have had. Enjoy this beautifiul, heartfelt piece. I know I did. ~Lisa Rosenthal
A desperate cry that is often heard on the RMACT Ladies Night In Online bulletin boards is this question, “How do you know when it is time to give up?” Usually the person asking is in a really painful and desperate place. It’s such an individual decision; still, there is no one else except you that can answer it. Here are my thoughts, examining this question for myself; I’m willing to share my journey, hoping that it will provide insight for you.
There is no magic number of years trying, or IVF cycles, or losses. Each person has their own pain threshold, what might be bearable for some will be way too much for others.
I recently heard of an interesting study where infertile women were offered as many free IVF cycles as they could bear (no pun intended, really) to conceive. Do you know what the average number of cycles underwent was before most people gave up?
Three. Can you believe that? Three. After three cycles the average person said ‘enough. I can’t do this anymore’. It was too painful for them to carry on. Now for some of us, well me, this is just unbelievable. Free cycles and you say ‘enough’? I am moving on to cycle #4 (not including a cancelled cycle). Am I crazy? No. Are they crazy? No.
I don’t think it is about how much you want it. That’s not what this is about. It's not about how badly you want a child, I think it’s about what you are prepared or able to go through, what you are prepared to give up or suffer through in order to have a child. For some people the cost is too high. They are not prepared to risk their mental health, their emotional stability, their marriage etc. in order to get a child.
I deeply envy those people who have come to the point in their lives where they say ‘enough’; where they can make the decision to live childfree. They get off the clichéd roller coaster and get on with their lives; away from the invasiveness and all consuming cycles, meds, needles, betas, hopes and disappointments. They go back to being normal. How wonderfully liberating. It must be like being let out of prison. It's a place of ‘acceptance.’ I envy them. I really do.
Because I can’t give up. Even living through all the pain I have, and continuing to live this hell daily, I still can’t give up. Because giving up is scarier to me than carrying on. A childfree future is just not an option for me. Which means that I am never giving up.
Am I brave or am I stupid? Is it perseverance or is it obsession? I don’t know. All I know is that I am not prepared to live my future childfree. And yes, I will do what it takes to get there. There are so many people in my life (luckily not my family, who know how important this is to me), who think I am obsessed; that I am crazy for doing this to myself. To put myself out there time and time again, only to have my soul destroyed and my heart broken so often. They don’t understand my need or drive for a child. They say: ‘don’t you think you should give up now?’, ‘don’t think that god/fate/nature is sending you a message?’
And therein lies the rub. I am not prepared to buy into the belief that this is my lot in life, that this is my life plan. That I am not ‘meant’ to have a child. Bullshit. I am not going to accept that. I am not an observer in my life, I am a participant. I have control over my fate, because I have choices. I will have a child one day. I understand and accept that it might not be in the way I expected. So my child might come to me through donor eggs, adoption, whatever. The how is no longer important to me, the end result is.
I am not obsessed. I felt close to obsession, about three years ago, when it consumed my life, but now I am just determined. I will succeed, because the alternative is not an option to me. Making the decision to eliminate childfree as an alternative for me has brought incredible peace. Because I know, come what may, I will have a child. It makes the daily grind of infertility so much easier to deal with, because I know I will have a happy ending in my life story.
To get back to the question of when is enough, enough, I know the answer for me is when the pain of trying is worse than the pain of giving up. For me, the pain of stopping is way greater than the pain of trying. Don’t let anyone make you doubt yourself. Do what is right for you. If it takes 5, 10 or 20 IVF’s for you to come to the place in your life where you either achieve success, or where you say ‘enough’, then that is what it takes. I know of a few people who almost feel embarrassed at the number of IVF’s they have done. They shouldn’t feel embarrassed. Going through this over and over is incredibly brave; it shows incredible determination and drive. Only you will know when enough is enough. And if you decide you can’t or won’t do this anymore, then celebrate your decision as a very brave decision, and live your life to the fullest. We each can have our own version of a ‘happily ever after’, but it has to be right for each one of us.
Meet IVF Lab Manager Katherine Scott, BA, M.Sc.
One of the best things about hanging around at the Norwalk office of Reproductive Medicine Associates of Connecticut (RMACT) is who you bump into to chat with informally. A reminder: I do work there so I’m not simply “hanging around” because that just didn’t sound right, did it? My point is that the unplanned meetings that take place there, for me, are often as important as the formal meetings.
Yesterday, I had the privilege of meeting Katherine Scott for the first time. Scott is our newly appointed IVF Lab Manager. I’d heard a lot about her but had not met her yet.
She described herself as not warm and fuzzy. Her words. I actually found her quite engaging and friendly. And very, very smart. I hope she wasn’t quite smart enough to realize that I didn’t understand some of what she was saying when she started talking about the technical and scientific aspects of the lab. I’m not a clinician, so I stick firmly to my belief that it is the reason I didn’t understand all of what she was saying.
So I’m actually way overdue to introduce Katherine Scott, BA, M.Sc. to you. Funny how that works though, getting to talk to her in person, there’s now more that I can share.
First thing you get from Katherine Scott is her passion. She lives and breathes the lab. Her life commitment is her work and her interest and desire shine through her words and her eyes. She talks about the advances in the labs and her excitement is palpable. I feel very lucky that she has landed here with us.
Second thing that you get from Scott is her compassion. Interesting, given that she describes herself as not warm and fuzzy. Without revealing personal information about her, let me just say that she spends free time giving back to the community in quiet, unsung ways. It’s just part of who she is and reflects what she believes in. One of her biggest concerns that she expressed yesterday, several times, is that she isn’t necessarily compassionate enough with patients. We talked quite a bit about personality and how what appeals to one person may be directly opposed to another person. We talked about maintaining personal integrity rather than people pleasing, as it is impossible to please every person that we run across in our lives. After speaking to her, I’m not at all worried about her speaking to patients. Her professionalism and care in her work are reflected very beautifully in her words. Patients will easily understand how well she does her job; caring about their care and their embryos.
We also talked about the skill sets needed. Do we need an embryologist to be warm and fuzzy? Is that a necessary skill set for a lab manager? Or is the skill set that we need and want for a lab director to have to manage and handle the scientific and clinical aspects of handling sperm, eggs and embryos?
I vote for the latter. We need the right person for the right job. There’s no doubt in my mind that Katherine Scott is a wonderful choice for a lab manager. She is smart, (very smart), she is passionate about her field of medicine/science, she is dedicated, she is devoted and she is extremely qualified.
And aren’t all of those the things we all want in a lab manager?
Keep reading, Scott will be submitting blogs regularly starting sometime in April.
Katherine Scott, it was a pleasure to meet and speak with you.
Happy weekend everyone.
IVF (in vitro fertilization) Laboratory Manager K. Scott, BA, M.Sc.
As Manager of RMACT’s Embryology Lab, Katherine is responsible for all clinical laboratory functions in RMACT’s laboratories, including embryology/IVF, andrology and endocrinology. She works with RMACT’s team of Board Certified reproductive endocrinologists to perform assisted reproductive technologies (ART) and to lead clinical research.
Katherine has experience in cryopreservation and vitrification of oocytes and embryos, as well as embryo manipulation, culture, transfer and biopsy. She also has extensive experience with male infertility, including semen analysis, cryopreservation and preparation for IUI, ICSI and IVF. She is passionate about her clinical responsibilities and how her work in the lab affects the lives of patients and parents to be.
Katherine’s affinity for math and statistics drew her to study psychology at University of Alabama. As she concluded her degree, she was recruited to provide statistical support for Nathan Treff, Ph.D., at Reproductive Medicine Associates of New Jersey (RMANJ). Katherine’s enthusiasm, diligence, and technical acumen were quickly recognized as she moved into the Embryology laboratory and facilitated first with on-site training, then with institutional support in the pursuit of her Masters of Biochemical Sciences with an emphasis on Clinical Embryology and Andrology from Eastern Virginia Medical School. During her time in the laboratory, Katherine has enjoyed the opportunity to refine her skills, participating in more than 10,000 IVF (in vitro fertilization) cycles. Armed with this experience, Katherine began to travel, teaching vitrification to other laboratory professionals across the country. Katherine joined the RMACT team in 2013.
Katherine is a member of the American Society of Reproductive Medicine (ASRM) and American Board of Bioanalysts (ABB).
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CCS IVF: Prize Winning Fertility Treatment Update
Three years ago, Reproductive Medicine Associates of Connecticut (RMACT) had news to share with the world and we sent out the press release below, which you can read in its entirety. Since then, CCS has been a scientific technique that has been used successfully by our patients when it’s medically appropriate. Successful as defined by pregnancy and also as defined by babies born. One of the most common reasons for using CCS is for repeated miscarriages of seemingly healthy pregnancies. It’s probably not necessary to say how heartbreaking that is for men and women who are hoping to have a baby. CCS also gives peace of mind when there have been repeat losses, that with CCS, the possibility is much, much lower. Without a doubt, CCS has changed the lives of many men and women who have been trying to become pregnant and to deliver a baby.
Three years later, CCS continues to make significant differences in the lives of our patients.
RMACT recently participated in a breakthrough study titled "A Prospective Randomized Controlled Trial Demonstrating Significantly Increased Clinical Pregnancy Rates Following 24-Chromosome Aneuploidy Screening: Biopsy and Analysis on Day 5 with Fresh Transfer," which was led by Infertility Specialist Richard Scott, M.D. and Nathan Treff, Ph.D., of Reproductive Medicine Associates of New Jersey (RMANJ), an affiliate of RMACT.
Pre-Implantation Genetic Screening (PGS)
This study, which earned the top research award from the American Society for Reproductive Medicine (ASRM) in October 2010, examined technology that is the first and only fully validated system to reliably evaluate all chromosomes in a small biopsy obtained from an embryo during in vitro development. This is the first and only prospectively randomized trial showing real benefit from Pre-Implantation Genetic Screening (PGS) and RMACT is the only fertility practice in New England to offer it.
“This technology will revolutionize reproductive medicine,” said infertility doctor Mark Leondires, M.D., Medical Director of RMACT and Lead Physician for RMACT on the Clinical Study. “The purpose is to identify the best embryos for a healthy pregnancy. By selecting chromosomally normal embryos without damaging them, pregnancy rates were dramatically increased to more than 90 percent and miscarriage rates were lower compared to the control group. This data is historic in its nature and implications.”
Sustained implantation rates were 75 percent in the study group, much higher than compared to 56 percent in the control group. Clinical pregnancies, which are a typical result of genetic abnormalities, were significantly lower in the study group (60 percent) than versus the control group (92 percent).
“Our goal is one embryo, one healthy baby," said Dr. Scott. "So, the driving force behind most of our research is to assess reproductive competency to better predict which embryo will most likely produce one healthy baby. This is the first study of its kind that has shown dramatically improved clinical pregnancy rates with blastocyst biopsy, 24 Chromosome Aneuploidy Screening and fresh embryo transfer. Though similar screening technologies are being marketed, none have been validated through the critical studies, culminating with a randomized clinical trial, which provides this high level of medical evidence.”
The procedure starts when a couple goes through In Vitro Fertilization (IVF) Treatment with intracytoplasmic sperm injection (ICSI); the embryo is then grown to the blastocyst stage and a small biopsy of five to 10 cells is taken from the embryo on day five to six days of life. The biopsy sample then goes through computer analysis to identify any abnormalities among the chromosomes. This process identifies chromosomal disorders such as Down syndrome before the embryo is transferred into the female patient’s uterus. This error rate of the technology is less than one percent in more than 4,000 embryos tested.
About Comprehensive Chromosomal Screening
What separates this technique of Comprehensive Chromosomal Screening (CCS) from other PGS processes is that the embryo is able to grow for five or six days, allowing the cells to split and the chromosomal analysis to be more accurate. In addition, since the technology can be used to find small breaks in chromosomes and even single gene disorders it defines itself as the most robust and reliable technology for evaluating pre-conception embryos available. RMANJ has previously shown 24 chromosome analysis technology to be significantly more reliable than other existing methods. However, with this latest clinical study, the new technology has been improved because it no longer requires freezing embryos for weeks before thaw and use. The breakthrough is based on a shorter timeline, which has better results; the same comprehensive screening is conducted within hours instead of days. It is the first technology of its kind that allows for assessment of blastocysts and still enables a fresh embryo transfer, which generally has a higher success rate than freezing embryos.
The study included patients seeking IVF who were less than 43 years old and had no more than one prior failed IVF cycle. The control group underwent routine care and typical screening methods, whereas the study group underwent biopsy of the blastocyst and CCS on day five.
In a related retrospective evaluation presented with this research, the study shows that this new technology dramatically decreases the occurrence of abnormal pregnancies such as Down or Turner syndromes. This technology will allow women in their late thirties and forties, who normally have a high risk for genetic abnormalities, to nearly eliminate these risks and thereby maximize their chances for a successful pregnancy with in-vitro fertilization. CCS represents a major step forward in helping patients have healthy pregnancies and thereby allowing them to choose a single embryo transfer to minimize the risk of twins.
“A singleton pregnancy is the safest for mother and baby,” stated Leondires. “This technology will allow couples to choose a single embryo transfer without jeopardizing their chance for success. It is truly an amazing advance which will change the landscape of reproductive medicine in the future for both patient and physicians.”
Infertility affects 7.3 million Americans and for 20 percent of infertility patients the cause is unknown, according to The National Infertility Association. Through 24 chromosome aneuploidy screening, fertility doctors can determine which embryos are normal, increase healthy pregnancies while at the same time reduce the number of miscarriages. The technology will transform reproductive medicine and instill confidence in transferring only one embryo, leading to fewer multiple gestations. In addition, for patients who have had several miscarriages, it can enable them to make informed decisions about their next steps, such as working with an egg donor.
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IVF News - More Babies, Less Multiples
In the news today! The "Number of test-tube babies born in U.S. hits record percentage," reported The Chicago Tribune, along with other outlets picking up the same IVF news released by SART (Society of Assisted Reproductive Technology) and announced in ASRM (American Society of Reproductive Medicine) Bulletin Volume 16, Number 12.
More IVF babies (when are they going to stop calling them test-tube babies? For goodness sakes, it’s just a little outdated, no?) were born in 2012 than in any other year since the inception of the scientific and technological treatment in the 1980’s.
SART released that data based on the fertility practices that verify and report their treatment results. For those challenged by infertility or more correctly, sub-fertility, this is great news. Technology is working, despite all the recent media buzz about men and women being mislead about succeeding in creating their families with IVF.
IVF Success Rates Released
So let’s be really clear. The numbers are these:
165,172 IVF cycles and 61,740 babies. IVF succeeds and it fails. Many of those cycles represent people who have undergone more than one cycle, having had both an IVF cycle failure and then an IVF cycle success. Many of these 61,740 babies are twins; fewer are triplets or higher order multiples (3 or more embryos/fetuses/babies).
These are the statistics. I’m not going to tell you whether they are good or bad statistics. You, anyone, can read them any way you want. An average of 1/3 success. An average of 2/3 failure. Too many twins. More singletons. Technology that is used to help create families. Technologies that cost a lot of money and result in people still not having their babies. Any point of view has its own validity. There is no one right point of view. IVF fails. IVF succeeds. IVF fails at a larger rate, on average, than it succeeds.
I have a few points that I’d like to focus on.
1. It does matter where you are in treatment. It does matter what the pregnancy rates are; that the fertility program you are considering reports to SART. To me, that’s one of the few slam dunks. For the pregnancy results to be verifiable and not just what someone would like you to believe. If it turns out that the fertility practice that has the highest pregnancy rates in your area is one that you are considering, dig a little deeper. Pregnancy rates aren’t the only means in which to measure success. Odd sounding? Consider. If a fertility practice will not take a patient over the age of 40 or 42, or 44, given that over the age of 35 IVF is far less successful, then that’s a practice that is treating patients who will skew their statistics down, not up. If a fertility practice will not accept patients for IVF with a FSH of over 12 or 16, or 18, there again, you have a program that is only accepting patients that will, statistically, do very well with IVF.
2. Be aware of the issues. I would not suggest that you discriminate against a fertility practice that accepts patients who may not do as well as other patients, who, by definition, will skew their pregnancy statistics downward. But be aware of these issues. Ask the questions, even if they do not apply to you. Because conversely, the fertility programs that are eliminating patients who might cause a drop in their pregnancy rates are also, in essence, artificially raising their pregnancy rates. Please note, I did not say they were being misleading or lying. It just makes perfect common sense, statistics aside, that if a fertility program will not take patients that are “difficult” (high FSH, low AMH, advanced maternal aging, premature ovarian failure, etc.) that there pregnancy rates will be higher.
I am not saying don’t use these practices. I am saying KNOW what the fertility programs that you are considering use as a barometer to accept patients. If you have any of the criteria that make you a “difficult” patient, you will want a fertility practice well versed in handling those issues, both in the medical treatment they provide and the support services they offer.
3. Be an educated patient. It will serve you well. It will help you avoid the feelings that have been expressed by so many recently in the public eye about having been deceived and betrayed. Know the questions to ask and if you are not sure, educate yourself. SART, ASRM, ACOG (American College of Gynecology) are all reliable and responsible websites and organizations that you can trust. They are a great place to start. The patient not-for-profit organizations are also full of helpful and reliable information. Try the following websites: Resolve, The American Fertility Association, INCIID (InterNational Council on Infertility Information Dissemination), Fertility Within Reach, PVED (Parents Via Egg Donation), A.T.I.M.E. (A Torah Infertility Medium of Exchange), and Centerlink (The Community of LGBT Centers).
IVF Statistics and Considerations
Finally, on a very human note, there are babies being born, enlarging families, every single day, from IVF (in vitro fertilization) treatment. They are not IVF statistics. They are not 30% of a baby. They are the 100% baby that are the dreams that their parents are dreaming when they come into fertility treatment. They are real, tangible, flesh and blood children who cry and poop and sleep and eat and drool.
There’s a lot to consider when reading an article about statistics. Ultimately, you will take away from such an article what you most want to believe. Maybe you will take away from this article what you most need to believe.
Educate yourself; learn more about the fertility treatment and program that you consider using. Honor your feelings and, if you need to, find a way to silence so that you can discover what you are feeling. Statistics and facts can only lead you so far. Only you will know what is right for you.
We’re here to help.
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Affordable IVF: The IVF Opportunity Plan Option
No one denies that infertility treatment can be costly. In fact, for many patients, the cost of IVF (in vitro fertilization) is their primary concern before learning more. The fertility doctors and financial specialists at RMACT strive to offer affordable IVF options to bring the cost of IVF within reach. One of these options is the IVF Opportunity Plan.
Is there Infertility Insurance Coverage?
Infertility insurance coverage varies among providers. Some insurance providers do not offer coverage for fertility services at all. Others offer limited amounts of coverage, depending on individual plans and treatments. The IVF Opportunity Plan is an option, exclusively available to patients at RMACT, for those who do not have insurance coverage for infertility treatment. In addition, if a patient decides to withdraw from treatment, the plan offers refunds matched to various stages of the process.
What’s in IVF Coverage?
The IVF Opportunity Plan covers a group of comprehensive services provided by RMACT's team of surgeons, nurses and other specially trained patient care professionals. The coverage includes baseline blood work and ultrasound, IVF Teach class, cycle monitoring (blood work and ultrasounds), egg retrieval, anesthesia for the egg retrieval, embryo transfer, ICSI (if appropriate, on all eggs retrieved), assisted hatching, embryo cryopreservation and one year of storage, and cycle medications for up to and including ten days of stimulation. Certain specialized costs that may be relevant for some IVF patients cannot be included in the plan and these are described clearly at the beginning of the process.
How Much Does IVF Cost?
It's one of the most common questions: how much does IVF cost? After qualifying for the IVF Opportunity Plan, patients pay $11,750 for one IVF cycle. A full refund will be granted upon withdrawing from the program before starting medications. After starting medications, a $4,050 refund will be granted. If your cycle is cancelled prior to egg retrieval due to a medical reason (i.e., poor response, premature ovulation) you will receive a refund of $5,055. If you have your egg retrieval but do not have an embryo transfer, you will receive a refund of $650.00.
Financial Flexibility for Affording IVF
People can withdraw from the IVF Opportunity Plan at any time. Unlike some fertility centers that try to reduce costs by using lower medication doses or by limiting access to their programs, RMACT seeks to improve pregnancy outcomes by offering the highest quality treatment to everyone. We want to help you find the financial opportunity that meets your needs. Additional payment programs for affordable fertility treatment at RMACT will be highlighted in upcoming posts.
Patients who choose The IVF Opportunity Plan at RMACT are treated by our outstanding team of surgeons, nurses and other specially trained patient care professionals. Find
out if The IVF Opportunity Plan is right for you. To learn more, contact a Financial
Service Representative at RMACT at (203) 750-0400.
Lisa Rosenthal's Google+
Pregnant with Twins: One Couple's Reaction
Bear with me, there’s a blog out there that I want to comment on concerning IVF and twins. Namely, the blog about a couple who is pregnant with twins and are “pissed off” about it. Being me, I have a few things I want to say first.
Becoming pregnant and having a safe and healthy delivery and beautiful baby afterwards.
Those are the goals when you are up against infertility issues.
A lot of us go through a period of wishing, hoping, and even praying for twins.
You have your baby. And your baby has its sibling.
And so you’re done.
Some of us stay in that phase and are thrilled when that is what comes to pass. Two babies at the same time. Twins.
Many of us move on to feeling that one at a time, or simply one is a safer, healthier, even saner choice.
IVF and Twins: Elective Single Embryo Transfer (ESET)
Certainly the infertility field and most board-certified reproductive endocrinologists and fertility programs are moving away from multiples with elective single embryo transfer (ESET). There are many reasons why conceiving, carrying and delivering a single baby is preferable to multiples.
Main reason: it’s safer for baby and mom. The outcome is more predictable with just one at a time.
Really. We all know this.
Thank goodness so many twins and multiples are born healthy and strong and vital. And that so many moms make it through just fine as well. That’s a huge comfort for any of us carrying more than one. Good prenatal care, eating properly, exercising moderately, sleeping and listening to your doctor’s advice carefully will help ensure a good outcome.
This is the longest preamble in history to talk about the blog on CNNHealth yesterday.
Title: “We’re Pissed” to be pregnant with twins.
Here’s a quote from the dad to be: "To say we're excited would be an exaggeration," the dad wrote on Babble.com in an anonymous post that recently started trending on social media. "More truthfully, we're pissed. And terrified, and angry, and guilty, and regretful."
I know this is not politically correct. I know that we’re all supposed to be happy and thrilled because there’s a healthy, on-going pregnancy and that infertility has been conquered. I know that those of us who are still not pregnant could feel really resentful and angry towards this couple for speaking out about their upset.
I want to send them a thank you note.
What I have learned about human nature is that we are not unique. Well, we are, of course. We are all individuals and have our own DNA and personalities. Of course we do.
We also have a lot more in common with every other human being on earth than we do with any other species.
That’s a lot to have in common.
And in my humble opinion, there are folks out there that are relieved that this couple opened their mouths and said what they were not comfortable saying. Because it’s not politically correct or okay. And they said it anyway. They have voiced what some of us may have felt when we found out that there was more than one gestation.
That they’re scared. And upset. And maybe they would have preferred childfree to two at one time.
I thank them because if it relieves guilt and shame for other people pregnant with more than one, then that’s a good deed.
Pregnancy Emotions and Honest Admissions
Admitting to mixed or even negative feelings is not easy to do. But it’s honest. And it’s not a predictor, by the way, about how they will do as parents. Feelings aren’t reality. Feelings can pass. They can change and shift, especially with the help of a mental health professional.
Many of us are thrilled to become pregnant with multiples.
But not all of us.
And for those of us who are not, I applaud this couple for speaking so frankly about what others may not want to say. It can relieve the shame and guilt of these feelings.
So please, let’s not judge them. They’re not asking you to feel differently. And they are entitled to how they feel and to say it out loud. I know it’s hard to hear. Still, they have the right to say it.
More tomorrow on how to make choices and avoid situations that truly are not right for you.
Lisa Rosenthal's Google+
Navigating the Fertility Treatment Path
Fertility treatment is often a process that changes midstream. Often, fertility treatment is compared to a roller coaster or a stream that meanders down, lazily moving around rocks in the way. Or a road with detours. Or a path with many bends. There are many metaphors out there that fit. Simply put, it all just doesn't always go as expected. And that's not simple at all.
In over 25 years of being a patient and educator, I rarely hear someone say that infertility feels like the path that they were meant to be on. In the larger picture, it's not a path we would embrace or even choose. In the day to day of fertility treatment, delays and changes are equally unwelcome. Even when necessary, we feel disappointment and frustration when treatment changes direction, especially abruptly.
When a cycle gets cancelled, it can feel devestatingly disappointing. It does not feel like a postponement, it feels like a pregnancy will never happen. It feels, deep inside, in our cells, that this is the sign that a baby will never come. Or a healthy, growing pregnancy will occur instead of a loss.
It's hard, even almost impossible to put it into perspective.
The only news in fertility treatment that is welcome is good news. Very good news. That everything is going perfectly. That everything is on schedule, that our clinical response is just what our doctors want to see.
Even that is not always reassuring when we have had "perfect" cycles before that have been unsuccessful.
What to do?
The cycle, embryo, fertility treatment plan will not always go perfectly and still we get pregnant. Sometimes, in a cycle, almost nothing goes well and we get pregnant.
IVF Cycle Journeys
Just last month, I spoke with a friend who was in her fifth round of IVF who wanted to go out and drown her sorrows with a margerita or four. Because she was sure that her cycle hadn't worked.
Her pregnancy test was the next day. I encouraged her to wait until the following evening as the pregnancy test could be positive. After so long in treatment, she knew it wasn't.
I assured her that she could not actually know that.
She told me all the symptoms and reasons why this was so. Everything she felt and didn't feel physically. How the cycle itself had gone badly.
Still, she decided she could wait one more night for a fabulous drink.
And yes, she was pregnant.
And yes, just this past week, she heard a heartbeat.
When she least expected it.
When it shouldn't, couldn't have happened.
The delays and starts and stops are heartbreaking.
They may be those detours on your way to parenthood.
I wish they weren't there. I wish this was a smoother trip for you.
My bigger hope and dream is that baby in your arms.
And I'll keep you company while you travel this path.
Lisa Rosenthal's Google+