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 For goodness sakes, it’s just a little outdated, no?)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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IVF Cost - Lies About Infertility Treatment?
I’m going to push back a little. It may turn out that I will be pushing back a lot. I’ve been reading a lot lately about the lies about fertility treatment, specifically IVF cost and money. And hope.
Latest article in Elle online: "$47,000 Dollars Later, I Have No Baby: The IVF Scam," by Ali Margo. Ali is very specific with who and what deceived her. Maybe it’s because it’s the scientific protocol that RMACT uses that raised my hackles. After all, I wrote last week about "The Big Lie," (See my blog about the book The Big Lie, Motherhood, Feminism and the Reality of the Biological Clock) and I supported what the author said. In some ways.
I feel a little like something is being discovered that was discovered a long time ago. That old joke about Columbus “discovering” America, when the Indians (as they prefer to be called in Arizona) were already living here. What did we really discover?
This isn’t making much sense yet. Here’s what I’m trying to say.
$47,000 is a boatload of money to spend on a product that you don’t get. If I were paying for a car or a boat, I’d expect to pay my money and have my product.
Fertility Treatment Is a Service
Fertility treatment is not actually a product; it’s more akin to a service or even a series of services. Without a doubt, the hope is that the services result in a product; a baby (a successful pregnancy). Still, there is no one out there, that I know of, that guarantees the product; a baby.
Doesn’t this all sound a lot like a business? Yes, sigh, unfortunately. I won’t go into whether other medical fields/treatments are also businesses; I’ll save that for another day.
Here’s something to consider though. We are buying services with fertility treatment. We are buying treatment. Not a guarantee about successful pregnancies resulting in babies. Not buying the end product. And just to be crystal clear, I agree with all the conversations whirling around that we do not talk enough about the patient who leaves treatment unsuccessfully; without their baby. I rarely, if ever, bold a statement in a blog. Maybe twice in over four years of writing five days a week. So if there’s only one take-away message from today’s blog, please let it be that I agree whole heartedly with the message in this blog and so much else that is being discussed in the infertility world; we do not talk enough about patients that leave treatment unfulfilled.
Pregnancy Rates - Clarity About IVF Scams
What I feel like pushing back about is this: when we are told about treatment, we hear numbers. Percentages. We are told that there is a 20%, 30%, 40%, 50% or any other number per cent chance that we could achieve a sucessful pregnancy. That leaves us to understand that directly opposite are the chances of not becoming pregnant. A 70% chance, 60% chance, 50% chance, all the way down to a 20% chance of not becoming pregnant, if you are lucky.
I know we don’t all get that. And that sometimes, in some clinics, we don’t even get told that. (Shame, shame, shame on fertility practices that don’t tell the truth about the chances and non-chances of pregnancy.) But please, please, please. Let’s not pretend that the information isn’t out there. These authors have not discovered something brand new. They really haven’t. If you’re at a fertility program or with a physician (or naturopath or acupuncturist, or reiki master, or yoga instructor) who does not share the possibility that you will not become pregnant in treatment with them, then they are not being honest or candid with you. Shame on them, absolutely.
But please. And I am using the word “but” here very deliberately, knowing that it negates what comes before it. I’m also saying please, trying to be polite. Another truth is that information abounds. It is so abundant. There is a book at least once a year about how fertility treatment doesn’t work. There are articles, blogs, message boards, and more, that speak to the fact that fertility treatment is very expensive and that it often doesn’t work. If you are going into fertility treatment, it is near to impossible to not hear the rampant conversations that go on about fertility treatment, success rates and cost.
In the most respectful way possible, how far does one need to stick one’s head in the sand to NOT know that fertility treatment doesn’t always work? And that you still need to pay for services?
Here’s a quote from Ali Margo’s blog, “The odds for women over 42 are so low some clinics won’t even offer IVF to women of that age—so why would anyone in their right mind even consider it?” Good question. Isn’t that responsible of those clinics? However there are many fertility programs that do offer IVF to 42 year old women, because even with the odds against them, women do get pregnant and that’s also their choice. I would like to add that with CCS, (Comprehensive Chromosomal Screening), which RMACT offers, the chances of pregnancy are as high as 70%. For the most recent pregnancy rates from RMACT, visit SART (Society for Assisted Reproductive Technology) and click here.
We come down to hope. I love what Ms. Margo had to say about that, “But what they don't realize is that not only did we run out of money, we ran out of something far more important—hope.” Even there, though, it has been my experience for the last two-and-a-half decades that hope is a renewable resource. Sometimes, often, much more so than money, hope replenishes itself. I see and experience over and over again, in the trenches with women trying to become pregnant, that hope bottoms out, only to fill again. And again and again.
I wish that Ms. Margo had been treated more gently and lovingly at the fertility practice that she was using. She deserved a phone call or more; she deserved compassionate attention. We all deserve that when news is as catastrophic as the news that she got was; 20 embryos, none of which survived. My heart goes out to her, having to leave treatment without her hoped for baby. It hurts that not everyone leaves with a baby. It really, really hurts; deep down inside in places that you feel will never stop aching.
I admire, support and will continue in these conversations because it brings me back to another point that I want men and women to hear about this. One that I consider crucial and shows us the way to survive. We need to leave as intact human beings. We may not get what we are hoping for or what we think we paid for; still, we need to leave being able to recognize ourselves in the mirror. And if that is not possible, then we need to leave with the tools to create a meaningful and loving life for ourselves.
With or without a baby.
Read the Elle article I reference: "$47,000 Dollars Later, I Have No Baby: The IVF Scam"
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Why one baby at a time?
Some very simple basic reasons.
Why am I talking about this?
Because once again, I spoke to a patient who was hoping for twins. One boy, one girl. Done.
I get it.
Never have to go through fertility treatment again?
I get it.
We all get it, actually.
Your doctors, your nurses, your medical staff, they get it too.
But we also get how much more challenging a pregnancy is with more than one baby.
We want you to have the healthiest possible outcome.
We all see multiple pregnancies that are healthy and uncomplicated.
We also see babies that have serious health problems and mothers that are on bedrest for months at a time, often with their own health problems.
We try to avoid this. We are encouraged to avoid this. Both SART (Society for Assisted Reproductive Technologies) and ASRM (American Society for Reproductive Medicine), the two professional organizations dedicated to reproductive medicine, ask us too. Tell us to, actually.
There are guidelines that infertility programs in the United States are supposed to follow. the guidelines dictate how many embryos are transferred in an IVF cycle. The amount of embryos depend mainly on diagnosis and age of mother.
Most infertility programs follow these guideline. Check. Ask. If your program does not follow these guidelines, you may want to consider a different program.
Yes, we do get it. Creating a family via fertility treatment is very challenging and stressful. Not to mention time consuming and financially difficult.
Having the chance to do it all at once is tempting. Very, very tempting.
We want to support you having as healthy a family as possible.
That's our job.
We don't all get pregnant the first month we are trying to conceive. Often we don't get pregnant the second month either, despite many reports of honeymoon babies.
If, however, you have not gotten pregnant after twelve months, usually there's a problem.
If you are over 35, we advise you to see a fertility specialist (Board Certified Reproductive Endocrinologist) after six months.
Here's the assumption that you do NOT have to make.
Do not assume that you will have to spend tens of thousands of dollars or have invasive surgeries.
Many problems in our reproductive system need a simple adjustment with either timing or medication. There are protocols and procedures that can easily tilt fertility in your favor.
In fact, some of the diagnostic tests are also theraupetic. The HSG (Hysterosalpinogram) is one of those tests:
Hysterosalpingography, or HSG for short, is an X-ray procedure used to evaluate the status of a woman’s fallopian tubes, the two structures that carry eggs from the ovaries to the uterus. It is also used to make sure that the uterine cavity has a normal shape and size and to identify uterine malformations, adhesions, polyps or fibroids. These types of problems may cause painful menstrual periods or repeated miscarriages.
Because the HSG uses a dye that moves through the fallopian tubes, often small blockages are cleared out and a pregnancy will occur.
We know that it can be difficult to decide to see a fertility specialist. We know that you don't really want to be in our office. We know that you would have preferred to have gotten pregnant by being intimate with your partner.
Just also know that your path to fertility might be much shorter and simpler than stories you may have heard or read about.
One way to find out.
If you haven't gotten pregnant or been able to carry a pregnancy to term, find a fertility specialist in your area.
The Society for Assisted Reproductive Medicine (SART) is a great source to find one. All of the physicians in the field of reproductive medicine who report their findings are listed here, as well as other pertinent information about the infertility clinics.
Please feel free to ask questions here. They come to me personally and I will answer you, either on the blog, or privately.
You do not have to do this alone. I'm here to help.
Let's talk about pregnancy rates.
You probably have all heard those stories that start out with, "when I was your age, I had to walk three miles to school in the snow, chop wood for the fire and walk the same three miles back home".
Well, when I was trying to conceive, pregnancy rates were hovering about nineteen per cent. Yes, nineteen per cent. Actually, they were a bit higher for me as I was 26 years old, with unexplained infertility. So maybe my chances of getting pregnant were about twenty three per cent.
How things have changed. While some things have remained very much the same, pregnancy rates have most decidedly not. They have gone up, up and up.
More good news.
Fertility treatment cycles do work the first time. Perhaps not often enough, but more often than any of us realize. At RMACT, our pregnancy rates are something that we are very proud of and that you can check on our website.
Even more good news. You can check this type of information on the SART website.
So, for my friends out there who have been in fertility treatment for longer than they'd like to be and are starting to lose hope, please hang in there. I know it's discouraging to hear bad news, to have cycles that don't work, to see everyone around you become parents.
The best news is that fertility treatment does work. A lot of the time, even the first time.
It's not an easy journey, I know that too, but, as often said here, you are not alone. I'll be glad to keep you company.
The American Society for Reproductive Medicine (ASRM) is having their annual meeting in Denver Colorado this week. The meeting brings together the finest reproductive endocrinologists, scientists, clinicians, administrators, attorneys, nurses and more, in the reproductive health field. ASRM’s annual meeting is an opportunity for the professionals in the reproductive health field to take post-doctorate courses, continuing medical education courses, (CME’s), present oral presentations, papers, posters, and videos for just some of the following topics:
A sample of the topics to be covered includes: steroid hormone action, stem cell research, technological advances in reproductive surgery including robotics and adhesion prevention, effects of appetite and diet on reproduction, gender-specific aspects of cardiovascular disease and impact of infertility diagnoses and therapies, the ethics of cross-border reproductive healthcare, molecular genetics of male and female gametes and the early embryo, medical and public health ramifications of menopause, new innovations in contraception, ovarian stimulation, oocyte and sperm cryopreservation, and integration of medical and psychological care of the couple undergoing reproductive medical care.
Reading the press releases is a way that I have always found useful to sift through the tremendous amount of information that is both presented at the meeting and released to us, the public. The first press release that I will share with you this week is on a subject that we have been addressing closer to home at Reproductive Medicine Associates of CT with our nutritionist and our Fertility Seminar Series. That subject is obesity and infertility. Read below for ASRM’s press release:
Denver, CO - Two studies released today at the 66th Annual Meeting of the American Society for Reproductive Medicine, shed light on the link between obesity and infertility.
In the first, investigators used the national database collected by the Society for Assisted Reproductive Technology (SART). Examining the 158, 385 cycles where the height and weight of the woman were reported, they found that cycle cancellation rates increased with increasing body mass index (BMI). The odds of the patient failing to become pregnant, or that pregnancy not being successfully carried to term, also rose significantly with increasing obesity.
A team from Harvard and Brigham and Women’s Hospital in Boston sought to explore the reason behind the link between infertility and obesity. In their study they examined the quality of the eggs and embryos from women of different BMI categories. They found that the eggs from women with high and low BMI’s were more likely than other women to produce immature oocytes during an ART cycle. This led to lower odds of successful embryo transfer per retrieval and a lower live birth rate.
“Clearly a healthy body weight is an important advantage in all aspects of health, including reproductive health. We are hoping that with better information we can provide better help to our patients whose struggle with infertility includes a struggle with weight,” said James Goldfarb, MD, President of the Society for Assisted Reproductive Technology (SART).
More to come this week from the ASRM annual meeting. The information that comes out of this annual meeting, whether it is medical breakthroughs, research, scientific data, legal updates, a clearer understanding of the emotional components is always outstanding and sometimes startling. There will be updates on this blog throughout the week.
How to Choose a Top Fertility Doctor
How to pick a top fertility doctor
; course 101. You can get recommendations from everywhere, some places much more reputable, reliable and dependable than others. Doctors are pretty savvy these days. You will see advertisements on billboards, in the yellow pages, magazines, newspapers, all over the internet, on television. You will hear advertisements on the radio as well. In some ways, you can barely escape the marketing that swirls around. Here, there are three ways that are reliable, can work together and that are safer than picking a doctor from the yellow pages.
3 Tips for Choosing Top Fertility Doctors
1) Ask your primary physician for a direct referral.
Hopefully, you are talking to either your primary physician or Obstetrician/Gynecologist (OB/Gyn) if you are trying to conceive. Your OB/Gyn will generally know the specialists (reproductive endocrinologists) in the area, either through the hospitals where they attend meetings together, or from residency programs or even just from practicing medicine in the same area for a period of time. They will also hear things that perhaps a lay person would not; how well regarded the specialist is in the medical field. While your OB/Gyn may not share all the information that they have with you, rest assured it is part of why he/she is referring you to a specific physician. Sometimes your doctor will send you to the closest doctor in the area, sometimes they will send you to a doctor who they feel might be a better temperament for your personality. If you want to know why they are referring you to a specific doctor, ask them. Some OB/Gyn's are aware of pregnancy rates from a particular reproductive endocrinologists program or specific procedures that they feel you may need.
2) Learn more about a reproductive endocrinologist that you are considering seeing by visiting SART and CDC websites.
Both of these organizations give you specific data that is controlled and proven to be true. Neither website accepts advertising and the information that they release is not based simply on what a clinic says but on particular data that they check. The SART and CDC reports have become easier to read over the years and it is simple to compare two clinics in a close geographical area.
Careful about deciding on a reproductive endocrinologist simply on the pregnancy rate though, for a few reasons. One, the SART report is typically two years behind. Right now, they are reporting on 2008, so information is not up to date. Second, this is the disclaimer that SART puts at the bottom of each clinic summary, "Caution: Patient characteristics vary among programs; therefore, these data should not be used for comparing clinics." Of course, that's in the small type, running alone the bottom, barely noticeable. The treatment type on the summary clinic is IVF (in vitro fertilization) only; nothing is mentioned about other types of infertility treatment, such as IUI (intrauterine insemination). It's good to understand what "patient characteristics" mean though. Some clinics will routinely not treat patients with an FSH (follicle stimulating hormone) level above a certain number. Some clinics will not accept patients into their programs who have been unsuccessful for a certain amount of IVF cycles at another clinic. Maternal age (how old the woman is) also factors into a clinics decision about treatment. Third reason to avoid choosing a clinic solely on pregnancy rates is the still somewhat confusing information listed by SART. As they don't subdivide by diagnosis, simply choosing your age group does not give you an accurate idea of your individual chances of pregnancy.
Absolutely the SART report (I was not able to find a report more recent than 2006 on the CDC website so I am not going to discuss it here) has valuable information and is a good way to compare clinics for certain things. An invaluable and reliable resource, definitely.
3) Look at a prospective fertility doctor's website.
You'll find information about whether that doctor would be a good fit for you. What do they choose to say about themselves? Using what language? What treatment options do they offer?
What types of support programs are available? Do they have mental health professionals on staff? How much information do they actually disclose in terms of their credentials, certifications, degrees? Do they have educational materials on their website? One simple way to ascertain the level of training and proficiency is to check whether a doctor is a board certified reproductive endocrinologist.
A physician referral, the SART report, and what the doctors say about themselves are three methods to choosing a doctor. They are not exclusive of each other. When I choose a doctor, I use all three. I ask for a referral from a doctor that I already trust and respect, then I go see what else I can find out about them through medical organizations and their websites.
Coming into a consultation with a doctor that you all ready trust because of the research that you have done can bring a level of comfort that would not be there otherwise. That comfort can go a long way when you are worried about trying to conceive.
Take some of the worry out of the picture by choosing a doctor in a way that feels safe and comfortable for you. Please share other ways that have worked well for you, perhaps it will help someone else.
How do you know when you are looking at a website to get accurate, reliable, well documented infertility
and egg donation information, that this is what is being delivered? It takes a while of going through the website, starting with "about us
". "About us" is the first place I look when I visit any new website. I want to know if there is an agenda on the part of the author and I want to know what it is. I have learned the hard way that disclosure is not always all that apparent and a website may not always be what it seems. Here are a few websites that I trust and often start with when researching infertility issues. I went looking to see what information there was out there, specifically regarding financial compensation for egg donation (oocyte donation). I am in no way suggesting that these are the only websites that can be trusted, however they are the two largest organizations of reproductive endocrinologists in the United States.
One of the first places to take a look is at the American Society of Reproductive Medicine, (ASRM) website. This is what ASRM says about itself under the tab, "about us": http://www.asrm.org/mission.html
The Vision of the American Society for Reproductive Medicine (ASRM) is to be the nationally and internationally recognized leader for multidisciplinary information, education, advocacy and standards in the field of reproductive medicine. The ASRM is a non-profit organization whose members must demonstrate the high ethical principles of the medical profession, evince an interest in infertility, reproductive medicine and biology, and adhere to the objectives of the Society.
If you have never looked at ASRM's website, now might be a good time. ASRM Ethics Committee Report on the Financial Compensation of Oocyte Donors is well written, thoughtful and has the brain power of many well respected leaders in the field of reproductive endocrinology. ASRM also has a series of well written, well researched patient fact sheets that are worth taking a look at.
Another area of the ASRM website that I have found helpful is the index of professional groups of ASRM. There is a wealth of knowledge there and I find that the more I look, the more I find . A new find for me has been the mental health professional group's book reviews for patients. Love the reviews, they are thoughtful and professional, great combination.
A second website that you can take a look at, that is the Society of Assisted Reproductive Technology (SART) has this to say about itself:
SART is the primary organization of professionals dedicated to the practice of assisted reproductive technologies (ART) in the United States. ART includes the practice of In Vitro Fertilization (IVF). The mission of our organization is to set and help maintain the standards for ART in an effort to better serve our members and our patients.
One of the most important functions of our site is to help patients locate and contact infertility clinics and view national and individual clinic IVF success rates.
While SART doesn't speak specifically to financial compensation for egg donors, it has a good general section with an overview regarding donor oocyte. SART also is the most reliable, up to date place to get information about an infertility program or clinic. SART collects data, having worked closely with the Centers of Disease Control (CDC) in the past and then reports on the data which is available for patients to see. A good overview of what SART's purpose is available and easily read. And having said that the SART reports on infertility programs are easy to read, I will now backtrack. They are easy to read, slightly harder to understand. When you compare fertility clinics, make sure you are comparing apples to apples, so to speak. The SART reports are a good place to get a very general idea of a infertility program, not the way to make a decision about a program. The reason being that there are lots of variables that the SART reports do not take into consideration when doing the reporting. More in the next few weeks concerning how to read the SART report in a way that will be most helpful to you.
Take a look at the websites, if you have any questions, any of the RMACT doctors will be glad to answer. So, ask away!