Sunday, August 28, 2011

Being overweight is also about fatty ovaries

There is a new study out that says that being overweight isn't just bad for your health, and doesn't just make it harder to get pregnant. It also has a negative effect on embryo development.

Professor Jo Leroy from University of Antwerp says that, “We know from our previous research that high levels of fatty acids can affect the development of eggs in the ovary, but now we have shown a negative impact on the surviving embryo."

The extra fat is a double whammy if you are trying to get pregnant. It reduces the odds of egg fertilization in the first place, and even if an egg is fertilized the pregnancy may not go full term due to irregularities in embryo development again due to the extra fat.

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Wednesday, May 18, 2011

UCSD online IVF cost calculator

The UCSD Fertility Center announced the availability of their online IVF cost calculator yesterday. The press release speaks to the common problem of fertility patients being surprised by the true cost of IVF treatment. Often only the nominal cycle cost is mentioned but there are also precycle evaluation costs and many times addons to the nominal cycle that also add cost.

The IVF calculator can be found at this link. It looks like they did a good job with it. It is easy to use and it leads you through a number of optional choices that you may have not considered. If some of them are unfamiliar to you then you can do some research to determine if an additional procedure is likely and then come back to select whether you not to include it in the cost estimate.

I ran what might be considered a typical case and the IVF calculator estimated costs of $1,500 for medication, $2,070 for precycle evaluation, and $9,810 for the cycle. Costs are broken down well so you see the major items. On this blog I am focused on comparing IVF costs domestically with what is available overseas for those readers who might be considering the niche of medical tourism now being called fertility tourism. So I compared the cost breakdown from the calculator to ivf costs published in the patient handbook from Jetanin Hospital in Bangkok. Now, I must say that those costs are several years old and I know they have increased if for no other reason than the steep decline in the strength of the U.S. dollar against the Thai baht. But there were a couple of items that stood out.

Medication cost from the UCSD IVF calculator was estimated at $1,500 which is quite a bit less than the $2,500 to $4,500 that Jetanin estimated. That one has me wondering because the medication cost is primarily the expensive hormonal medications that everybody buys from the same providers. So what has happened? Perhaps cost of the drugs has decreased in recent years? Or is Jetanin assuming more than one cycle? That might be it. I really don't know but if we take the calculator number and Jetanin number as is then that swings the cost advantage toward domestic IVF fairly strongly, at least until we consider the other costs.

Looking at precycle and cycle costs we see that semen analysis is $125 (U.S.) versus $30 (Thailand), semen culture $135 versus $50, basic cycle is $8600 versus $1250, blastocyst transfer is $630 versus $350. One thing not itemized in the Jetanin cost is anesthesia so maybe that should be added. But even if we add the full U.S. anesthesia cost of $580 to the basic cycle the cycle cost is still $9810 in the U.S. versus $2180 at Jetanin.

So if one were to take a guess about how much costs have risen in Thailand and how IVF treatment here today would compare to that in the U.S. I think they would come to the same conclusion as in the past, that it is about one-third the cost. At over $13,000 for pre-cycle plus one cycle in the U.S. you are probably looking at saving around $8,000 to start with and about $6,000 on every cycle after that. That more than pays for your transportation and hotel costs if you are coming from another country.

Of course, you would need to do an updated comparison of costs no matter where you were considering getting IVF treatment. But this IVF calculator from UCSD does look like a good tool.


Friday, March 18, 2011

News story about Bangkok baby farm

I think the news broke a couple of weeks ago about a surrogacy company located in Bangkok that was raided for some reason that isn't entirely clear. There were vague suggestions of human trafficking or some other possibly illegal activity surrounding it. It was not clear to me what the issue was that prompted the raid. Surrogacy is not uncommon in Thailand. We even looked into it ourselves when we were exploring all the possibilities in case we needed them. Our lawyer said it is kind of complicated but definitely not illegal. So what was raid all about?

Well, today I read a story titled "Underworld: upending an Asian baby farm". It repeated much of the previous news that left me wondering what is the issue. The story is basically that there is a company called "Baby 101" that offered surrogacy services online. They have a large house in Bangkok where they house a group of Vietnamese women who are surrogate mothers. According to the story they are there voluntarily, although there was some mention that a couple of them were mislead about what they would be doing when they came to Bangkok - a distinct lack of details on that angle. And the business owners were acting like their "keepers" by controlling their schedules and movements, something that was advertised on their site to ensure prospective customers that the surrogates were eating right and staying healthy during their pregnancy. So...sounds like not a lot of scary human trafficking or slavery type stuff going on, as in none.

The only thing that may have actually been an issue is that surrogacy for profit is illegal some places. Perhaps it is illegal in Thailand; maybe that is what our lawyer meant when he said it was a little complicated. If that's the case then you can see how if we were to help take care of the surrogate mother during the pregnancy we would have to carefully avoid having it look like she was doing it for profit. Since Baby 101 was openly running a surrogacy business for profit and if that is illegal in Thailand then yes, there would be an issue.

Thailand's health minister, Jurin Laksanawisit, made the statement that "By law, we’ll only charge the cross-border human trafficking agency and the hospitals if they did the artificial insemination illegally." Uh, why is he calling it a human trafficking agency? And the only potentially illegal activity is doing the artificial insemination "illegally". What exactly does that mean?

This followup story leaves just as many questions in my mind. And on top of it we have a writer giving a ridiculous title to the story "Underworld: upending an Asian baby farm". Underworld? Oh really. The company was operating out in the open with a website and contact information publicly available.


Wednesday, November 17, 2010

Fertility is not a disease

I had a small chuckle at a post by someone who was pointing out another very annoying feature of the new health care bill. She said
Among the new health care law's many flaws is its apparent inclusion of free contraceptives for women. This is subsidized (not free) treatment for what is not a disease -- fertility.

Haha. Yes, that is the kind of thinking that got us where we are today, which is the misuse of insurance.

Insurance is meant to offer protection from unexpected major events, not for routine or expected events. So I have to agree with this person's criticism of this benefit in the bill. Now the question is, does the bill offer benefits for fertility treatment such as IVF? If should not, of course, because that is a lifestyle choice not an unexpected sickness or disease that would be the type of thing insurance should cover. But since we are piling on stuff that should not be there then why not.

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Monday, November 15, 2010

Male infertility and laptops - a study

Some time ago I posted about some debate over laptop computers and the possibility that men using them on their laps could suffer sperm damage. There is a new study published in the journal called Fertility and Sterility with some numbers and recommendations for laptop users.

Researchers at the Department of Urology and the Department of Applied Mathematics at the State University of New York identified the potential for rapid hyperthermia (over-heating) among male laptop users. They said that even when laptop "cool pads" were used there was still substantial heating of the scrotal area. They said that a relatively simple technique would help - sit with your knees apart.

Even when taking precautions like that gives only a temporary solution. Without knees spread temperatures in the important areas exceeded normal temperatures in only 10 to 15 minutes. With knees apart that doubled to 28 minutes. Still, one needs to limit the time using a laptop on one's lap.

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Thursday, October 14, 2010

Guilty verdict in sperm matchmaker case

It was a rather interesting case of the two men from the UK who were operating a rather specialized online matchmaking service. They paired up women and sperm donors. And it seems their operation was quite successful with the website generating over 250,000 pounds in about one year.

But the authorities claimed they were violating the law because they need a license to provide donor sperm. They argued that they were doing nothing more than providing a matchmaking service so their business was not subject to the regulations. A judge found otherwise and they were found guilty and ordered to pay a fine, do community service, but suspended the jail sentence.

The details of what actually happened seem a little fuzzy in the published reports. Perhaps they did cross the line and were acting as brokers for donor sperm rather than just putting women and donors together to work out the details themselves. But it sort of sounds like even the latter is not allowed under the law which requires that testing for diseases and verification that warning information has been received and understood. So what type of matchmaking site is next to take this kind of hit? Will dating sites be held liable for testing the health of their members?


Monday, August 09, 2010

BPA now implicated in male fertility

BPA is the chemical in many plastics that was previously implicated in infant health concerns, wasn't it? I remember there was some debate about the composition of some plastic baby bottles and possible side effects, and if I remember correctly it was BPA that was the concern.

Well now comes news of a study led by Professor John Meeker from the University of Michigan in conjunction with the Harvard School of Public Health. 190 men were recruited to the study through a fertility clinic and 90 per cent tested positive for BPA in their urine. And men with the highest levels of Bisphenol A (BPA) in their urine had a sperm count 23 per cent lower on average than those with the lowest BPA levels.

The study is kind of small and hasn't been repeated yet so maybe it is too soon to call this conclusive. Or maybe if you are a man having fertility issues this is another thing to add to a rather long list of cautions - avoid food and beverage packaged in hard plastic containers since they usually use BPA to achieve the hardening of the plastic.