Sunday, December 25, 2005

Missing work for IVF

One of the more mundane but potentially troublesome issues for working people undergoing IVF is the need to take time off work for doctor visits. A recent article in the Lexington Herald-Leader interviews several people who discuss how they dealt with the issue. It can be quite sensitive since many couples prefer to keep it private. But when the time comes to miss siginificant amounts of work, especially when it may coincide with critical work deadlines, the issue may need to be discussed with superiors.

The greatest schedule demands are on the woman, of course, but husbands must be present at the critical time for sperm donation. And couples may also wish to visit the fertility clinic together for each examination. So the men may also be faced with missing work and have to deal with the issue of how to clear the absences with their boss.

Those interviewed in the articled used several different approaches. Some were direct about it with their superiors. Others were more discreet and just said they were having some medical issues. Although there is no single approach that works for everyone, everyone needs to consider this issue as they enter IVF treatment.

IVF as television drama

Perhaps it is a sign of the times and the growing trend in assisted reproductive technology (ART) when a television drama is based around the lives of fertility clinic staff. The show is (was) Inconceivable and was in the Friday 10:00 p.m. slot on NBC until it was pulled in October. Only two episodes aired and apparently it didn't draw the ratings necessary to keep it in the lineup.

With one in seven couples undergoing ART therapy and annual revenue around $1 billion in the U.S. the subject of infertility and IVF is not new to many. And well-known actress Angie Harmon played a leading role in the show. Still, it seems it wasn't a big enough draw to keep the series alive.

Tuesday, December 20, 2005

Similar results from implantation of one and two embryos

Although implantation of multiple embryos (usually two or three) is common practice in IVF therapy, two studies published in the December issue of Fertility and Sterility show that similar results are obtained for implantation of a single embryo as for two embryos. The conventional thinking has been that implantation of more than one embryo increases the chances for a successful pregnancy. One study showed that in 200 IVF cycles the live birth rate for single and double embryo implantations was virtually the same. Only the rate of twins born was different. Another study done in Australia reported similar results.

There continues to be increased attention paid to the issue of the higher rate of multiple births and associated risks and costs in IVF versus natural conception. Many IVF clinics are hoping to move to single embryo implantation as standard practice in the future.

Tuesday, December 13, 2005

New Zealand goverment to pay for PGD

The government of New Zealand has announced that it will begin paying the cost of IVF with PGD for couples with a high risk of having children with serious genetic disorders. They estimate the cost at $12,000 New Zealand and expect about 40 couples per year would qualify for the assistance. Approximately 150 IVF/PGD cycles are currently performed each year in the country and now 40 of them will be paid for by the government. New Zealand laws prohibit the use of PGD for selection of the sex of embryos for implantation, although this practice is not prohibited in many other countries.

Sunday, December 11, 2005

Delaying freezing your ovaries

Many women have chosen to delay getting pregnant and starting a family in favor of focusing on career in their younger years. In the back of their minds is the idea that if they have trouble getting pregnant later they can always resort to in vitro fertilization. But IVF is not a magic bullet; it is very costly, has only a moderate probability of success, and can be quite physically and emotionally distressing.

There may be a new option on the horizon for those ladies who want ensure they have the option of child bearing in later years - freezing their ovaries. Ovarian tissue freezing, which usually involves removing an ovary and freezing it for later reimplantation, may soon be the method of choice to preserve women's fertility. It has several advantages over other methods, such as mature egg freezing, because it does not require hormonal treatment, is a low-risk outpatient procedure, and could also act as a means of hormonal replacement.

The American Society of Reproductive Medicine believes this rapidly evolving procedure holds great promise, but it is currently only being applied to women who must undergo cancer therapy and fear losing the ability to get pregnant following the treatment.

Friday, December 09, 2005

Obese women to be denied IVF treatment

Scotland is about to establish guidelines that will deny obese women access to IVF treatment, according to a story in the Sunday Times - Scotland. The recommendation follows studies that show Scotland has one of the lowest success rates for IVF in Europe with a life birth rate of only 2%. Furthermore, inducing pregnancy in severely overweight women represents a health hazard for both mother and child.

The limit being considered is a body mass index (BMI) of 36 - above that and IVF may be denied. A BMI of 30 or more indicates a person is obese and a BMI of 40 or more morbidly obese. The likely hood of serious medical complications during pregnancy increases dramatically for highly obese women.

Sunday, December 04, 2005

ART procedures on the rise worldwide

A study released in October 2005 by members of the International Committee for Monitoring Assisted Reproductive Technology (ICMART) shows that the use of ART is increasing worldwide. The study results are based on surveys completed by more than 1,400 clinics in nearly 50 countries and compared ART procedures for the year 2000 to those in 1998. The numbers showed a 10% increase in the number of aggregate procedures, with the only procedure showing a decrease being GIFT.

This stands in sharp contrast to another study that shows IVF procedures are decreasing in the United States. With costs as high as they are in the U.S. and the lack of insurance coverage for IVF in most states, it is logical that the U.S. would be lagging while countries where insurance coverage is available (many European countries) or much less expensive (Asia).

However, this study is based on data collected for the year 2000, almost six years ago. We wonder why it was only released now. It would be useful to see some more up-to-date numbers. Perhaps the ICMART can be a little more timely with its next study release.

Saturday, December 03, 2005

Three common IVF protocols

A brief desrciption of three protocols commonly used in IVF:
  • stop protocol: involves the use of Lupron (leuprolide acetate), a GnRH agonist given during the mid-luteal phase of the patient's cycle, which occurs about a week before menstruation, until the beginning of menstruation. This is followed by the use of gonadotropins (hormone drugs) from day 2 of the cycle until a drug known as human chorionic gonadotropin (hCG) is given to induce ovulation.

  • microdose flare protocol: involves the use of oral contraceptives started during the previous menstrual period, followed by twice-daily doses of a GnRH agonist, then gonadotropin doses on day 2 of the stimulation cycle until the day hCG is administered.

  • regular dose flare protocol: includes the use of gonadotropins given in combination with a GnRH agonist from cycle day 2 until hCG is given.

Limited studies seem to indicate that the microdose flare protocol may have a significantly higher success rate in women with poor response to ovarian stimulation hormones, this according to a study by the Center for Reproductive Health at the University of Cincinnati Medical Center, published in the November issue of the Journal of Fertility and Sterility.