IVF Info

Being overweight is also about fatty ovaries

2011-08-28T20:33:00.000-07:00

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.

UCSD online IVF cost calculator

2011-05-18T03:46:00.000-07:00

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.

News story about Bangkok baby farm

2011-03-18T05:47:00.000-07:00

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.

Fertility is not a disease

2010-11-17T06:32:00.000-08:00

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.

Male infertility and laptops - a study

2010-11-15T16:37:00.000-08:00

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.

Guilty verdict in sperm matchmaker case

2010-10-14T05:13:00.000-07:00

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?

BPA now implicated in male fertility

2010-08-09T05:02:00.000-07:00

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.

Unforseen circumstances for some IVF children

2010-08-03T05:08:00.000-07:00

This is another corner case for children born from IVF. It involves social security benefits paid to surviving children when a parent has died. In the old days, a child could not be conceived after their father had died, but these days it is happening more and more. A woman who has undergone IVF and had embryos frozen can have a child fathered by her already deceased husband. That's an unexpected issue to consider.

Typically, the wife is eligible for survivor benefits. But is the new child, born perhaps years after the husband died, also eligible? There are eleven states that explicitly allow recognition of a parent-child relationship that begins with posthumous conception, but in other states for the relationship to exist a parent must be alive at the time of conception.

There is a case being fought in the courts at the moment in which a woman gave birth two years after her husband died. She used frozen sperm from her now deceased husband to become pregnant. She initially received some benefits for her child but now the states social security administration has demanded she pay it back and she is challenging it. The case will be heard by the Utah supreme court.

If you consider the precise purpose of insurance you must conclude that no benefit is warranted. Insurance benefits, including the survivor benefits paid by social security, are for the purpose of mitigating unexpected and catastrophic events, such as the death of a parent after children are born. A child conceived after the father has already died is not such a case. However, the purpose of insurance has become so perverted in the U.S. that it is now considered a way to make the unaffordable affordable, as if the money magically comes from somewhere else. It is common thinking that health "insurance" should pay for checkups, common colds, and family planning, all things that are normal expected events.

The outcome of the Utah court case may be of some interest, depending on whether the purpose of insurance is observed, or if it is just another free-for-all give away, turning "insurance" into nothing more than a government subsidy. Of greater interest is to keep track of how different states apply the test of a parent-child relationship and planning for where you can game the system the most.

8 rounds and 100,000 pounds in IVF

2010-07-31T19:28:00.000-07:00

Quite a story of persistence, and perhaps just wanting something too much, but they eventually got it. A couple went through seven unsuccessful rounds of IVF and the doctors told her she would never have a baby. They nevertheless decided to go for one more round, bringing the total they spent on fertility treatments to 100,000 British pounds, and they ended up with a new baby.

Their advice to other couples having trouble conceiving was just don't give up. Of course, that might not be an option for those who don't have that kind of money to spend on assisted reproduction technology.

How young is too young for fertility treatment?

2010-07-26T06:23:00.000-07:00

Is two years old too young? Wait, what? Ok, this isn't your routine fertility treatment. This is what is called a fertility preservation procedure. A two year old girl needs to undergo chemotherapy and radiation treatments which will most likely render her sterile. So her parents have decided to give her a shot at having her own children should she make it to adulthood by having one of her ovaries removed and frozen.

The procedure has been performed quite a number of times, even on very young females. The youngest prior to this one was three years old. It isn't really known if an ovary can be frozen that long and then re-transplanted back into the girl once she has grown up. There have been successes in adult women but the freezing time has been much shorter than that anticipated for the very young patients.

Cute ad for sperm donors

2010-05-07T23:34:00.000-07:00

There has been a terrible shortage of sperm donors in Australia since a law was passed that allows children born of donor sperm to find out the donor's name. Given the absurd laws about claims on property and such, many men who were donors fled amid fears that decades in the future someone may show up at their door and claim to be their child and rightful heir to their property. No thanks many prospective donors rightfully said.

But there were some respondents to a recent ad for sperm donors by IVF Australia, Sydney's largest fertility clinic. Maybe because the ad was quite cute. Here is the graphic from it.

Study shows frozen embryos better than fresh

2010-02-20T06:03:00.000-08:00

Reuters reports on a study that shows that frozen embryos may be better than fresh for IVF. It was a Finnish study reported in the Journal of Human Reproduction. Here are the numbers.

They studied 2,300 children conceived with frozen embryos, more than 4,100 born after fresh embryos were used, and 32,000 pregnancies that did not require IVF or other fertility treatments. Overall, 258, or about one in 11, of the babies from the fresh embryo transfer group were born prematurely, compared to 120, or about one in 16, in the frozen embryo transfer group. Similar ratios applied to low birth rate.

The article gives a cost data point: The average cost of a fresh in vitro fertilization cycle in the U.S. is $12,400. Freezing embryos can reduce the cost of subsequent cycles to about a third of that.

Multicycle IVF insurance plan

2010-02-11T05:19:00.000-08:00

Older women have an increased likelihood of requiring multiple IVF cycles before achieving a pregnancy. That means the odds are pretty high that costs are going to be prohibitive. Now there's an insurance plan for those women.

The Reproductive Science Center of the Bay Area (RSC) announced they have launched a new program from IntegraMed geared toward easing the risk of infertility treatment for qualified women up to 49 years old. You purchase a plan that costs about the same as two complete cycles of IVF but the plan covers the costs of up to four cycles.

For this to work and RSC to be able to make a business of it they must have a very good idea that most women will require only one or two cycles so that premiums can cover the three and four cycle patients while still leaving some profit for RSC.

More details of plans from RSC are available at http://www.rscbayarea.com/financing-program-for-infertility-patients.

A gel to increase sperm motility?

2010-02-10T05:03:00.000-08:00

Perhaps this product has been around for a while and lots of couples are using it to try and conceive the natural way. But it's the first I have heard of it. It is called Conceive Plus gel and the claim is that it helps improve sperm motility.

At first that might seem like quite a claim but all they are really saying is that it is designed to mimic natural body fluids and give the best potential to the sperm. I'm not sure if that really qualifies for improvement of motility but it certainly is an improvement over other harsher artificial lubricants.

Background check before IVF

2009-09-03T23:48:00.000-07:00

There is a new law in Australia that requires couples seeking IVF treatment to first undergo police background checks. This to to ensure they are fit parents (!).

Well, this is more than just slightly amazing, and the vast majority of couples involved are incredibly offended. They question why they should be investigated while couples having babies naturally are not - what's the difference when it comes to being a fit parent?

From the source news story:

A report from the Victorian Law Reform Commission recommends people should be barred from IVF if they have convictions for serious sexual or violent offences, have had children taken from their care, or are assessed as a potential risk to children.

Choosing the gender of your baby

2009-08-22T05:22:00.000-07:00

Perhaps you are considering IVF not because of fertility issues but because you want to choose the gender of your baby. Although many professional organizations frown on this, even establish ethical codes against it in some places, there are many who still want to employ PGD for sex selection. It's a somewhat expensive procedure and added to the overall IVF procedure it might be out of reach for many patients.

Enter "natural sex selection" or "secrets for gender selection" or something similarly named. There are a lot of old wives tales about various positions/foods/incantations that supposedly lead to preference of one sex versus another. There are also clinical studies that show certain environmental factors such as heat, chemicals, etc that lead to an increase in female versus male offspring. Has anybody put this all in one place? Perhaps now they have, and then some.

Pick the Gender of Your Baby claims to have it all covered. Their (partial) list of factors is pretty extensive and includes:

Certain foods to eat and avoid
Timing your baby-making sex
PH levels
Male factors that include size and depth of penetration (really?!)
Love making position for a girl versus a boy

And a lot more. Ok, I don't know if this really works but it seems like all the ideas I have ever heard of are detailed in one place so it might be worth a look. And it's a lot cheaper than PGD. Pick up the ebook here.

Bangkok Hospital discounts IVF

2009-05-13T06:23:00.000-07:00

I'm a little late posting this news, but Bangkok Hospital announced in March they are offering oocyte pick up and in-vitro fertilization for the price of 80,000 baht, which is approximately US$2,300 at today's exchange rate. But you have to hurry because the special price is valid only until June 30, 2009. More information is available at the Bangkok Hospital website, although you may need to contact the hospital as I did not see this special mentioned on the site.

The debate about public assistance for IVF

2008-09-24T06:13:00.000-07:00

ABC News online has a short article about the jump in babies born in Australia through assisted reproduction. There has been a 40% increase in 2006 compared to 2002. That's moderately interesting. But the more interesting part is the debate in the comments section of that article. Much of it revolves around whether or not public funds should be used to pay for IVF treatments. If you step back and look at the overall picture it once again looks like those who support public assistance are the ones who have used it and would not have otherwise been able to get treatment, whereas those against it are taxpayers who don't and won't use it. There is always this split in opinion between those who say pay your own way and those who want the government (which means taxpayers) to pay. Which side do you come down on?

Another cell phone study re male fertility

2008-09-22T04:25:00.000-07:00

Another study has just been published that warns men about possible adverse effects of cell phones on their fertility. The online version of Journal of Fertility and Sterility reports that men who keep their cell phones in their pockets or clip them to their belts while in use may be compromising their sperm count. The study involved actually exposing sperm to a cell phone in talk mode for one hour. That does seem to be much more empirical than the anecdotal results that come from surveys. The researches reported that there was a 7% decrease in sperm motility and 11% decrease in viability after the exposure.

Stolen embryos

2008-09-22T04:11:00.000-07:00

There have been stories before about custody battles over frozen embryos but this is the first I've heard of the possible theft of embryos. It wasn't a burglary or armed robbery. This allegedly involved forgery by the former girlfriend of the donor male's signature in order to obtain frozen embryos so she could have them implanted. She became pregnant and had a son. The man only learned of it after the child was already 18 months old and the British Child Support Agency contacted him and demanded payments.

Source

3 year wait for donor sperm in Britain

2007-11-14T05:35:00.000-08:00

Another update on the donor sperm shortage in Britain. Dr David Farquharson, the clinical director, Women and Reproductive Services, at NHS Lothian, is telling couples seeking IVF with donor sperm that the wait could be up to three years. The crisis has been caused by new legislation which ended the donors' right to anonymity, enabling children born after IVF treatment to make contact with their biological parents. Since that legislation became effective the number of donors has almost completely disappeared. One enterprising couple did a donor recruitment drive, enlisting the help of a local TV station, which helped them move up the list faster. For most couples, however, they must simply wait it out and hope they get to the top of the list before they are too old to be eligible for treatment.

DHEA boosts egg production in older women?

2007-10-29T06:03:00.000-07:00

Yes, that's a question. I've long known of DHEA as a popular supplement for men as they get older to help keep hormone levels closer to what they were as young men. The wisdom of that is rather questionable unless there is some real medical need. But apparently some women who are undergoing IVF treatment have been self-medicating (without telling their doctors) with DHEA and had a surprising increase in number of eggs harvested. The Center for Human Reproduction in New York began exploring the effects of DHEA in 2004 when they learned that an older patient of theirs had been taking the drug without telling them. Other fertility specialists have been discussing this but no clinical trials have been performed. Doctors also advise that high doses of DHEA can have adverse side effects so you should consult your doctor about it.

Womb on a chip

2007-10-29T05:05:00.000-07:00

Researchers at the University of Tokyo are experimenting with a "womb-on-a-chip", an alternative to the petri dish for use in IVF. The hope is that this new approach will improve IVF results.

This artificial high tech "womb" is comprised of a silicon chip on which a bed of uterus cell have been cultured. An egg is deposited on the chip and sperm are added to fertilize it. Then a micropump continuously applies a wash of culture fluids to the early embryos until they are ready to be implanted a real womb.

Research is currently underway using eggs and sperm from mice. Possible use for human IVF is still a ways off.

Growing eggs from ovarian tissue

2007-09-22T18:05:00.000-07:00

Doctors at the Bridge Fertility Centre in London have unveiled a technique for developing human eggs in the laboratory from samples of ovarian tissue. The technique involves taking slivers of ovarian tissue which contain thousands of immature eggs through keyhole surgery. The ovarian tissue is then frozen until the woman is ready to try for a baby. At that time it is stimulated with hormones to mature the eggs in preparation for IVF treatment.

The process of in-vitro maturation (IVM) has been in use for some time already. Previously, however, the process involved harvesting of around 10 immature eggs for maturation in the laboratory. This new method unveiled by the British researchers takes a much larger number of immature eggs in ovarian tissue samples that are then "banked". Both procedures have the advantage of eliminating much of the cost and risk associated with traditional IVF which comes from the large doses of expensive follicle stimulating hormone.

Doctors say they are probably five years away from being able to offer this new procedure to patients. The entire process still needs to be perfected.

Fertility humor

2007-08-07T23:05:00.000-07:00

An older couple who is having difficulty conceiving visits the fertility center. As usual, the doctor advises that they should first check the husband's sperm. The husband is given a jar and told to bring back a sample. The next day he returns to the doctor’s office with an empty jar.

“What happened?” says the doc.

“Well,” the man starts, “I asked my wife for help. She tried with her right hand, then her left — nothing. Then she tried her mouth, first with the teeth in, then with the teeth out, still nothing. We even called in Arlene, the lady next door, but still nothing.”

The doctor blurts out, “You asked your neighbor?”

“Yep. No matter what we tried, we couldn’t get that damn jar open.”

It doesn't have to be all serious when it comes to fertility treatment, does it?

PGD may decrease pregnancy success rate

2007-07-06T07:27:00.000-07:00

On the heels of the study that says PGD does not increase the rate of birth defects in IVF babies, a new Dutch study suggests that PGD actually decreases the pregnancy success rate in older women. The study showed that the live birth rate for older women who had PGD as part of IVF was 24 percent compared to 35 percent in women who had IVF without preimplantation screening.

The study was performed at the Center for Reproductive Medicine at the Academic Medical Center in Amsterdam on 408 women between 35 and 41 years old. If the results are correct then it is rather ironic since PGD is normally performed to detect abnormalities and also to select the healthiest possible embryos for implantation with the goal to increase the chances of a successful pregnancy. In older women the opposite may actually be happening.

PGD does not increase birth defects

2007-06-22T06:19:00.000-07:00

According to the results of a study released at the annual conference of the European Society of Human Genetics, the number of malformations in babies born from embryos subjected to preimplantation genetic diagnosis (PGD) is no higher than IVF without PGD. Professor Ingeborg Liebaers, from the Research Centre for Reproductive Genetics, Free University of Brussels, Brussels, Belgium, says that the results of her study of 583 children born after PGD was reassuring.

There has been some concern that the additional handling of the embryo during PGD when a cell is extracted for testing might lead to an increase in complications. The conclusions of this study, the first large study done at one fertility center, indicate that is not the case. There are plans for further studies at other centers.

Very good animation explains ART

2007-06-14T06:41:00.000-07:00

In my previous post I mentioned an article at MSNBC. The webpage with that article is packed full of all kinds of other information and links about fertility and IVF. One of them is this animation explaining assisted reproductive technology. Very nicely done and worth a visit.

MSNBC story on IVF tourism

2007-06-14T05:58:00.000-07:00

Not only has medical tourism gone prime time but "IVF tourism" is coming of age as well. MSNBC.com has a story on the phenomenon. A couple of cases are covered of women who went abroad for IVF, one to South Africa, another to the Czech Republic. Their stories are interesting.

One of the women is a 44 year old from Massachusetts who learned it would cost her and her husband around $30,000 out of pocket for IVF at a center near their home. Their research led them to a clinic in the Czech Republic that treats around 10 American women per month. After satisfying themselves about the clinic's qualifications and track record they went for it. Total cost was $12,500 including donor eggs, all drugs and treatment, airfare and lodging for two. She is now pregnant and expecting in January.

As usual in an effort to "give both sides" in the story we get to hear a lot of FUD (fear, uncertainty and doub) slung around by western doctors. They warn about inaccurate reporting of success rates, potential issues concerning recruiting of donors, questions about the standards of the clinics, etc. The article even said there was "...one reported case of a Romanian clinic recruiting illiterate donors and failing to take appropriate measures to make sure that those donors were giving fully informed consent." Really? One reported case. Oh my.

Certainly all these things are concerns and should be thoroughly investigated even in your home country. A note to the authors of these kind of articles. How about interviewing some doctors at the overseas centers you are writing about. And checking into government regulations in those countries, how success rates are reported and monitored, etc. That kind of information would be much more valuable than the FUD we hear from the western medical community who are often uninformed about what is happening in the rest of the world.

Clearblue Easy Fertility Monitor deals

2007-05-14T06:11:00.000-07:00

There are some very good deals on the Clearblue Easy Fertility Monitor up on eBay. List price of this product is $200 and it goes for around $150 at Amazon. But a new in box Clearblue Easy Fertility Monitor can be had for around $50 on eBay. There seem to be new auctions regularly so if you miss this one there are more.

Sometimes better off without fertility treatment

2007-05-13T06:36:00.000-07:00

I stumbled across an article from last July on foxnews.com that talks about a study done in the Netherlands that showed that in many cases women's chance of conceiving is higher when they don't receive fertility treatment. The researchers said that identifying that group of women is possible and should be common practice.

Couples who don't get pregnant right away sometimes rush to the fertility doctor for help. But in their study of 253 couples over six months the researchers found a higher rate of pregancy in the untreated couples. They use an established predictive model to identify those women who have a good chance of becoming pregnant by allowing just a little more time. Avoiding the expense and risk of multiple births with fertility treatment is beneficial result of this method.

IVM with frozen eggs

2007-05-12T03:56:00.000-07:00

In vitro maturation (IVM) is the process of harvesting immature eggs and then maturing them in the laboratory. The potential advantage of IVM is that large doses of follicle stimulating hormone are not required as in traditional IVF where the desire is to collect a large number of mature eggs. Lower doses of hormone means a safer and less expensive procedure.

Researchers at McGill Reproductive Centre in Montreal, Canada claim to have successfully combined IVM with egg freezing. They collected immature eggs, matured them in the laboratory, then froze them for two months. After thawing they were fertilized and a successful pregnancy and birth resulted. The center claims this is the first time the combination of IVM and frozen eggs has been successfully demonstrated.

The details of the success are described in a story at globeandmail.com. There is another interesting data point in that story, which is that in Korea, where natural cycle and IVM have long been pursued, doctors collect one mature egg that has ripened naturally and three to five immature ones that undergo IVM in the lab. They report success rates around 43% which is as good as standard IVF where large numbers of mature eggs are stimulated, collected and fertilized.

The story also says that about 1,000 babies have been born of IVM worldwide. That's the first time I've seen that statistic. The success rate of IVM is also stated as around 20 percent compared to standard IVF at 50 to 60 percent, according to the story. There is that 60 percent success rate number again. I still haven't seen any solid numbers from fertility centers that back up that claim. I've see a number in the 30 to 35 percent range - that is the probability of achieving a live birth from one round of IVF. Are they coming up with a success rate based on multiple rounds of IVF?

Frozen eggs versus frozen embryos

2007-05-11T05:05:00.000-07:00

The ethical question of what to do with the frozen embryos left over from IVF may become a non-issue if progress continues in the use of frozen eggs. Some fertility centers are reporting excellent results using eggs frozen after collection but prior to fertilization. West Coast Fertility Centers of Fountain Valley, California claim a 60% pregancy success rate utilizing frozen eggs. That's quite a claim, but that's what they say in this press release. Perhaps they are stacking the deck a little by using frozen eggs only in cases where all other success rate factors are very high.

Regardless, the good news is that a number of centers are using frozen eggs now and the practice could soon become standard, eliminating the ethical dilemma of frozen embryo disposal. There are also other advantages, such as facilitating the use of donor eggs since they can be collected and stored then used when a patient needs them.

Free fertility treatment push in Bahrain

2007-05-11T02:57:00.000-07:00

A story comes from the Gulf Daily News of an initiative to make fertility treatment free in Bahrain for Bahraini couples. What is interesting about the story is the cost data points that were mentioned. They said the costs range between BD1,400 and BD1,600 for "regular cases" and BD3,000 to BD4,000 in "complicated" ones.

The current exchange rate is about 2.7 US dollars per Bahraini Dinar. So that would mean the regular procedures cost an average of about US$4,000 and complicated ones US$9,500. They didn't give specifics as to what procedures were being performed in the two groups of cases. If one were to assume they are talking about a standard cycle of IVF for the regular cases and a couple cycles or perhaps ICSI plus PGD for the complicated cases then the cost data is quite interesting, on par with costs in some of the fertility tourism destinations such as Thailand and India.

Maternity Card PPO offers savings

2007-05-09T23:28:00.000-07:00

Maternity Card PPO is offering a program they say will save women as much as 60% off their maternity bills. They guarantee that customers will save money on

Doctor Visits
Hospital Stays
Lab Work
Sonograms
24 Hour Counseling
24 Hour Nurse Hotline
Anesthesiologist
Pre Natal Vitamins
Newborn Tests and checkups
Immunizations
Prescription Coverage

And they are backing up those promises with something they call their Certificate of Guarantee, stating that you will save at least the cost of your yearly membership or they will pay you the difference plus $200 and you get to keep the benefits for an additional 12 months free of charge.

Sperm made from your own bone marrow

2007-04-14T05:19:00.000-07:00

A research study by a team led by Karim Nayernia of the University of Newcastle upon Tyne in Britain has taken adult stem cells from bone marrow and developed immature sperm cells. Further research may result in fully mature and viable sperm.

While the research was aimed at helping men rendered infertile by cancer therapy, the startling implication is that no male is needed at all for reproduction. Two women could have their own biological daughter by fertlizing one woman's egg with sperm produced from the other woman's bone marrow stem cells.

The research results are published in the journal Reproduction: Gamete Biology.

Ultrasound instead of ovarian reserve test

2007-03-20T05:14:00.000-07:00

A study has shown that ultrasound-based tests could be used instead of hormone-based ovarian reserve tests to predict the number of eggs a woman's ovaries would produce when stimulated during IVF treatment. Janet Kwee et. al. from Vrije Universiteit Medical Centre in Amsterdam published the results of their study in Reproductive Biology and Endocrinology. They studied 110 women aged 18-39 who had difficulty conceiving, counting the number of antral follicles, small egg-bearing ovarian follicles about 2-10 mm in diameter, with transvaginal sonography (ultrasound). Their conclusion was that the follicle count is just as good a test for ovarian response as expensive and time consuming endocrine tests.

The article is available on the website of Reproductive Biology and Endocrinology at http://www.rbej.com/

Hot baths may reduce male fertility

2007-03-05T17:32:00.000-08:00

I think this is old news, or at least an old wives' tale, that sitting in a hot tub reduces a man's fertility. But now there has actually been a study completed at the University of California, San Fransico that seems to indicate this is true. Men participating in the study who changed their normal bathing habits to avoid hot baths for three to six months saw a big jump in sperm motility.

So an old wives' tale seems to have been validated. However, the study consisted of only 11 men. Those numbers are pretty small from which to draw firm conclusions. There may be many other uncontrolled factors in the experiment. Still, it is a simple adjustment to make if there are fertility issues. The other urban legend, that frequent use of laptop computers may reduce fertility, has some backing from research published in the Journal of the Brazilian Society of Urology. They also mention tight underwear as a factor.

Dancing On Ice star calls IVF soul destroying

2007-02-28T05:09:00.000-08:00

Dancing on Ice star Emily Symons says that after two failed rounds of IVF attempts over a period of six months "I felt it soul-destroying...". She and Lorenzo Smith soon split after they learned the second round had failed.

To state the obvious, it wasn't the IVF, it was her (their) own mind that ruined the relationship. If you go into it with the expectation that the chance of failure is greater than the chance of success - which it obviously is since in the very best cases the success rate approaches 30% - then you just take it as a happy surprise if you do end up pregnant and deliver a healthy baby. Sure, undergoing the procedure can be bit difficult, more so for some than others. But seriously, it's all about your own mind, not the IVF procedure.

Study shows bright light can improve fertility

2007-02-25T04:39:00.000-08:00

Bright light is often used to treat Seasonal Affective Disorder, which goes by the contrived acronym of SAD. But a recent study suggests it also might improve fertility.

The study was performed at the Russian Academy of Medical Sciences and its purpose was to determine if bright light treatment could shorten menstrual cycles. It did not. But it did seem to have an affect on the fertility of the women in the study.

However, there were only 22 women total in the study and 4 got pregnant. Numbers that small would seem to not be statistically significant.

SART IVF success rate reports

2007-02-17T22:27:00.000-08:00

The website of the Society for Assisted Reproductive Technology www.sart.org has a very interesting and useful feature, IVF success rate reports for fertility centers across the U.S. Clicking on the link for IVF Success Rate Reports takes you to a page with a clickable map of the U.S. You can also search by zip code on that page. The results of your search is a list of fertility clinics in the region you selected. Clicking on a clinic name brings up a page with that clinic's contact information and a link to the ART Data Report. Click on the ART Data Report link and you get a page that looks like this:

It is packed full of statistics on the numbers and types of procedures performed at the particular clinic as well as success rates. Very interesting and useful.

New record for oldest mother

2007-01-02T04:13:00.000-08:00

The last day of 2006 saw a new record set for the world's oldest mother. A 67 year old woman in Spain gave birth to twins by caesarean section at a Barcelona hospital. The woman became pregnant via IVF treatment in Latin America. She beats out the previous oldest mother, Romanian Adriana Iliescu, who was 66 when she had a baby in January 2006.

IVM safer and cheaper alternative to IVF

2006-12-30T01:47:00.000-08:00

The procedure of in vitro maturation (IVM) continues to receive support form fertility doctors because it does not require the woman to receive large doses of follicle stimulating hormone with its potential for serious health risks and its high cost.

The IVM process involves extracting up to ten immature eggs early in the mentrual cycle. A tiny amount of stimulating hormone is added to the culture containing the eggs which are then matured for 24 to 48 hours. They are then fertilized with the man's sperm and the resulting embryos are allowed to develop for several days before implanting them in the woman's uterus.

According to a story in the Times Online, 400 babies have already been born to women using this technique. The story gives no details, however, so we don't know when or where those 400 babies were born. A 30 percent success rate is cited, comparable to standard IVF according to the story. That's a little high to quote as the "standard" success rate. Perhaps they are limiting their statistics to the optimal candidate group. Also, it appears too early to tell if there is a higher incidence of genetic disorders or other problems with the babies born through this technique.

Overall, however, a very promising procedure that is much safer and less expensive for women considering IVF as well women donating eggs.

IVF treatment may cause chromosone damage

2006-12-11T03:37:00.000-08:00

Professionals involved in IVF treatment are apparently aware of a risk that a woman's eggs may suffer chromosone damage from the high doses of fertility drugs used during treatment. An article in BioEdge talks about how this risk, although known among doctors, is unknown to patients.

This is the first I've heard of it and I've read quite a bit of information provided by doctors in the way of patient handbooks, etc. There are many risks discussed in the information supplied to patients but this isn't one of them. Some IVF professionals are calling out this risk and advocating a movement toward minimal stimulation IVF.

IVF camp for men in India

2006-12-11T03:24:00.000-08:00

An IVF center in India named Forerunners Healthcare Consultants is holding an "IVF camp" for men. The object is to counsel them about the treatment of male factors infertility with the use of something they are calling TSEICSI, Testicular Sperm Extraction with Intra-Cytoplasmic Sperm Injection. The two techniques are not new, although perhaps combining them is new at this center. What is new is the acronym they coined which they pronounce "sexy" - ok, that's fun.

They center says that 10% of Indian couples have fertility issues and for close to half of them it is due to male factors. The center says that previously it was believed that a period of sperm "maturation" was required before it could be used for ICSI. But with new techniques they can take the sperm directly from testes to ova and achieve fertilization.

Metabolomics - new technique may improve pre-implantation screening of embryos

2006-11-24T18:24:00.000-08:00

An emerging medical technology called metabolomics may help to improve the results of screening embryos prior to implantation. Embryos are screened based primarily on how regular their shape is and the rate at which cells are dividing. Studies have shown that as many as half of embryos that pass this screening are actually abnormal and unlikely to develop if implanted. Pre-implantation genetic diagnosis (PGD) is a more involved screening method that requires extracting a single cell from the developing embryo and subjecting it to tests for genetic disorders.

Metabolomics may identify genetic disorders by examining the byproducts of cellular activity without having to extract any cells from the developing embryo. By precisely anaylzying these molecular "waste" products the health of the cells can be determined to a higher degree of accuracy. A very good, though rather technical, description of the technique is over in the docinthemachine blog.

Baby born from embryo frozen for 13 years

2006-11-11T04:11:00.000-08:00

From Spain comes news of a birth of a baby from an embryo that was frozen for 13 years. The embryo was surplus from an IVF procedure done 13 years ago. Under Spain's adopt-an-embryo program another unnamed woman received the embryo and carried it to term, giving birth to a healthy baby. This is believed to be the record for the oldest embryo to result in a succesful birth.

Popularity of procreation vacations

2006-11-10T23:39:00.000-08:00

Couples who are "fertility challenged" are opting for more romantic vacations dubbed "procreation vacations" in the hopes of getting pregnant sooner. These aren't couples with diagnosed fertility issues. These are people whose hectic schedules and stress interfere with babymaking. Hotel chains and the travel industry are marketing more to these couples, offering romantic getaways with couples-oriented activities, counselors, and even traditional fertility food menus and elixirs.

MSN Travel had an article about this trend. There were some intereting sounding getaways mentioned, particularly the one offered by Westin. But there is an incredible statistic given in the article, that 61.8 million U.S. couples took a romantic vacation last year. That's a amazing number, especially considering that according to census data in 2002 there were only 57 million married couples in the U.S. and by 2005, according to the American Community Survey there were only 52 million married couples in the U.S. So, as much as the travel industry would like to impress us with this trend they should quote some numbers that are at least realistic.

"Miracles Do Happen" by Carol Andrews

2006-10-26T23:49:00.000-07:00

There is an ebook written by a woman named Carol Andrews available for download in which she describes a breakthrough technique she learned to conceive when, late in life, all other options were failing for her. She was 34 years old when her and her husband decided to start a family. They tried and tried but she was unable to get pregnant. Disappointment turned to sadness and dispair after time went on. She did not want to try IVF after hearing about the troubles her friend had with it. Eventually she happened upon something that led to her having two children (you need to download the ebook to find out the details).

Download Miracles Do Happen.

Cell phones pose risk to men's fertility

2006-10-24T17:44:00.000-07:00

Study results released yesterday at the American Society for Reproductive Medicine annual meeting in New Orleans indicate that men who use their cell phones for more than four hours per day may risk lower sperm counts and reduced quality of sperm. A previous study showed a similar correlation between cell phone use and sperm quality but this is a much larger study involving 361 men in Cleveland, Ohio and Mumbai, India. Men who used a mobile phone for more than four hours a day had a 25 per cent lower sperm count than men who never used a mobile. And men with highest usage also had greater problems with sperm motility and a 50 per cent drop in the number of properly formed sperm. Researchers are speculating that the cause of the drop in sperm count and quality could be the result of electromagnetic radiation, heat, or hormone changes. But the precise mechanism is not known and there is certainly the possibility that cell phone use and some other behavioral or environmental factor that is causing the fertility impact are strongly correlated.

Pill claims to boost male fertility

2006-10-22T03:47:00.000-07:00

A story from Australia says a new pill called Menevit, which contains seven antioxidants and minerals, can boost male fertility by reducing sperm DNA damage and improving embryo quality. The new pill is aimed at attacking free radicals from sources such as smoking, obesity and exposure to chemicals, which damage sperm. The inventor, Kelton Tremellen, an Adelaide fertility specialist, says the pill has been the subject of three years of research and two clinical trials. It will be sold through multinational drug maker Bayer.

All the online sources regarding the clinical trials seem to point back to this page. So it seems the clinical trials are real. I just don't know how to interpret the results. The inventor claims the results are outstanding. If this proves to be true it could mean a much easier time for many couples who are having problems conceiving due to male factors. Up until now the solution has typically been IVF using ICSI which is costly and hard on the woman.

Fertility Predictor Watch

2006-10-16T18:50:00.000-07:00

There was the cell phone with built in fertility timer. Now we have a wrist watch with a chemical sensor that predicts fertility. It is called the OV Watch^®. It works by measuring the concentration of chloride ion on a woman's skin. The inventor of the watch says this is a better predictor of the best time to try and conceive because the chloride ion concentration begins to rise four days before ovulation. LH, on the other hand, gives only 12 to 24 hours notice. LH changes are measured with urine test strips which makes it messier, far less convenient and prone to error. A graph comparing the chemical changes appears below.

The maker says because of the greater convenience, accuracy and advance notice the probability of conception is much higher compared to testing for LH. Another graph:

You can purchase the OV Watch with a 3 month supply of sensors.

Fertility forecasting with AMH test

2006-10-12T05:31:00.000-07:00

AMH, the Anti-Mullerian Hormone, is a hormone that is produced by young healthy egg follicles in the ovaries, and it can be detected by a simple blood test. This hormone does not fluctuate month to month like other hormones, so it may actually be a true test of a woman's biological clock, say some researchers. Studies have shown AMH may be the strongest predictor of how many healthy eggs a woman has left in her ovaries, and it also helps predict which women are likely to have success with in-vitro fertilization procedures, and which women will not.

A test kit called Plan Ahead was introduced by a UK company named Lifestyle Choices Ltd. in May of this year. The test requires 3mls of blood to be taken from the arm on the second or third day of the woman's period. From analysis of the blood sample, the number of eggs present in the ovaries is calculated using the Ovarian Reserve Index and this is plotted onto a graph to show the woman's 'actual' position compared to the average population at that age. The test allows the ovarian reserve for the following two years to be calculated, enabling women to make an informed decision as to whether, or how long, they can potentially delay before trying to conceive.

This sounds pretty interesting. But a lot of (somewhat) informed people at this forum believe it is not a credible test (actually, they used some stronger language). The test costs 179 British pounds (about $350 U.S.) so is not cheap.

New cell phone tracks fertility cycle

2006-10-06T20:18:00.000-07:00

According to a story at Gizmodo, Mitsubishi is shipping a new cell phone that tracks a woman's monthly cycle and informs her of the optimal time for attempting to achieve pregnancy. It is the FOMA^TM D702iF model.

Cell phones do almost everything these days.

The case for "natural" IVF

2006-10-03T19:00:00.000-07:00

The standard IVF treatment cycle involves the administration of hormones to stimulate the ripening of multiple follicles so that a number of eggs can be harvested and fertilized, hopefully yielding several healthy embryos for implantation. However, the hormones can cause complications in some cases, and they are quite expensive. A few fertility centers are practicing what they call "natural" IVF. There are no hormone injections, just close monitoring of the monthly cycle and development of the (normally one) egg. Just as the egg is ripening it is harvested, fertlized and implanted as in standard IVF.

The advantage, say the fertility centers practicing this approach, is no risk from the use of ovarian stimulation hormones, normally healthier embryos since a high percentage of eggs produced as the result of hormone injections are abnormal, a healthier and more natural uterine lining leading to higher implantation success rates, and the cost is one-third that of standard IVF.

The main disadvantage is lower success rate per cycle, typically 10% in the best cases, compared to 25% to 30% with standard IVF.

Obviously the costs savings is offset by the lower success rate, since it might take three cycles at one-third the cost to reach the same success rate as standard IVF. That is not on a per case basis, of course, but an overall average. The centers say that the lower success rate is largely due to the implantation of a single embryo instead of two as in standard IVF. However, some studies have shown that single embryo implantation are nearly as successful as multiple embryo implantation in standard IVF and some doctors are advocating it to avoid the risk of multiple births. So the much lower success rate of "natural" IVF seems a bit of a mystery.

Health tourists get free IVF in Britain

2006-10-03T05:56:00.000-07:00

In a curious reversal of what one normally thinks of when they hear the term "health tourist", some couples from other countries have come to Britain and received IVF treatment paid for by NHS. Normally, people are leaving Britain and becoming health tourists/medical tourists in other countries like Thailand and India because the health care there is excellent, it is inexpensive, and it is available when you need it.

In England IVF is free, paid for by the NHS. But there have been long waits and shortages of donors that have left many citizens frustrated. However, a few couples who are not even entitled to IVF paid for by the NHS have managed to get it. Details of those couples' circumstances are unknown. Perhaps they were temporary residents in England and sought treatment during their stay, maybe not even realizing they were supposed to pay for it. But a Dr. Luca Sabatini of St Bartholomew's Hospital in London did a study earlier this year that suggested that up to half of British fertility clinics are being duped by patients who lie about their age or identity to get treatment.

The story of Donor #15

2006-09-29T07:04:00.000-07:00

A very interesting read over at Reason.com. A story by Kerry Howley, an associate editor of Reason, of her experience as an egg donor. The article is a bit long but worth the read as it gives a good summary of the history of assisted reproduction and the strangely intimate yet anonymous experience of contracting to donate her eggs to a couple for IVF treatment.

I most often see stories of the recipients of IVF treatment, less frequently stories of donors. Howley describes some of the nuances of a donor's emotions with comments like "Selling ova to another woman is at once impossibly intimate and wholly impersonal". And she describes the process as "...a transaction well suited to the Internet, which tends to provoke uninhibited sharing among strangers cloaked in anonymity."

Inhalable FSH to be evaluated

2006-09-18T23:22:00.000-07:00

A new follicle stimulating hormone (FSH) from Syntonix Pharmaceuticals Inc. will undergo evaluation by Swiss firm Serano SA. The FSH:Fc SynFusion product is aimed at providing long-acting FSH therapy for the treatment of infertility. The chief advantage of the new product is that it can be inhaled and dosed less frequently than the hormones currently used which require daily injections.

Patients who are confident enough to administer daily injections themselves are not terribly inconvenienced by the current method, but they do experience varying degrees of discomfort. Other patients make a trip to the doctor or a nursing station to receive daily injections, which is a major inconvenience during the IVF protocol. If this inhalable FSH is successfully developed then IVF treatment will become even more routine.

Update on the donor sperm shortage in Britain

2006-09-16T05:33:00.000-07:00

An update on the donor sperm shortage in Britain appeared in the Health section of the BBC News online edition. 74 of the UK's 85 fertility clinics were surveyed and 70% of the respondents said they had no donor sperm or insufficient supplies, with waiting time for couples of up to six months to receive donated sperm. The secretary of the British Fertility Society, Dr Allan Pacey, calls it a crisis and is critical of the British law that has caused the shortage. That law removes anonymity for sperm donors.

The interesting part of the story comes from the groups that brought about this law, charities that represent "donor-conceived people". They say that this new law simply puts donor-conceived people on a par with those who were adopted and feel a need to contact their biological parents. Olivia Montuschi, of the Donor Conception Network, says the shortage has been aggravated by the way in which fertility centers panicked donors by saying that the law could possibly be retroactive or that donor conceived people would make huge demands on them.

IVF related death in England

2006-09-10T06:23:00.000-07:00

The news site thisislondon.co.uk has a story about a woman who died from complications suffered during egg retrieval during IVF treatment at Leicester Royal Infirmary in England. Details are sketchy, but if the complication was a direct result of the egg retrieval procedure this will have been the first death involving IVF treatment in Britain. The couple are originally from India and were now living in Leicester, England.

This is a very sad story and a reminder that even procedures that have come to be routine still carry an element of risk. One aspect of the story to note is that although India has become a major destination for IVF treatment due to its high quality fertility centers and low prices, this Indian couple elected to have the IVF procedure in England. There is a certain irony to this when one considers how the western medical establishment disparages treatment at offshore medical centers, and then a rare death like this occurs at a British facility.

Internet sperm ban in UK

2006-08-28T06:44:00.000-07:00

Recall the story about the sperm shortage in Britain, brought on by the abolishment of anonymity for donors. Some women and couples are getting around the shortage by ordering sperm over the internet from international sources. I raised the issue of how the abolishment of anonymity for donors might become an issue for imported sperm ordered in this manner. Well, it hasn't been directly addressed yet. But a new requirement bans internet sperm companies from supplying fresh sperm. Ostensibly it is to protect recipients from possible diseases. The new requirement, set to go into effect next April, requires the firms supplying the donor sperm to store it for six months prior to sale to ensure that it is disease-free.

Some statistics on Bumrungrad's fertility center

2006-08-21T23:19:00.000-07:00

A short news item at Yahoo News about fertility tourism in Thailand gives a few interesting statistics about Bumrungrad's fertility center. According to Phattaraphum Phophong, a fertility specialist at Bumrungrad International hospital, they receive about 500 foreign patients per month at the fertility center, 60% of which are American. They come primarily for IVF treatment, attracted by both the price, which can be one-third of what it costs in the U.S., and also for certain procedures that may be prohibited or restricted in other countries, such as sex selection using pre-implantation genetic diagnosis (PGD).

That is a pretty big number, 500 foreigners per month. And that doesn't include local Thai residents, although at Bumrungrad foreign patients may be the majority. Jetanin Institute for Assisted Reproduction is the largest fertility center in Thailand, and although they treat many foreigners, Thais are probably the majority. I haven't seen numbers for Jetanin but have visited them and Burmrungrad's fertility center as well. Jetanin is a big fertility center and also has complete hospital facilities for delivering babies. Their numbers must be quite substantial.

New Zealand's first birth following PGD

2006-08-19T05:47:00.000-07:00

Pre-implantation Genetic Diagnosis (PGD) is something new for New Zealanders. It was first allowed by the government only last year and is subject to tight restrictions. The New Zealand government has budgeted $500,000 to pay for PGD where there is a risk of passing on a serious genetic disorder. PGD for sex selection is not permitted in New Zealand, except to avoid sex-linked conditions such as Duchenne muscular dystrophy.

The first birth following the use of PGD with IVF happened last month for a 39-year old woman who had miscarriages for five years due to a frequently occuring genetic disorder in her embryos. She gave birth to healthy twins.

More on made-to-order embryos

2006-08-18T18:26:00.000-07:00

The new service by the San Antonio based adoption and fertility company Abraham Center of Life is starting to get a little more media coverage. An article today on the ReasonOnline website gives some additional background and perspective. One bit of trivia not important to the meat of the story but curiously interesting is pointed out by the author, Ronald Bailey. That is that the name of the center evidently refers to the Bible story of the use of surrogacy by patriarch Abraham who, at his wife Sarah's urging, had a son by his wife's Egyptian slave-girl Hagar. Ok, not all that interesting perhaps.

The article mentions that there is some "ethical hand wringing" about the new service and references a post at Lifesite.net. If you read that post you see they say that Many ethicists have long complained that the use of IVF technology with preimplantation genetic diagnosis, combined with recent breakthroughs in understanding of human genetics, will lead to a nightmare “Brave New World” in which babies are made to order in labs and sold as commodities. But there is little else article, including why this "Brave New World" they refer to is such a nightmare.

Parents want healthy and happy babies born free of genetic defects. Applying diparaging labels like "made to order babies" doesn't implicate the parents' feelings about their new loved one. And being "sold as commodities" is similarly impertinent to the parents, whether they are buying an embryo or buying an adopted child, or don't they critics refer to adoption as buying a baby?

The Reason article points out some of the other obvious conflicts in the ethicists' criticisms.

Made to order embryos

2006-08-11T07:08:00.000-07:00

The Abraham Center of Life in San Antonio, Texas is offering made to order embryos. According to Jennalee Ryan, the director, embryos are created with sperm and eggs from rigorously screened donors that meet the specifications of their customers. For $10,000 customers receive two embryos.

Ms. Ryan claims the process is superior to standard IVF and better than using donated eggs or sperm from a traditional IVF clinic. Her reasoning goes like this. The donors she uses are "proven", meaning they don't have any of the fertility problems that bring clients to the fertility clinic in the first place. As a result, she claims they achieve 70% success rate compared to around 30% for standard IVF. She also says their donor men are highly educated, most have PhDs, and the donor women all have some tertiary education. And compared to adoption this method is superior because she says "Babies offered for adoption tend to come from lower class women who often have a history of drug or alcohol abuse."

A couple of interesting assertions are made by Ms. Ryan. The claim of 70% success rate is quite amazing. Is she really asserting that it is the quality of the embryos alone that drive the implantation success rate up that high?

As for the educational level of the parents, I'm not sure the embryo is going to have much sense of whether or not the father obtained a PhD, although it might carry the trait of snobbiness that many PhDs so unattractively exhibit!

An interesting side note. Although this story is about a fertility center in the U.S. I have seen no news about it in the U.S. media. I saw this story on an Australian website and it was picked up by a couple of UK websites. This seems like it would be a lightning rod for moral outrage by religious groups in the U.S.

PGD for sex selection being promoted

2006-08-11T06:16:00.000-07:00

Thailand has been a destination for "fertility tourism" for some time. Bumrungrad Hospital's fertility center receives around patients per month from other countries. The primary motivation in the past has been cost; fertility centers like Bumrungrad's and Jentanin Institute, Thailand's largest, provide world class treatment at around one-third the cost of IVF in the west.

Now another feature of Thai IVF clinics is bringing foreigners to the Kingdom, the availability of sex selection through preimplantation genetic diagnosis (PGD). PGD is used world wide to screen for healthy embryos prior to implantation. However, in many countries the use of PGD for selecting the sex of the embryos to be implanted is prohibited by medical code or laws. Thailand's national medical board has advised against the practice of sex selection but there are no laws or codes prohibiting it. And many customers are requesting it, according to Bangkok-based Ramkhamhaeng hospital group which is considering promoting the service.

The arguments against sex selection during IVF ultimately seem to boil down to religious beliefs, something along the lines of "we shouldn't be playing God", or accusations of misogyny in the cases when males are favored. A rational basis for arguing against it seems elusive, however, especially when you consider that the fertility doctor must select some embryos for implantation and some to be left behind, perhaps frozen for future use. Given that there are ample healthy embryos from which to choose one can just as well pick all males or all females. In cultures where the predominant religion is not based on belief in a god but instead on understanding the law of cause and effect (e.g. Buddhism in Thailand) the emotional vitriol against sex selection seems quite irrational.

New rent-a-womb service

2006-08-05T07:24:00.000-07:00

A Singapore adoption center has expanded its offerings to include a rent-a-womb service, surrogate mothers for hire in China. Greenhouse Adoption Agency has experienced a dramatic slow-down in its adoption business since the Singapore government clamped down on adoptions from China. Private adoption agencies have all but been forced out of bringing adopted children from China to Singaporean parents. Now all adoptions are required to go through two designated voluntary welfare organisations. As a result, many adoption agencies now focus on adoptions from Malaysia and Indonesia. But Greenhouse has taken on the challenge of matching prospective parents in Singapore with surrogate mothers in China.

The process is complex and there are few guarantees. Couples travel from Singapore to China where IVF procedure is performed using the couple's egg and sperm. The embryo is implanted in the surrogate. Since the service is still new there are open questions about how the baby is then treated by immigration authorities. But Greenhouse says they have it all worked out with relationships already established at all the pertinent government agencies.

The cost is significant, 40,000 Singapore dollars, about twice the cost of an adoption. And four times the cost of a round of IVF treatment. And of course there are no guarantees that a single round of IVF will result in a pregnancy. Other questions that come to mind are the costs of delivery, especially if there are complications. And what about multiple births which are somewhat common with IVF.

Sperm shortage in Britain

2006-07-29T20:10:00.000-07:00

Recall the previous post about one sperm donor for the entire country of Scotland. The shortage of sperm for IVF treatment in Britain is becoming acute, with some groups calling it a "national crisis". The abolition of anonymity for donors and allowing of children to contact their donor fathers has all but eliminated the donation of sperm. Some in the government have called the abolition of anonymity "stupid" and in need of a rethink. But the spokesman for the Department of Health says the government does not intend to change the law.

Some fertility clinics are closing while others are importing frozen sperm from the U.S. and Denmark. And some couples are going abroad for fertility treatment, which is a viable option since there are numerous world class fertility centers in other countries. Still others are buying frozen sperm online. A website called Man Not Included reports a three-fold increase in donor sperm purchases. They were established to provide donor sperm to lesbian and single women who were denied IVF treatment. Now married couples are turning to them due to the shortage of donor sperm at IVF clinics.

One question that comes to mind is how the law abolishing donor anonymity treats imported donor sperm. Do they not require that the importers certify who the donor is? If not, that is an interesting loophole that may eventually be plugged if the government remains firm on its position on donor anonymity.

Wearing glasses increases fertility?

2006-07-29T02:04:00.000-07:00

A press release claims that a "study" (no reference or source given for said study) has shown that seasonal changes in hours of daylight trigger melatonin release in the body, and that in turn makes women more fertile during the months in which conception would lead to birth in the spring, a more favorable time for newborns to enter the world. The advent of electric lighting has upset the natural ebb and flow of melatonin and hence fertility. With artificial lights on long after the sun sets, fertility is supressed since this would simulate the longer days of spring and summer; pregnancy at that time would lead to birth in the cold winter months.

The so-called study says that it is light in the blue spectrum that supresses the melatonin release. So an enterprising scientist has developed a set of glasses that filter the blue spectrum. Women can wear the classes for gradually increasing periods of time to fool the body into thinking that a seasonal change is occuring and the time for conception is optimal. There are other products as well, including light bulbs and filters for TV screens that block the blue light.

This is the first I have heard of this theory about melatonin and fertility. If this is true it seems that taking melatonin supplements would also be quite effective in boosting fertility. Many people currently take melatonin to regulate their sleeping patterns, especially when traveling across time zones. The hormone is readily available and inexpensive.

Custody battle over frozen embyos

2006-07-26T05:18:00.000-07:00

There has been a steady stream of news and court decisions coming out of the UK this year regarding all aspects of IVF, including government funding of treatment, warnings about IVF abroad, even liability of sperm donors for eventual offspring. Now from Dublin, Ireland there is the story of a court decision regarding custody of frozen embryos.

An Irish couple has been battling in the courts over what to do with embryos frozen during their IVF treatment several years ago. The husband does not want additional children and wishes the embryos to be donated for medical research. The woman feels the embryos are her yet-to-be-born children and should be implanted in her so she can give birth to them. The court ruled that there was no consent given by the man for future IVF treatments using the frozen embryos, so the woman cannot have them implanted.

There are several issues raised by this proceeding, including the fact that in Ireland there is a constitutional prohibition against abortion at any stage, which begs the question what about the disposal of unused embryos from IVF treatment. The constitutional amendment doesn't make it clear that these embryos are covered. The judge in the case said the case would now move into the issue of legal protection for frozen embryos as persons. The outcome of the next phase of this case could set a precedent for legal treatment of the disposal of embryos from IVF as abortion, a precedent that may be noted and followed in other countries.

62 year old IVF mother

2006-07-09T05:44:00.000-07:00

This story has received a lot of news coverage already. But in case you missed it, Dr. Patricia Rashbrook, age 62, just became the oldest woman in Britain to give birth. She received IVF treatment in Italy after being refused treatment in her home country. Dr. Severino Antinori of Rome performed the IVF procedure. He arranged for Rashbrook to receive donor eggs in Moscow. Dr. Antinori says he only considers couples with at least 20 remaining years of life expectancy.

20 years of remaining life expectancy might be a little optimistic for this couple (husband is 61), especially considering that the average life expectancy in the UK is currently 78.54. But who knows, with future advancements in medicine maybe 82+ is a reasonable forward looking estimate for the parents.

New book nurtures women through IVF

2006-07-08T06:27:00.000-07:00

A new book written by author Lynn Daley provides women undergoing IVF with guidance to help them through what can often be very stressful times. Ms. Daley says she has been through multiple cycles of IVF herself, and interviewed over 100 women undergoing IVF to gather background for the book. The book aims to help women keep everything in balance, including their emotional health, rather than just focusing on "getting through the cycle".

Title of the book is Nurturing Yourself Through IVF.

$3 office visit

2006-07-07T02:44:00.000-07:00

This post is off topic in that it isn't about IVF. It is about my recent trip to the dentist in Bangkok. I had a tooth ache so I went to the dental center at Bumrungrad International Hospital (they have a fertility center, so perhaps this is vaguely on topic). Bumrungrad is perhaps the most famous of the big private hospitals in Bangkok that are all known for outstanding medical care at amazingly low prices. I had been to Bumrungrad's dental center before to repair a broken filling. That was a great experience, quickly and expertly handled, for the handsome fee of $35 U.S.

This time I suspected something more involved than a quick repair of a filling. Sure enough, the tooth under one of my crowns had gone bad and I needed a root canal. I didn't have an appointment but they have several dentists on staff and normally there is one assigned to handle walk-in emergencies, which was me. One person ahead of me so I took a seat. 20 minutes later I'm in the dentist chair, then over to x-ray. Five minutes later doctor confirms from the x-ray that the roots have gone bad and gum is inflamed. The good news is no cavity around the base of the crown so no need to replace it, just drill through, do the root canal and patch it up. 40 minutes later the procedure is done.

Now the price:
Doctor's fee: 4,200 Thai baht ($110 U.S.)
Materials: 3,800 Thai baht ($100 U.S.)
Office visit: 110 Thai baht ($3 U.S.)

That's the full price. It includes the follow-up visits to do another round of cleaning and packing with medication, and then another for the permanent filling after the doctor is satisfied everything is completely healed.

Amazing, $3 for the office visit! And these facilities are far superior to any dental office I ever visited in America. That plus the added bonus of wonderful hospitality.

And when I went back for the second round there wasn't even a charge for the office visit that time. I guess the original $3 fee covered it.

IVF ROI

2006-07-06T04:47:00.000-07:00

This is the first I have seen such an argument for state funding for IVF. The UK's National Health Services (NHS) has been debating the necessity for, and amount of, state funding for IVF. At a conference of the European Society of Human Reproduction and Embryology held in Prague, Professor Bill Ledger, of the University of Sheffield gives an argument for considering the return on investment (ROI) for the state. The argument goes that NHS will spend 13,000 pounds on average for every live birth through IVF. But over its lifetime that IVF baby will contribute a net 147,138 pounds in taxes, and will have paid for itself by age 31. And that does not take into consideration wealth created in the private sector. An additional consideration for the UK is the aging of the population and need for more young people to enter the economy.

I found this concept of IVF ROI interesting and sort of amusing. For the people who want a baby this is the farthest thing from their minds. Indeed, they have enormous expenses to look forward to in raising the child if IVF is successful for them. But from the point of view of the state every birth is a good birth, as long as it means a contribution to the tax base. In some places that might not be the case if the prospects for employment aren't so good.

One sperm donor for the entire country

2006-06-07T05:54:00.000-07:00

The fallout from the change in sperm donor anonymity law that became effective April 1 in the UK has been swift and devastating. The Aberdeen Maternity Hospital in Scotland has become the first to close due to the lack of donor sperm. Scotland's five other clinics are also struggling. According to The Timesonline, there is only one sperm donor in the entire country. Incredible! Often, bad legislation such as this just simmers and erodes away services quietly. But the consequences of this new law have hit hard and fast.

IVF may raise risk of "low lying placenta disorder"

2006-05-25T07:54:00.000-07:00

Several European news sources are carrying a story on the results of a study released by Norwegian researchers that indicate that women underdoing IVF treatment may have a substantially increased chance of experiencing placenta praevia, a condition in which the placenta blocks the womb’s entrance. This condition, also referred to as "low placenta", is potentially serious for both mother and baby.

The study showed that women underdoing IVF had up to six times increased chances of experiencing placenta praevia. The reason for the complication is still unknown but researchers believe it may be related to the causes of infertility. If that is the case, that would mean that it is not the IVF treatment itself that is causing the complication. But the condition leading to the need for IVF treatment. If researchers can definitively identify the cause that could lead to safer IVF treatments.

Medical tourism specialty: Fertility tourism

2006-05-01T07:01:00.000-07:00

Medical tourism isn't new. It has steadily grown for years, more rapidly in recent years as medical costs spiral up and quality of care plummets in the west. Now we are getting medical tourism specialties. A story in early April in Newsweek's online international edition has a web page titled "Fertility Tourism: Childless Couples Try India". The story focuses on a British couple that went to India to find a surrogate. That part of the story is quite interesting and includes some of the issues that make finding a surrogate in the UK so difficult. But the thing that caught my eye was the term "fertility tourism". I suppose all sorts of related terms could be coined, dental tourism, etc. As the popularity of medical tourism grows the specializations and specialized terminology are bound to grow as well.

Britons warned about IVF holidays

2006-04-29T05:42:00.000-07:00

The Human fertilization and Embryology Authority (HFEA), which monitors fertility clinics in England and Wales, issued warnings to Britons who are considering having IVF treatment at a foreign fertility center, spreading FUD (fear, uncertain, and doubt) about the safety of it. The HFEA said couples should consider what happens if there are complications, or how their personal information might be handled, considerations, of course, no matter where you undergo IVF treatment, including in your home country if you are a Briton.

The western medical community and media typically take a very parochial view of the world, disparaging the world class treatment available elsewhere, perhaps out of ignorance or maybe fear of losing their control and position. Experience has shown that the top IVF centers in Southeast Asia and elsewhere have better treament of patients who have complications, which can occur anywhere. And there is no waiting to get treatment, like in the UK.

A spokesman for the HFEA named Suzi Leather was quoted in a Reuters news story saying she had "heard stories" of foreign IVF doctors implanting an excessive number of embryos to ensure pregnancy. Well, Ms. Suzi, we have all "heard stories" and many of the really bad ones are about medical treatment in the U.S. and UK.

China institutes controls on IVF procedures

2006-04-11T07:35:00.000-07:00

China's Ministry of Health has imposed a ban on commercial egg donation and supply. Also, interestingly, they now restrict the use of a single sperm donation to use in impregnating no more than five women. Only authorized institutions are allowed to receive donated sperm. As of the end of March, China had 64 institutions that were authorised to offer assisted reproduction related services and seven institutions have established sperm banks.

The restriction on the use of sperm from donors could be reasoned to be concerns over too many offspring from a single donor. The ban on commercial egg donation follows concerns arising worldwide about possible exploitation of women willing to sell their eggs.

New egg banking program in Bay area

2006-02-16T00:50:00.000-08:00

The Reproductive Science Center of the San Francisco Bay Area announced a new program allowing women to freeze and store unfertilized eggs at RSC for non-medical reasons. Normally IVF centers freeze fertlized eggs, embryos, for use by women undergoing IVF who may have them implanted later if their early attempts do not result in a pregnancy, or at a future time to avoid undergoing costly hormone injections and egg harvesting. Embryos typically survive freezing and thawing much better than unfertilized eggs, but as techniques improve the option for freezing and banking eggs for future use becomes more viable. Doctors can then fertilize only the number of eggs used for each IVF cycle and avoid the moral dilemma of patients have of what to do with viable but unused embryos.

IVM - new ART procedure - may be safer, cheaper

2006-02-14T00:40:00.000-08:00

A new assisted reproduction technology (ART) procedure called in vitro egg maturation, IVM for short, may be safer and cheaper than the normal IVF regimen. Instead of removing fully mature eggs from the ovaries and then fertilizing them, physicians remove immature eggs, ripen them in a lab dish, then add sperm. With this approach, the woman requires only three days of fertility drugs to stimulate her ovaries - compared with up to two weeks under the conventional method. This may be particularly useful for women who suffer from polycystic ovarian syndrome, a hormonal disorder that disrupts ovulation. It's a leading cause of female infertility and it makes infertility treatment extremely risky because the ovaries can easily be overstimulated.

In fact, IVM is not really new. It has been used successfully in some cases since 1994. But it is a challenge because during normal egg maturation the egg undergoes meiosis in which the nucleus jettisons half of its chromosones in preparation for receiving DNA from a sperm. But achieving meiosis in laboratory glassware instead of inside an ovary is not a perfected process. And even when it is achieved the egg often develops a hardened membrame that reduces the changes of a sperm penetrating and fertilizing it. Still, the process holds promise as it is developed further.

Sperm donor ordered to pay child support

2006-02-04T17:21:00.000-08:00

This is not a new story, but only recently came to our attention. In Sweden a man who donated sperm to a lesbian couple has been ordered by the courts to pay child support. Although the donor donated sperm with the understanding and agreement by the recipient that he would not be involved in the raising of any children, the mother sued for child support after her and her lesbian partner parted ways. The case was appealed all the way to the supreme court and the ruling that he must pay child support was upheld.

This makes it clear that it is a bad idea, in Sweden at least, for a sperm donor to be known by the recipient.

Five embryo transfer for women over 40

2006-01-23T06:22:00.000-08:00

It seems like studies on the optimal number of embryos to transfer are pointing in opposite directions. An earlier study showed that single embryo transfers were as good as multiple when the success rate of live births was considered. Now a study by Dr. Elizabeth Ginsburg from the Brigham and Women's Hospital Center For Reproductive Medicine, Boston shows that five embryos is the optimal number for women over 40.

The study involved 863 transfers in which 142 patients received five, 392 received fewer, and 329 received more than five embryos. It showed that when fewer than five embryos were transferred, the overall pregnancy rate was 19 percent, and the live birth rate was four percent. With five embryos, the pregnancy rate was 40 percent and the live birth rate was 23 percent. More than five embryos resulted in too high a risk of multiple births.

The earlier studies considered all ages so for younger women perhaps the single embryo transfer is viable.

Lunch hour DNA tests

2006-01-13T06:50:00.000-08:00

A clinic in North Wales is now offering customers lunch hour DNA tests. Apparently there has been enough demand by men concerned that their children were really fathered by them that this new clinic was opened. Directors of the clinic also say that women who have undergone IVF can have DNA tests to ensure that their child actually came from their own egg.

Perhaps there is a lot of cheating going on in North Wales, and frequent mixups at the IVF centers, enough that there is a real business opportunity for this type of service.

Increasing pressure for single embryo transfers

2006-01-11T05:31:00.000-08:00

Recent studies show that multiple embryo transfers don't significantly improve the chances of a successful pregnancy, but only increase the rate of multiple births and hence the risks and costs of delivery. That alone has lead to many IVF centers to consider making single embryo transfers standard procedure. Now, a recent article in The Scotsman reveals a study that indicates 10,000 more IVF cycles could be funded each year in the UK if multiple births could be eliminated from IVF therapy.

The study showed that a single pregnancy costs 3,313 British pounds ($5,860 USD), while twins cost 9,122 pounds ($16,120 USD) and triplets 32,354 pounds ($57,170 USD). The study calculated that savings in government-funded health costs from eliminating multiple pregnancies would enable an additional 10,124 IVF cycles.

Advances in PGD on the way

2006-01-10T03:24:00.000-08:00

Present testing methods have the ability to detect about 150 genetic disorders in embryos. But there are approximately 6,000 disorders that can result from single gene mutations. New technology may be available soon to screen for a larger number of these defects.

To take advantage of the new technology, and to reduce the number of genetic disorders in IVF babies (reportedly as high as 40% in some countries' studies), Health Canada plans to introduce PGD as standard procedure at IVF clinics in May 2006. No reports yet on who will shoulder the extra cost of IVF.

DNA contamination during IVF

2006-01-07T01:56:00.000-08:00

A few articles have appeared recently discussing the possibility of DNA contamination if ICSI is used during IVF. Some researchers in Spain have intentionaly injected bacteria along with sperm into mice eggs and determined that DNA from the bacteria is present in the DNA of the resulting offspring. This raises a potential concern that contamination could occur during handling of sperm or during the ICSI process that could result in foreign DNA being present in the embryos. However, researchers say there is little cause for alarm since the contamination does not manifest any characteristics. Nevertheless, there are calls for increased attention to this matter since the available data is minimal and the likelihood of contamination by bateria on the sperm donor's skin is quite high.

Where problems may arise

2006-01-06T05:44:00.000-08:00

Problems may arise at several stages in the IVF cycle:

1. The treatment cycle may be cancelled for any of the following reasons:

ovulation induction did not produce enough stimulation of the ovaries or less than three follicles fail to develop
hormone levels fail to show a satisfactory rising pattern
hormone levels fall before follicles have completely developed
there is an excessive response (more than 15 follicles)
ovulation occurs unexpectedly before admission to the hospital, which means it is impossible to properly time the procedure (such incidence is rare)

2. Egg pick-up may be unsuccessful and no eggs recovered.

3. Eggs are recovered but fail to fertilize.

4. Embryos are transferred to the uterus but fail to implant, resulting in a period seven to 14 days later.

5. Like natural conception, IVF can lead to:

biochemical pregnancy (transient rise in pregnancy hormone followed by late period)
miscarriage (needing uterine cotterage)
ectopic pregnancy (requiring surgery)

6. Multiple pregnancy (twins, triplets, etc.) is more common with IVF than with natural conception because of the practice of transferring more than one embryo to the uterus. In general, the success rate is higher if more than one embryo is transferred. However, the maximum number of embryos transferred is normally limited to three.

Missing work for IVF

2005-12-25T19:05:00.000-08:00

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

2005-12-25T03:21:00.000-08:00

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.

Similar results from implantation of one and two embryos

2005-12-20T04:31:00.000-08:00

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.

New Zealand goverment to pay for PGD

2005-12-13T04:50:00.000-08:00

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.

Delaying pregnancy...by freezing your ovaries

2005-12-11T03:43:00.000-08:00

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.

Obese women to be denied IVF treatment

2005-12-09T03:25:00.000-08:00

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.

ART procedures on the rise worldwide

2005-12-04T02:41:00.000-08:00

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.

Three common IVF protocols

2005-12-03T03:15:00.000-08:00

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.

IVF and acupuncture double blind study to begin

2005-11-29T21:06:00.000-08:00

You may know acupuncture as an ancient Chinese medical procedure used to treat all sorts of conditions. Combining it with IVF is a relatively new idea. Some couples have reported success with acupuncture treatments and IVF combined, after a number of failed IVF cycles without acupunture. To date, however, there have been no so-called double-blind studies of IVF with and without acupuncture.

The University of Maryland Medical Center has announced plans for a double-blind study of IVF combined with acupuncture. The study is funded by the National Institute for Health and is currently recruiting patients to participate. They hope to identify if acupuncture results in increased blood flow to the uterus, a rise in hormone levels, or reduced stress that might account for the apparent increase in IVF success rate.

A couple of issues came to mind when we read this news. One is how they might implement a double-blind test. It seems that it might be quite difficult to have a placebo control group. How might they make the placebo group believe they had a real needle insertion when there was none? Or perhaps they insert needles but not at the correct point in the body? The details of how they plan to do this would be interesting.

Another issue concerns the basic differences upon which Chinese and western medicine are founded. The study is going to look for changes in physical systems as understood by western medicine, while acupuncture is based upon a completely different model of the body and energy flows. So if the study does not find changes in uterine blood flow or hormone levels do they conclude that acupunture has no effect? That would seem to be a flawed conclusion. If the study group is statistically significant and the number of live births is compared then that might lead to useful conclusions.

The marketing of IVF

2005-11-26T04:05:00.000-08:00

The St. Louis Business Journal's online publication called St. Louis Bizwomen had a recent article titled " Infertility specialists boost marketing" in which the trend of fertility clinics applying new business approaches was discussed. While the focus of the article was the marketing of fertility treatment, the story had a number of interesting statistics.

Some of the statistics of interest included the following:

More than 6 million women in the U.S., or 10% of reproductive-age women, have fertility issues.
ART (assisted reproduction technology) procedures grew 43 percent in the U.S. from 1997 to 2002.
Average cost per ART cycle is $10,000 plus thousands of dollars more for diagnostic exams, genetic screenings and other expenses.
More than 100,000 ART procedures are performed each year in the U.S.
Infertility treatment is a $1 billion per year industry in he U.S.
Kato Ladies' Clinic in Tokyo, Japan is the world's largest IVF center and administers 14,000 cycles per year.
1 percent of the babies born in the U.S. each year are the result of IVF while in Europe the number is 5 percent, the difference being attributed to readily available insurance coverage in much of Europe.

The article also says that only about 20 percent of the demand for ART is met in the U.S. because so many couples who want it cannot afford it. Some centers are exploring innovative methods to make treatment more affordable such as long term financing and success guarantees.

The issue of insurance coverage for ART has clinics divided, some saying it will give access to more people while others say it will encourage lower quality treatment. The insurance providers are definitely against mandatory coverage requirements, and cite concerns such as the costs associated with complications such as delivery of triplets which can cost $250,000 U.S.

Potential side effects of IVF treatment

2005-11-21T05:33:00.000-08:00

Side effects of clomiphene citrate and gonadotrophins are rare and of short duration. Although concerns have been expressed over prolonged use of clomiphene, short-term, closely monitored treatment is considered safe. However, there are two important risks from ovulation induction - ovarian hyperstimulation syndrome (OHSS) and multiple pregnancy. When the likelihood of either is detected via ultrasound doctors typically stop the treatment cycle and do not proceed to the hCG injection.

The two potential side effects are:

Ovarian hyperstimulation syndrome (OHSS): A rare condition which occurs when too many follicles grow and cause abdominal distension, discomfort, nausea and sometimes difficulty breathing. In extreme cases hospitalization is necessary. OHSS is potentially serious but can be avoided by careful monitoring.

Multiple pregnancy: Studies show that multiple pregnancies are associated with an increased risk of miscarriage and premature delivery.

Prominent hospital sets upper age limit for IVF

2005-11-17T19:46:00.000-08:00

The Sydney Morning Herald reports that a prominent IVF center in Australia has decided to set an upper age limit for women seeking IVF treatment at their facility. The Westmead Hospital reviewed their cases and found that for women 43 and older there were only two live births for 250 women treated at their center. With a success rate of less than 1% for this age group they have made the ethical choice to limit IVF treatment to women under 43.

Elsewhere in Sydney the success rate for women 42 to 44 is reported to be five to ten percent per cycle. Westmead said that 50% of their patients are smokers, so perhaps this is contributing to a lower than average success rate.

Westmead is a nonprofit clinic which may be one reason why they have chosen to limit treatment instead of pushing it even for low probability cases. Older couples should remain realistic about their chances of success with IVF treatment. Remember that if you are in the 5% to 10% probability of success range that means each IVF cycle has only a 5% to 10% chance of success. It is not like you can do 10 cycles and guarantee success - each cycle is independent.