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Advanced Fertility

Fertility, IVF and Egg Donation

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Do IVF Clinics Cherry Pick Better Cases?

by on Feb.23, 2011, under CDC Report on Fertility Clinic IVF Success Rates, IVF Clinic Success Rates, SART IVF Success Rate Report

Cherry Picking?

I see a lot of couples that fail IVF at other in vitro fertilization programs and then come to us for their 3rd or 4th or 5th IVF attempt. They seek an IVF clinic that can give them a better outcome. Recently I’ve been hearing a similar story from couples that have failed at certain other IVF clinics in the Chicago area.

What to do if your first IVF cycle fails

These couples asked their fertility doctor why our clinic (Advanced Fertility Center of Chicago) has higher IVF and donor egg success rates than they have. They have been told that “Dr. Sherbahn cherry picks the best patients and does not treat patients with a low chance to get pregnant”. In other words they are accusing me of turning patients away with a low chance for pregnancy in order to cherry pick only the best patients and thereby artificially pump up our success rates.

It is a total crock. Patients that fail IVF again and again are likely to do IVF related research on the internet. They will find the CDC and SART websites where they can see if another clinic in their area has better pregnancy rates than the program where they failed.

How to research IVF success rates at US clinics

  • People are often motivated enough at that point to drive farther to a clinic that might give them a better chance for success.
  • Therefore, people that fail and often have egg quality problems or other issues holding back their success will tend to switch to programs with higher success rates after they have done research.
  • This results in programs like ours with higher than average success rates getting more patients with previous failures – which tend to be the most difficult cases.
  • As a result, we will get relatively fewer “easy” cases

We do not send patients away or tell them we will not do IVF on them unless they are menopausal or otherwise clearly have a very low chance of success. I believe that if the couple has about a 5% or better chance of success and has been educated about their chances – we should allow them to cycle here. Taking patients with a 5% chance of success is certainly not “cherry picking”

  • Some fertility specialists with big egos and poor quality IVF programs either just can’t accept the fact that their IVF programs aren’t very good – or perhaps they’re in denial and really believe that other programs have better success rates because they “cherry pick”
  • Either way it’s pitiful

The clinics with low success rates often say that the reason IVF success rates are different between clinics is because:

Because these things can be different between clinics they claim that comparing success rates is not valid. However, just because comparisons are not perfect does not mean that comparisons should not be made. We cannot expect 100,000 IVF patients coming to 500 clinics across America to all have equal potential for a successful pregnancy. Every case is different, every egg and every sperm is unique and even the uterus can vary to some extent.

  • However no clinic gets all the good cases, and no clinic gets only bad cases
  • A mix of patients will present themselves to every clinic for treatment

If we look at success rates of clinics in the US according to the CDC and SART 2008 data sets (see graph below), we see a range of live birth success rates for cycles using fresh donor eggs from 25% to 81% per transfer. The national average for 2008 was 55% per transfer.

Our donor egg success rates

Graph of success rates for 2008 egg donation cycles in USA

(continue reading…)

Richard Sherbahn

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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SET, Single Embryo Transfer for IVF – Pros and Cons

by on Nov.06, 2010, under IVF Cost, Number of IVF Embryos to Transfer, Single Embryo Transfer

Single embryo transfer is an up-and-coming more commonly utilized procedure in the field of in vitro fertilization in recent years. There has been a push for several years to reduce the number of multiple pregnancies by reducing the number of embryos transferred with IVF. However, the push to do elective single embryo transfer is opposed by most couples that do IVF in the US.

It is a simple problem without a simple solution:

  • Single embryo transfer success rates are lower than when 2 are transferred
  • Couples want a baby (or twins) ASAP, and they don’t want to pay for multiple IVF attempts
  • They fear failing to become pregnant more than they fear the risks from a twin pregnancy

This dilemma is often due to the fact that the large majority of patients in the US are self-pay for all costs associated with IVF. In the US the average cost of IVF is about $10,000 (for monitoring and procedures) and about $3500 for the medications. With these high costs, couples will often push for at least two embryos for transfer – even if the female partner is young.

Guidelines from the American Society for Reproductive Medicine (ASRM) were established many years ago for the maximum number of embryos to transfer (see table below). These guidelines take into consideration the age of the female and other criteria that help predict risks for having a multiple pregnancy.

ASRM guidelines have been modified over the years – with the recommended maximum number for transfer being reduced each time. I believe that the ASRM guidelines on the maximum number of embryos for transfer are excellent.

ASRM guidelines on maximum number of embryos to transfer
See PDF document with ASRM transfer guidelines

Currently the guidelines suggest a maximum of 1 to 2 embryos to be transferred for a female partner under 35 years old if the transfer is being done on day 2 or 3 – and a maximum of one embryo to be transferred for that age group if the transfer is being done on day 5. These maximum numbers are for patients considered to have a “favorable prognosis”.

When female age is over 35, the maximum number of embryos allowed increases. Everyone knows about the Octomom mess – a situation where a physician went way overboard – with a patient that was just as far out there…

Favorable prognosis would be couples having their first IVF attempt, good embryo morphology scoring, left over embryos available for freezing, or a previous successful IVF cycle. The guidelines allow transfer of additional embryos for patients that have a less favorable prognosis.

When single embryo transfer is performed, blastocyst embryo transfer on day 5 after fertilization appears to be the best method. Embryos that have continued developing normally to the 5th day have a higher chance of implanting than do day 3 embryos (on the average).

Day 5 blastocyst embryo

(continue reading…)

Richard Sherbahn

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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Is Mild, Micro or Mini IVF Cost Effective?

by on Aug.22, 2010, under IVF Clinic Success Rates, IVF Cost, Micro IVF, Mild IVF, Mini IVF, Minimal Stimulation IVF

There are some in vitro fertilization clinics in the US that market aggressively for mini-IVF or micro IVF (also called mild or minimal stimulation in vitro fertilization). Some claims regarding the benefits of mini-IVF are exaggerated or completely untrue. This post clarifies some issues regarding standard vs. mini IVF.

Mild IVF (or micro, or mini IVF) seems to be slowly growing in popularity over the last few years. Is it a good fertility treatment?

  • The basic concept is to do in vitro fertilization after a low level of ovarian stimulation with oral medications (possibly with some “low dose” injectables as well).
  • This is in contrast to the usual method of ovarian stimulation for IVF which involves more aggressive stimulation of the ovaries with multiple injections over about 8 to 15 days.
  • The standard method of stimulating is done in order to try to get about 10 or more eggs to work with for in vitro fertilization.
  • The IVF cycle cost for mild IVF (including medications and everything) should be less than the total cost for standard in vitro fertilization
  • However, the success rates for standard IVF are much higher
  • Success rates with mild in vitro fertilization are much lower – often in the range of about 5% to 15% per attempt, depending greatly on the age of the female

Why do we try to get so many eggs for “standard” IVF?

IVF success rates are much higher with a “good” number of eggs due to the substantial drop-off that is seen in early embryo development.

The chart below shows the average number of eggs, mature eggs, fertilized embryos, “good” embryos on day 3, blastocyst embryos on day 5, etc. in three age groups of women at our clinic.

  • If there are extra embryos available for freezing, we freeze on day 5 and day 6 (possible freezing shown by purple arrow going up).

As shown in the chart, in the average case there is progressive drop-off over time with in vitro fertilization. Human reproduction is not extremely efficient – if we were mice or cows we would be efficient reproducers. Alas, we are not so lucky – we are stuck being human…

(continue reading…)

Richard Sherbahn

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

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2008 SART IVF Clinic Success Rate Report

by on Feb.28, 2010, under IVF Clinic Success Rates, SART IVF Success Rate Report

In the United States it is very easy to investigate IVF success rates for all in vitro fertilization clinics

There are two websites that report IVF success rates annually to the public:

  • CDC website (Centers for Disease Control and Prevention)
    • CDC is a US government agency
  • SART website (Society for Assisted Reproductive Technology)
    • SART is an organization dedicated to the practice of IVF in the US
  • Links to these sites that report IVF success rates

The CDC IVF Success Rate Report for 2008 report has not yet been released. In vitro fertilization statistics are currently available from the CDC for 1999 through 2007.

In late February 2010 the Society for Assisted Reproductive Technology (SART) released the IVF Success Rate Report for 2008 cycles.

The SART report is released every year on the web and is available to the public. Almost all reputable in vitro fertilization centers are members of SART. Members are required to submit their in vitro fertilization data annually. Each clinic has its own listing page that shows its success rates on the SART website.

To view any clinic’s success rates through SART:

  1. Go to the SART website
  2. Click on IVF Success Rate Reports
  3. On the map, click the state that you are interested in.
  4. A list of all reputable SART member clinics in that state comes up.
  5. Click on any individual clinic – a page called “Clinic Contact Information” appears. At the bottom click the link next to “ART Data Report”. You will go to a page showing that center’s in vitro fertilization success rates for 2008.
  6. To see the center’s IVF statistics from a previous year, use the pulldown menu at the upper left where it says “Select Year”.

Although clinics with low success rates don’t mention it, there are large differences in success rates between clinics

There are number of reasons for this, but the biggest difference between different clinics is the degree of quality control within the system.

Patients often ask me why our success rates are so high. The answer is simple. (continue reading…)

Richard Sherbahn

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

more...

Egg Freezing to Extend Fertility – Ready for Prime Time?

by on Jan.20, 2010, under Age and Fertility, Egg Banking, Egg Freezing, Fertility Preservation, Oocyte Cryopreservation

What are the issues with freezing eggs to preserve fertility?

Can you freeze eggs in an attempt to preserve fertility for a future pregnancy?

There is currently controversy about:

  • Who should be offered egg freezing?
  • What should women of different ages be told about their chances for having a baby with frozen eggs?
  • Are women who freeze eggs well informed about the chances to have a baby in the future with their frozen eggs?

What do recent studies show regarding pregnancy success rates using frozen eggs?

Egg freezing is relatively new

  • IVF with fresh eggs has reportedly resulted in the birth of about 3 million babies worldwide
  • IVF with frozen eggs has resulted in the birth of about 2000 babies worldwide
  • Studies continue to investigate whether the older “slow freezing” technology or the newer method of “vitrifying” eggs will be better

Older studies

  • Studies from the 1990’s to early 2000’s showed pregnancy success rates with frozen eggs of about 2% to 10% (live birth rate per embryo transfer cycle).

Recent studies

  • A recent study from an Italian group found similar fertilization and embryo development rates of vitrified versus fresh eggs. Vitrification is a relatively new freezing method.
    • This study involved 40 cycles in women (average age 35.5)
    • The ongoing pregnancy rate (beyond 12 weeks of pregnancy) with vitrified eggs was 30% per cycle.
    • This is a good rate since only 3 eggs can be inseminated under Italian law.
      • Study by L Rienzi, et al, Human Reproduction; January 2010

     

  • A 2009 study of 23 IVF cycles using frozen eggs (average age 31.5)
    • There were 14 pregnancies, 1 miscarriage and 13 ongoing pregnancies (57% per transfer)
      • Study by J Grifo and N Noyes, Fertility and Sterility; May 2009
  • A large multicenter Italian study compared IVF using fresh vs. frozen eggs
    • Italian IVF clinics tend to have lower success rates because only 3 eggs can be inseminated per cycle (by law)
    • They compared 2209 cycles with fresh eggs to 940 cycles with frozen eggs
    • The success rate was halved using frozen instead of fresh eggs
    • 748 thawing cycles in women less than 39 years old (average age 33.6)
      • Live birth rate per transfer with frozen eggs was 13.3% (age < 39)
    • 192 thawing cycles in women 39 and older (average age 40.5)
      • Live birth rate per transfer with frozen eggs was 8.1% (age 39+)
    • Study by A Borini et al, Fertility and Sterility; January 2010

(continue reading…)

Richard Sherbahn

Richard Sherbahn, MD is a fertility doctor practicing in the Chicago, Illinois area. Connect with me on Google+

more...

Welcome to the
Advanced Fertility

Richard Sherbahn, MD is a Board Certified Reproductive Endocrinology and Infertility specialist.

Dr. Sherbahn founded the Advanced Fertility Center of Chicago in 1997.

He will post regularly about fertility issues.

Dr. Richard Sherbahn
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