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Efficacy of “Mini IVF” Under Question, New Study at Center for Human Reproduction Reveals

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Posted by Marie on April 4, 2012 at 2:13 pm

CHRApril 4, 2012 (New York, NY) —A new study by New York’s Center for Human Reproduction (CHR) has cast doubts on the efficacy of low intensity IVF (LI-IVF) programs, marketed under various names like “mini IVF” and “natural IVF.” According to the study, LI-IVF programs, which utilize lower doses of fertility medications to reduce costs and monitoring visits, do not live up to their proponents’ claims of pregnancy rates comparable to those in conventional low cost IVF.

To evaluate the claims that LI-IVF is more economical and more “patient-friendly,” researchers at CHR matched patients in LI-IVF cycles to comparable patients undergoing traditional IVF cycles. In the resulting study, just published online in the medical journal Reproductive Biomedicine Online1, patients in LI-IVF cycles produced significantly fewer oocytes and embryos, and faced much lower pregnancy rates. Lower pregnancy rates for LI-IVF patients were observed both in initial IVF cycles and cumulatively, taking account of subsequent transfers of cryopreserved embryos.

Most surprisingly, however, when overall costs to achieve a pregnancy were compared, highly touted “cost savings” with LI-IVF were nowhere to be observed. Lower pregnancy rates associated with LI-IVF meant that LI-IVF patients on average needed more cycles to have a take-home baby, which meant the lower per-cycle cost of LI-IVF did not translate into lower cost to achieve a successful pregnancy and delivery. Patients in LI-IVF cycles also took longer to conceive.

“LI-IVF appears to reduce pregnancy chances and prolong time to conception without offering any appreciable compensatory financial benefits,” summarizes Norbert Gleicher, MD, the study’s lead author and medical director of CHR. “When patients started asking for LI-IVF at our center, we, like many other IVF centers, decided to offer the procedure. In contrast to other centers, we, however, explained to our patients that LI-IVF should still be considered ‘experimental’ since no data existed, that compared this method of IVF to standard IVF.”

CHR required that patients sign “experimental” informed consents, and started accumulating outcome data.  Dr. Gleicher now notes: “As the result of our study well demonstrates, doing otherwise would have been rather unethical.”

“We must caution patients against resorting to ‘mini IVF’ or ‘natural IVF’ without carefully weighing their options,” warns David Barad, MD, another author of the study and director of clinical ART at CHR. “Until more data becomes available, physicians should offer LI-IVF only as an experimental procedure.”

1Gleicher N et al., A case-control pilot study of low-intensity IVF in good-prognosis patients. Reprod Biomed Online 2012; In press. [Epub ahead of print].

 

About Center for Human Reproduction
Center for Human Reproduction (CHR, http://www.centerforhumanreprod.com) is a leading fertility center in New York City with a worldwide reputation as a “fertility center of last resort,” offering cutting-edge, research-based treatment options to patients with even the most complex cases of infertility. Dr. Gleicher and Dr. Barad are available for additional comments.

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US Denies Citizenship for In Vitro Fertilization Babies Born Overseas

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Posted by RobynNazarRN on March 20, 2012 at 2:03 pm

Children born to US citizens as a result of in vitro fertilization overseas may not be eligible for citizenship if a biological link between the parents and children cannot be established, reported USA Today online. This appalling legal loophole is a reminder of how US immigration laws are failing to keep up with reproductive technology.

Fertility Treatments Abroad and the Law

With the skyrocketing costs of infertility treatments at home and increasingly mobile culture of Americans, it is not all that uncommon for US citizens to receive infertility treatments, such as in vitro fertilization, while abroad. In fact, infertility treatments are currently one of the fastest growing areas of medical tourism in other countries.

However, according to the US State Department, a child born overseas cannot be granted citizenship until a biological connection can be proved with at least one parent. Should the woman have used an egg donation to become pregnant via IVF, then this biological link cannot be established.

“There is an established process for U.S. parents who want to transfer citizenship to their adopted children, but no such avenue exists for parents whose children, conceived with someone else’s eggs or sperm, emerged from their wombs,” Wolgel said.

USA Today reports that the US State Department is currently “studying” whether or not it can begin reinterpreting the U.S. Immigration and nationality Act in order to include children born overseas due to artificial reproductive technology, such as in vitro fertilization and egg donation.

 

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Can IVF Success Rates be Improved with New UK Technique?

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Posted by RobynNazarRN on March 15, 2012 at 2:14 pm

A new technique developed by researchers in Europe has been shown to significantly improve IVF success rates in the UK. However, can this same technique be applied in the US?

 

According to the study, which was published last week in the PLoS ONE journal, by using a new closed-incubator system in which embryos are handled in the in vitro fertilization process, IVF success rates were improved by up to 27%.

 

“By offering protection against external influences such as chemical pollutants, and protection from temperature and pH fluctuations, the [new] system facilitates consistent and reproducible outcomes in assisted conception treatments,” wrote the authors of the study in their report.

 

Normally, during and IVF procedure, between the time when embryos are created and transferred into the uterus, they are monitored in a laboratory setting. This monitoring process requires periodic removal from the incubators, and therefore exposure to the outside environment.

 

“Having a well-controlled environment in in vitro fertilization is very important for success,” explained Dr. Robert Stillman, medical director of Shady Grove Fertility Center, to TIME.

 

Can IVF Success Rates Be Improved in the US?

 

However, IVF success rates in the US are already generally quite a bit better than those in the UK. In Europe, due to healthcare restrictions and the widespread implementation of single embryo transfer policies, IVF success rates have been stuck in the low-30% for many years.

 

“The most recent European data show clinical IVF pregnancy rate per cycle of 32.5%,” said the Center for Human Reproduction in statement last month. “Conservatively assuming a miscarriage rate of 15%, this would translate into delivery rates of 26.6%. During the same time period, the US delivery rate was 40.7%.”

 

Similar advanced embryo incubator techniques, including the use of micro-environments and controlled video systems are already being employed in the US and therefore contribute to already significantly better IVF success rates.

 

“[These researchers] have the right idea,” concluded Dr. Stillman to TIME. “If you control the environment, you often get improvements in outcomes with IVF. But would we be able to increase our success rates by 27%? I think [the US is] already toward the max.”

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Landmark In Vitro Fertilization Case

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Posted by Franco Cignelli on March 9, 2012 at 11:26 am

In Vitro Fertilization

A Massachusetts appeals court has ordered a man to pay child support for his ex-wife’s twins, conceived through in vitro fertilization.

The ruling was made in spite of a written agreement between the couple that he would not be held financially responsible, and considering he’s not the children’s biological father.

Chukwudera Okoli now lives with his new wife, her son, and their three daughters in Boston.

He was married to his ex-wife, Blessing, for nine years, but they never conceived a child. After five years of marriage, the couple decided to separate.

In 2001, Okoli started a family with his new girlfriend, whom he eventually married. That year, Blessing asked him to sign papers to get pregnant through in vitro fertilization. At the time he was legally still her husband, and as a result she couldn’t receive IVF treatment without his permission.

The two agreed in writing,  “Okoli does not have any financial obligations with regards to IVF results,” and “Blessing Okoli will not at any time ask or sue for any other financial obligation.”

With IVF success rates, Blessing gave birth to twin daughters in 2003 and three years later, she sued Okoli for child support and won.

Okoli unsuccessfully appealed the decision. The court concluded that by signing the document he intended to create children. The written agreement was dismissed because Okoli had signed the IVF documents. The judge concluded that it was in the best interest of the children that Okoli financially support them.

Okoli has filed a complaint against the judge in the case, and is adamant that he will never be a father to the twins. He plans to take the case to the state’s Supreme Court.

It’s another recent example of how the courts need to change to adapt to the evolving way people are conceiving children. This is a landmark decision because it’s the first time where a man has been ordered to pay for children conceived through in vitro fertilization.

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Government Should Stay Out of IVF, Says Docs

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Posted by RobynNazarRN on February 7, 2012 at 1:37 pm

In vitro fertilization (IVF) pregnancy rates have been steadily rising in the US over the past few years, a stark contrast to European nations where dwindling success rates for this infertility treatment are believed to be a result of government bureaucracy.

 

According to a statement released by the Center for Human Reproduction (CHR) in New York City yesterday, the chances of women in the United States delivering a baby as a result of IVF infertility treatments is approximately 40.7%. However, for women in Europe receiving the same treatment, the birth rate is only a mere 26.6%.

 

This startling contrast has many experts wondering why such disparities could exist among nations which have equal access to available reproductive technology.

 

CHR’s founder Dr. Norbert Gleicher speculates that this is likely the direct result of European government policies which restrict the number of embryos which can be transferred during an IVF treatment cycle.

 

“A part of the reason is the recent propagation of single-embryo transfer (sET) in Europe,” explains Dr. Gleicher. “In Europe, fertility experts and governments alike consider the reduced risk of multiple pregnancies through sET a good enough reason to offset lower pregnancy chances caused by sET. Thus, many European countries mandate sET despite irrefutable evidence that patients value nothing more than better chances of pregnancy in choosing their infertility treatments.”

 

Single-embryo transfer policies were put in place with the hope of answering the question of how to prevent miscarriages among other fetal and maternal complications which come as a result of multiple pregnancies. However, according to Dr. Gleicher, these policies infringe upon individual rights, increase costs to patients, and reduce the chances of infertile couples achieving success with IVF treatments.

 

“If there is a lesson to be learned here,” says Dr. Gleicher, “it is that IVF pregnancy rates in the U.S. will continue to improve, as long as IVF research and clinical care remain largely unaffected by government interference, and primarily driven by success in the marketplace, as they have over the last few decades.”

 

 

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European Nations Fall Behind US in IVF Pregnancy Rates

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Posted by Marie on February 6, 2012 at 10:59 am

February 6, 2012 (New York, NY) – Recent reports of plateauing IVF pregnancy rates in Europe are in stark contrast to still-rising rates IVFin the US, according to Norbert Gleicher, M.D., a prominent fertility expert and Medical Director of the Center for Human Reproduction (CHR) in New York City. Behind this difference may be a fundamental difference in approaches to the patient-physician relationship in Europe and the US.

Focus on Reproduction, the official magazine of the European Society for Human Reproduction and Embryology (ESHRE), recently reported that in Europe overall IVF pregnancy rates have leveled off.

As first reported by Dr. Gleicher’s team in 2006(1,2), European IVF pregnancy rates are significantly lower than American rates.  The most recent European data show clinical pregnancy rate per cycle of 32.5%. Conservatively assuming a miscarriage rate of 15%, this would translate into delivery rates of 26.6%. During the same time period, the US delivery rate was 40.7%.

The question is why.

“A part of the reason is the recent propagation of single-embryo transfer (sET) in Europe,” explains Dr. Gleicher. “In Europe, fertility experts and governments alike consider the reduced risk of multiple pregnancies through sET a good enough reason to offset lower pregnancy chances caused by sET. Thus, many European countries mandate sET despite irrefutable evidence that patients value nothing more than better chances of pregnancy in choosing their infertility treatments.

“This is a good example for the fundamental difference in the socio-medical philosophy between Europe and the US,” points out Dr. Gleicher: “Europe values what they perceive as the ‘common good’ over individual rights of patients. What they fail to recognize, however, are the unintended consequences affecting the patient-physician relationship and, most importantly, IVF outcomes.”

He continues: “Not only do patients end up with much lower pregnancy chances with IVF than their U.S. counterparts, they, in the end, are also forced to undergo more IVF cycles , at more cost, and, of course, more risks.” Europe, therefore, performs more than three-times as many IVF cycles per capita than the US. The same philosophy in Europe also results in outright rationing. For example, most Scandinavian countries withhold all IVF treatment from women above age 40-41, an approach unthinkable in the US.

“If there is a lesson to be learned here,” says Dr. Gleicher, “it is that IVF pregnancy rates in the U.S. will continue to improve, as long as IVF research and clinical care remain largely unaffected by government interference, and primarily driven by success in the marketplace, as they have over the last few decades.”

 

(1)Gleicher et al. A formal comparison of the practice of assisted reproductive technologies between Europe and the USA. Hum Reprod 2006;21:1945-50; (2)Gleicher et al. Update on the comparison of assisted reproduction outcomes between Europe and the USA: the 2002 data Fertil Steril 2007;87:1301-5.

 

About Center for Human Reproduction

Center for Human Reproduction, or CHR, is a leading fertility center in the United States with a worldwide reputation as a “fertility center of last resort,” specializing in treatment of infertility in women with diminished ovarian reserve. Under the leadership of Dr. Norbert Gleicher, CHR has been helping many European patients—in addition to local New York and North American patients—receive state-of-the-art fertility treatments. Dr. Gleicher is available for additional comments.

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Gingrich Proposes Careful Review of IVF Ethics

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Posted by Amanda Rahi on February 2, 2012 at 3:56 pm

Newt Gingrich, republican presidential contender, proposed on Sunday that we need a higher level of consideration of the ethics involved in in vitro fertilization (IVF) treatments.

In an article published this week in Times Heartland, Gingrich is reported to believe that there are many ethical issues surround assisted reproductive technology that have yet to be touch upon. Specifically, he is concerned about frozen unused embryos.

According to this Times report, in 2003 there were approximately 400,000 frozen embryos. Today there are undoubtedly far more.  Given that they are hundreds or thousands of embryos frozen in clinics across the country and in the world, Gingrich believes that we should considering the ethics of making embryos, which are essentially human life, and then never using them.

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Don’t Let Infertility Treatment Get in the Way of Friendship

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Posted by Amanda Rahi on October 4, 2011 at 11:31 am

What do you do when you have to turn to infertility treatment and a good friend or an acquaintance tells you she is pregnant? It does not seem fair and you cannot find it in your heart to be happy for her.

Maybe you have been trying to get pregnant for some time now or maybe you went through an IVF that was unsuccessful.

Infertility treatment can by physically and emotionally demanding. Couples’ expectations combined with invested time and money committed to treatments can result in high stress and an intense setting. An IVF procedure, for example, can require a high level of emotional energy as a single cycle can take between six weeks and two months on average.

The Center for Human Reproduction IVF New York reports that,

“some couples may find it both physically and mentally draining.”

Fortunately, many physicians and staff members at fertility clinics are trained in dealing with the emotional aspect of an infertility treatment.

The Center for Human Reproduction believes that their extensive experience with couples going through IVF allows them to provide the support couple needs during the difficult time.

As a woman dealing with infertility, it is important to understand the difficulties at the emotional level and that it is very normal, natural, and understandable to deal with difficult emotions.

The news of a good friend’s pregnancy can be enough to give you heartbreak. If you are seeking infertility treatment, see your physician for ways to help you understand and cope with your feelings. In the meantime, hopefully your friend will understand what you are going through.

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IVF Clinic’s Selectivity Heavily Based on Weight

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Posted by Amanda Rahi on September 23, 2011 at 4:53 pm

A fertility clinic in Ottawa stands clear and firm in its position to deny overweight women IVF treatments.

According to Dr. Arthur Leader, the co-founder of the Ottawa Fertility Centre, women with a Body Mass Index higher than 35 are put at too high a risk while undergoing IVF. Such women are instead encouraged to begin a weight loss program.

Leader explains that women with BMIs over 30 are both three times more likely to have infertility problems and to have an IVF procedure failure. Given such high risks, Learner clarifies that his primary job to care for his patients and to do no harm prevents him from treating overweight patients.

Aside from a doctor’s duty to care for patients, it is hard to ignore the ubiquitous and controversial nature of the business of medicine.  Fertility clinics have to work hard to keep their ranking and prestige and having a high IVF success rate can help attract more clients and business. Therefore, it can be argued that by denying overweight patients, they are working to prevent the business from failing as well.

However, choosing to live a healthier lifestyle and losing extra weight can never be a bad thing and Leader has a good argument for guiding overweight women to start a weight loss plan. It could only be better for both women and their babies. It is also should be noted that Learner is one fertility doctor, and woman should also seek a second opinion about their conditions. There are very credible and valuable resources available to women interested in IVF. For example, The Center for Human Reproduction is a fertility center leading IVF New York for the past twenty-nine years and provides excellent information on fertility and IVF treatment.

To learn more about The Center for Human Reproduction visit http://www.centerforhumanreprod.com/ivf.html, or head to their YouTube Channel for more information.

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Guiliana and Bill Have Reason for Hope in Third IVF Attempt

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Posted by Amanda Rahi on September 20, 2011 at 1:51 pm

The Style Network star Guiliana and Bill are once again optimistic as they begin their third attempt at IVF. The heartbreak and disappointment of their miscarriage last year have not kept them away for long.

The celebrity couple started in vitro fertilization in March of 2010. Their first attempt resulted in pregnancy, but at only eight weeks Guiliana suffered a miscarriage. After their second attempt in November 2010 was unsuccessful, the heartbroken couple decided to put aside their desire for children in order to recover from the disappointment.

According to the Center for Human Reproduction, IVF pregnancy rates have been improving since the inception of the technique, but at a much slower rate in the last few years. In Guiliana’s case, the doctor reports that her uterus did not fail her and that she has reason to be hopeful in this next attempt.

Bill remarks that the doctor’s positive commentary “is a breath of fresh air”.

Despite their good candidacy, there is always the possibility of another failure. ‘We’re going to keep trying ourselves, but if it doesn’t work out, there are so many other great alternatives. We’re open to everything,’ commented Giuliana.  The couple’s alternatives include egg donation, or even adoption.

However, Guiliana emphasizes their optimism, stating that “we haven’t had this much hope in a long, long time”.

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