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Temporary Home of IVF Traveler

My apologies, but you have been redirected here from my main website – www.ivftraveler.com while it is undergoing some maintenance.   Please check back in a day or two and the website should be back with all of its content.

In the interim, if you need to reach me you can email me at info@ivftraveler.com

Why IVF in Czech?

I often get asked why people choose to go to the Czech Republic for IVF, donor egg IVF, and donor embryo treatments.  My friends Kathryn Kaycoff-Manos, MA and Lauri Berger de Brito over at Global IVF have recently been traveling in Europe speaking at a conference on cross border reproductive care. Their travels also included Prague and Brno and they kindly invited me to write a guest post for their blog on the subject of why people choose to go to the Czech Republic for their IVF Vacations.

Please stop by and let me know what you think, or tell me if I missed any key factors that made it appealing to you: http://www.globalivf.com/blog/?p=745

 

One last reminder…..this blog is has now been moved.  Please come over to our new home at www.ivftraveler.com/blog so you don’t miss out on new posts and hopefully many more lively discussions about traveling abroad for IVF treatments.

In case you haven’t yet found us at our new home, here are the most recent posts you have missed:

Comparing Clinic IVF Success Rates takes a look behind the statistics at what to ask a clinic to help you compare statistics and pick a clinic that is best for your case.

Will Transferring 2 Embryos Improve Implantation or Birth Rates talks about a new study suggesting that implantation and live birth rates may be higher from transferring two embryos due to a concept that suggests a stronger embryo might help a weaker embryo survive.  Controversial for sure.

To make sure you don’t miss any other updates, be sure to add the blog RSS feed to your favorite reader: http://www.ivftraveler.com/blog/feed    Or, just come by and visit the new site www.ivftraveler.com.

A Week Of Joyful Announcements

While everyone is still finding the blog in its new location, I thought I’d post links here for the next few weeks when a new blog post is published.

Here’s a link to today’s post: A Week Of Joyful Announcements 

Over the past month or maybe more, I’ve been in the process of moving this blog to new digs.  That’s why it has been so quiet here – moving and getting settled in my new online place was a lot more work than I had anticipated.  So thanks to those of you who stuck with me through the long pause.

I finally built a full IVF Traveler website, and now I have moved this blog into my new website home.   Now the move is done, and after lots of testing and tweaking, hopefully everything is working as it should.

So, please come join me over at my new place for a little open house – you can take a peek around and tell me what you think of my new website www.ivftraveler.com. I am offering some new services, and I’m very excited about how the business is growing.

I do plan to start more regularly blogging about IVF and egg donor IVF around the world on this blog.   The new blog URL is www.ivftraveler.com/blog I hope that you will stop by, and add my new RSS feed to your favorite blog reader.

A new non-invasive test for detecting Down syndrome was announced recently and reported in this NY Times article.  This new test by Sequenom tests for Down syndrome by testing a sample of the mother’s blood rather than the more invasive tests of amniocentesis or CVS (chorionic villus sampling) which are the routine tests currently performed to check for chromosomal abnormalities, both of which carry risk of miscarriage.

According to a recent study published by the journal Genetics in Medicine, this new test was 98.6% accurate in picking up Down Syndrome cases, with a less than .02% risk of a false positive.  However, in the cases where Down Syndrome is detected, further invasive procedures that test all chromosomes are often recommended for additional confirmation.

Because the test does not pose a risk to the fetus and because it can be used as early as 10 weeks of pregnancy (earlier than both other current tests) experts believe it may result in fewer of the more invasive procedures being performed.  The drawback is that the test is not able to detect other chromosomal abnormalities, including a few rare forms of Down Syndrome that do not have three copies of chromosome 21.

The controversy (and potential medical ethics question) that arises is whether tests such as these will lead to more pregnancy terminations when Down Syndrome is detected, which would lead to diminished support and services for those currently living with this condition.

Two other companies have announced plans to release similar tests in 2012, and with the technologies that are being utilized for genetic analysis in these tests, we can expect future tests that may make it possible to prenatally diagnose abnormalities that do not involve extra chromosomes.

Read more at:http://www.nytimes.com/2011/10/18/business/sequenom-test-for-down-syndrome-raises-hopes-and-questions.html

Fertility Success Rates recently published their list of the top US clinics for Live Birth rates with Fresh Donor Eggs.  They are reporting that this data is based on the 2009 Society For Assisted Reproductive Technology (aka SART) IVF Success Rates data (note: not all reproductive clinics report to SART).

The top two clinics were no surprise since they have been on the top of most DE lists for several years.  However, a few other clinics who rounded out the top 10 were not who I expected, and a few that I expected to be there did not make the list.

Of course, this data is from 2009 cycles, so we know that the current statistics may be very different, and it is in the best interest of the patient to check with clinics for their most recent statistics.   When comparing recent statistics, I personally think that clinical pregnancies are a good indicator for recent comparisons before the live birth rate is available.  After all, the reproductive doctor gets you pregnant, but really has very little control over what happens after a clinical pregnancy is confirmed and you are no longer under their care.

And so without further ado, here is the SART 2009 IVF Success Rates for Fresh Donor Egg cycles at clinics in the US – listed with Live Birth Rates, and number of cycles:

  1. San Diego Fertility Center – 85.1% live birth rate per transfer, 67 cycles
  2. Oregon Reproductive Medicine – 82.2% live birth rate per transfer, 90 cycles
  3. Houston IVF – 80.5% live birth rate per transfer, 41 cycles
  4. Utah Center for Reproductive Medicine – 79.2% live birth rate per transfer, 24 cycles
  5. Advanced Fertility Center of Chicago – 74% live birth rate per transfer, 50 cycles
  6. Pacific NW Fertility and IVF Specialists – 73.1% live birth rate per transfer, 93 cycles
  7. Reproductive Specialty Medical Center (Newport Beach, CA) – 73.1% live birth rate per transfer, 26 cycles
  8. Center of Reproductive Medicine (Webster, TX) – 72.7% live birth rate per transfer, 33 cycles
  9. Colorado Ctr. for Reproductive Medicine (Lone Tree, CO) – 70.6% live birth rate per transfer, 204 cycles
  10. Center for Assisted Reproduction (Bedford, TX) – 70% live birth rate per transfer, 30 cycles

Male Biological Clocks

Biological clocks – they aren’t just for women anymore.  A recent article referencing a male factor infertility study showed that there is a decline in male fertility after age 41, and it points to an even sharper decline after age 45.  It isn’t the same decline that we often see with women’s eggs, but certainly another factor to consider in the infertility big picture.  Isn’t it interesting that it took a donor egg study (that allowed them to eliminate the female partner’s eggs as a factor) to highlight this male fertility decline?

I have long been surprised and slightly irritated that so much focus is put on a woman’s eggs as the likely culprit when fertility issues arise. Often the only testing done for the male partner related to sperm quality is a semen analysis to measure volume, motility and morphology – even if the male partner is over 45 – 50 years old.   Even sperm that appears to be normal in a routine semen analysis may have extensive DNA fragmentation.  It has been reported that 40 – 50% of infertility cases have male factors as at least a contributing cause (although not necessarily the only cause), yet little is done to scrutinize potential male factors.

While I am certain that statistically speaking the likelihood of the eggs being the issue is high if the woman is over 40, but why not also test the male partner as well (beyond simple semen analysis) to see if DNA fragmentation may be a factor?   The SCSA test (Sperm Chromatin Structure Assay) is relatively inexpensive, and can at least provide some information to factor into the decision-making process.  A simplistic view of this is that a semen analysis looks at the outside of the sperm, whereas the SCSA does a better job of assessing the inside of the sperm and how DNA integrity may impact embryos. Inciid.org (The InterNational Council on Infertility Informatino Dissemination, Inc.) provides a very good article about SCSA testing that describes how it works and answers commonly asked questions.

While some doctors say the test is not always a 100% accurate determination of fertility, it does give some indication as to whether a little focus should be put in the male partner’s lap (ha!) too.  Generally, there is not a procedure that doctors can do to improve the results if they are bad.  Many experts will recommend specific vitamins (particularly antioxidants) and lifestyle changes (reducing stress, improving diet, minimizing opportunities for increased testicular temperature) that the male partner can implement.  These changes usually need to be in place for at least 3 months prior to providing the “swimmers” for a cycle to improve the odds of success.

Also, the results of this test may also trigger recommendations for the use of ICSI or PICSI to aid in selecting the best sperm for fertilization.  And in some cases, couples may instead use the test results to decide to use donor sperm in addition to donor eggs – or even consider frozen donor embryos.   But absent these test results (which is often the case) couples may not realize that sperm may be contributing to continued infertility (even with donor eggs).

I have seen cases where women are on their 4th or 5th IVF cycle before the doctor recognizes some signs that sperm may contributing to the lack of success.  Here are some things that may be an indicator that further sperm testing should be discussed with your doctor:

  • sperm does not survive freezing and thawing well
  • semen analysis shows high levels of abnormal sperm
  • male partner is over 45 years old
  • higher than normal embryo demise between day 3 and 5 in the IVF laboratory (the sperm has a lot of responsibility for growth during those days)
  • recurring miscarriages

I think often it isn’t until eggs and other female factors have been eliminated that the potential sperm issues finally get attention.  But why wait until the second or third very expensive unsuccessful cycle to explore something that is so easy, non-invasive and inexpensive to check early?

While the SCSA and other sperm testing is not some magic solution, it is most certainly worth discussing with your doctor to see if it may be a valuable tool in assessing your own fertility issues and treatment plans.

RESOLVE has started a petition directed to the Department of Health and Human Services Secretary Sebelius who is tasked with determining the Essential Benefits to be included in each state’s health insurance exchange effective January, 2014. RESOLVE’s goal is to gather 7,300 signatures, one for every one thousand Americans impacted by infertility. I think that we can do MUCH better than that.

Please join me and add your name to this initiative aimed at requiring health insurance coverage for the 7.3 million Americans diagnosed with infertility each year. Click here to make your voice heard.

A recent New York Times article posed the question “Do You Suffer From Decision Fatigue“?  It went on to describe how making decision after decision can wear people down, sometimes resulting in poor choices or a different choice than may have been made with a fresh mind.

It reminded me of the overwhelming number of decisions that have to be made during an infertility journey, particularly the choices made during an IVF cycle.  By the end of the cycle, or end of the journey, are we making the same decisions we would have made when our minds were fresh (or maybe we were more naive)?

I think there is something to be said for the fact that some decisions should be made after a good night’s sleep.  Whether it is own egg or donor egg IVF, fresh cycle or frozen donor eggs or donor embryos, domestic clinic or international clinic, proven or unproven donor, how many embryos to transfer, whether to do PGD testing, what foods to eat or avoid, accupuncture or not, which type of progesterone, POAS or not?  The list feels like an endless number of decisions that have to be made.

By the end of a cycle  we’re on the rollercoaster of emotions hopped up on estrogen and progesterone (and maybe steroids or blood thinners) and that is when we are making these all important decisions – and then second guessing them over and over again.  It is no wonder that we are driving ourselves simply crazy with worry and “what ifs”.  And usually, that is when we gather our trusted friends and confidantes around us to talk us off of the cliff and help us hold on to hope or at least cautious optimism or neutrality.

Although not much can be done to lessen the number of hard choices to be made, I think we can be cognizant of identifying which choices will need to be made, and when – and what decision points or input will be necessary prior to making those decisions.  I think it is the last minute – “quick, decide now” types of decisions that are most often replayed over and over in our minds.  The ones where perhaps we felt unprepared, or caught off guard – those are the ones that often keep people awake at night wondering…..what if.

So, my advice is to know yourself (when you are at your best decision-making) and try to make the majority of the important decisions with a clear, fresh head and full stomach. Then, make sure you review with your clinic and doctor what decisions you will be asked to make, and when. That way you can be prepared, and maybe even have a chance to discuss it with your partner (if you have one) or trusted IVF friends in advance for additional input.  And lastly, trust your instincts.  Usually your gut will not steer you wrong.   And if all else fails and there is no one “right” answer, what always worked for me was asking myself “if things go wrong, which choice will I regret less”.

Happy decision-making.