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Posts Tagged ‘donor ivf’

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

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Although it sounds counter-intuitive, in the past few years, several studies have shown a marked increase in IVF implantation/success when patients have undergone an endometrial biopsy (also known as LEI – luteal phase endometerial injury) prior to IVF treatment.

In the initial Israeli study by Dr. Dekel in 2003, they seemed to sort of “discover” this happy outcome by happenstance.  They noticed a correlation between women (doing own egg IVF) who had an endometrial biopsy and also had increased implantation success rates – regardless of the findings from the biopsy when the tissue was tested.  The initial study was quite small –  134 women – 45 who had the biopsy, and 89 who did not.   In that study 27.7% of women who had the biopsy got pregnant vs. 14.2% of the control group who did not have the biopsy.

Although there is no clear explanation for the increase, the general theory was that by injuring the lining of the uterus, the body was sending increased blood flow or proteins with healing properties that improved the ability of the embryos to attach to the uterus.

More recently, at the European Society of Human Reproduction adn Embryology (ESHRE) meeting in Stockholm, Dr. Fernando Prado Ferreira from the Federal University of Sao Paulo presented the findings of a similar study based at Santa Joana Maternity Hospital in Sao Paulo Brazil.  In his trial of 144 women, 46 were given biopsies and 98 were not.  He reported that in the patients who had a biopsy, there was almost double the chances of a pregnancy over patients who did not have the biopsy.

He went on to explain that “The endometrial biopsy appears to lead to scarring in the uterus that provides better adhesion of the embryo, either through the scarring itself or through substances called cytokines released when the wound is caused in the womb.”

Many reproductive experts have been skeptical of the outcomes and have called for further randomized studies on this subject.  It has been suggested that perhaps Dr. Ferreira’s use of the word “scarring” wasn’t the best word to use because the uterine lining would normally heal without scarring from this procedure.  Perhaps referring to it as “healing” may have been more appropriate, but the use of the word “scarring” may be attributed to the fact that English is not Dr. Ferreira’s native language.

There also appears to be a difference of opinion about when is most effective to perform this biopsy.   Generally, it seems to be performed shortly before starting the medications for the IVF treatment, FET (frozen embryo transfer), or donor egg IVF treatment cycle.

Still, the studies of this procedure to date have been small, and no randomized studies have been done, so there still remains much to be learned about the use of this procedure for increasing success.

The good news is that – unlike most fertility procedures – this one is relatively inexpensive to do.  Just a few minutes in your RE or OB office where they use a suction catheter through the cervix into the uterus where they take a small biopsy of the uterine wall.  There is no need to send the tissue out for testing, it is simply discarded since the value of this procedure seems to be the injury rather than any potential information gathered from the tissue.

In any event, in cases where there have been repeated IVF treatments with failure to implant and no known cause, it may be worth exploring this option.

I think perhaps the best advice is to discuss this with your RE to see if it might be beneficial in your specific case.

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I recently read this really terrific blog post about if and when to POAS (pee on a stick – or take a home pregnancy test)  after an IVF treatment.  The author, Lisa Rouff, Ph.D., is a psychologist specializing in infertility and adoption.   You can read the full post here.

Dr. Rouff  offers some great insight about deciding IF you should consider POAS, and if so, when to start trying – based on your own expectations and tolerance. In other words, she tells you how to be “smart” about POAS based on your own personality. 

One consideration that she doesn’t cover, is that sometimes home pregnancy tests can give you a sense of whether the embryo is implanting or not.  If your clinic tells you to test at day 12 – 14 post transfer, you may have a negative test – but not know that the embryo had implanted but your hCG has already fallen to the “not pregnant” level.  The one benefit of POAS rather early (say around 6 – 8 days post transfer for a donor IVF cycle, or 10 – 12 days post trigger shot for an own egg IVF cycle) is that if the embryo implanted and hCG started rising, you will likely get a positive test result early – even though it may turn into a negative if the pregnancy is not viable.   

While that seems like it would get hopes up unnecessarily (which is why some clinics prefer to test around day 14 post transfer), I have seen patients with more than one failed IVF use this information to help determine whether there is simply a failure of the embryo to implant, or whether it may be immune or embryo quality issues that are happening after implantation.  

I don’t necessarily recommend this option for everyone, but it is something to consider as an additional information tool in figuring out the infertility puzzle.

PS- In my experience, the most sensitive test on the market right now is the Target brand (called “UP” I think) two line test.   Stay away from the digital tests – they generally are not as sensitive as the two line tests, which seem to be even more sensitive than the + or – tests.

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In the past year several countries have made pretty significant changes to their legislation related to third party reproduction – particularly IVF with donor eggs or surrogacy.  Some have been progressive, and sadly, some made access to treatment more difficult in their own countries.   

Thankfully, the technology for these treatments has been steadily improving with amazing advances improving IVF success rates substantially from year to year. 

I wonder what 2011 will hold for us as this great new frontier offering options for family building expands and becomes more mainstream?

My hope is that rational minds will prevail and that these services (such as IVF, donor egg IVF, donor embryos, and surrogacy) will be more readily available to everyone – without discrimination based on marital status, country of origin, or other details dreamed up by ill informed politicians that frankly should not be anyone’s business except the people trying to have a family.

I think the trend towards fertility tourism (which means leaving your own country for treatment) may have a positive impact by helping provide more cost effective options for IVF.  

We can certainly be thankful that we live in a time that so many options are available to us (either in our own countries or abroad).  I look forward to a time when this is all so commonplace that society equally embraces all options for family building.   News of the recent surrogacy and donor IVF treatments that were used to conceive Elton John’s son and twins for Neil Patrick Harris put this technology in the mainstream media, and I happen to think that is a good thing.  For so long these treatments have been done in secret – so it is wonderful to see people starting to talk about it openly without shame or embarassment.  Conceiving a child through a donor just isn’t something to be ashamed about, it is something to be celebrated.  

So, congratulations to the celebrities for speaking out, and to all of the other couples in 2010 who conceived their children through IVF, donor IVF, surrogates or other fertility treatments and are willing to talk about it and decrease the stigma and secrecy.  Hurray!  We’re making baby steps in the right direction. 

And I, for one, can’t wait to see what new advances 2011 will hold for us.

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Oprah and the mainstream media seem too often to focus on the horror stories of surrogacy abroad.  That is not what this post is about.  Doing IVF Abroad in combination with using a local surrogate (local to where you live) can reduce the costs of surrogacy and make it more attainable for many intended parents who feel that the costs of surrogacy put it out of their reach. 

Most of the times when we think about surrogacy abroad, we think of clinics with foreign surrogates and intended parents traveling abroad for the birth of their children then staying there while the legal details for citizenship are worked out and the baby is healthy enough to fly home.  And while that is a viable choice that may help some couples with their family building, it may not be an option for everyone.  

There are other ways that intended parents can take advantage of the cost savings of IVF services abroad to save money on overall surrogacy costs while still using a surrogate from their home country.   

One of the significant costs of surrogacy (which can account for up to 30 – 40% of the total surrogacy fees) are the actual costs for IVF or donor IVF treatment to create the embryos that will be transferred to your gestational carrier (GC).   If your local surrogate is willing to travel for transfer, you may want to consider having her travel abroad (perhaps to Europe) for the IVF transfer.  This could save you $20,000 to $30,000 for a donor IVF cycle (using donor eggs and your partner or husband’s sperm – or even donor sperm) and probably around $10,000 savings for a traditional IVF cycle (using your own eggs and your partner or husband’s sperm – or perhaps donor sperm).  It makes the overall surrogacy costs cheaper without relying on a surrogate located in a foreign country.

Logistics:

You and your partner could go abroad alone for the first part of the IVF cycle.  That would include your ovarian stimulation or in the case of donor eggs, you would arrive just in time for the egg retrieval and fertilization (if you are using fresh s.perm).  Optionally, if your husband/partner cannot travel with you – you may wish to ship the frozen s.perm in advance  – making the trip shorter for everyone.  Your surrogate would arrive a few days after egg retrieval and only has to stay about 3 days to have the transfer, rest, and then fly home – hopefully with a great souvenir on board for you.

As long as your surrogate is willing to travel, they get a nice little European vacation out of it without being away from home or their children for an extended period of time.  Of course, you will have added travel costs for the surrogate to travel there, but those costs are far less than doing a cycle in the US if you don’t have insurance coverage for IVF. 

In this scenario, you still have all of the benefits of using a local surrogate, participating in the pregnancy, and having your child born locally rather than dealing with the legalities of bringing home a baby born in another country. 

Another scenario would be to travel abroad for your IVF cycle, then ship the embryos back to a US clinic near the surrogate for transfer.  Because frozen embryo transfers have a somewhat lower success rate than fresh transfers, it is a less popular option. 

A few things to consider:

1) You will want to verify with the IVF clinic abroad that you intend to use to ensure that they will allow you to have embryos transferred to your gestational carrier and to find out what testing will be required from your GC in advance.  Some countries may have laws prohibiting this, or some clinics may not offer these services, but generally I have found that clinics are happy to work with intended parents who are using a gestational carrier. 

2) Make sure that your surrogate is willing to travel for transfer and include that in your contract discussions so you are all on the same page of expectations.  You may need to also pay for a companion to travel with your surrogate, and I recommend that you use an agency to coordinate the IVF cycle to make sure everyone is following the protocols, is well cared for, has a local contact who speaks English, and that things go smoothly all along the way.     

I have personally worked with several intended parents taking their surrogates abroad for the IVF treatments and coming home with great souvenirs.  An IVF Vacation is a great way to make surrogacy more affordable as an option for family building.

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I recently discovered this wonderful book for toddlers and children conceived through IVF with donor eggs. It provides a great basis for parents to begin a natural conversation about “their birth story” with their children. 

The author, Kim Noble, very delicately handles this topic and focuses on how much the child was wanted rather than too many specific details of the process of mommy and daddy needing help to have a baby.  This is a fun and lighthearted read that will be enjoyed by many families.  

One More Giraffe

This book can be purchased on online at Amazon through this link:

http://www.amazon.com/One-More-Giraffe-Kim-Noble/dp/0692005781/ref=sr_1_1?s=books&ie=UTF8&qid=1284345636&sr=1-1

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Well now, that’s a mouthful.  It’s no wonder the medical community comes up with all of these acronyms.  PDG – so much easier to say.   This is also sometimes referred to as PGS – pre-implantation genetic screening.  So, we continue our discussions of genetic testing. My last blog entry was about pre-conception testing, this one is focused on the most common form of testing done after an embryo is growing, but before it is transferred back to the uterus (usually on day 5 or 6). 

So, what is PGD and when would someone decide to use it? 

PGD can only be used when the embryos are fertilized and grown outside of the uterus – like in IVF.  The process of PGD is that the embryologist will take a biopsy of a growing embryo (usually on day 3) and remove one or two cells then usually they send it off to a lab that can test select chromosomes of those cells for a variety of genetic disorders and have the results back before the patients decide which embryos to transfer. This way you are eliminating the embryos that you know have genetic defects(not the standard 23 sets of chromosomes) and are only transferring embryos that are considered “competent” or without defects for the chromosomes tested. 

Who would want to do this testing?

There are a few main reasons that a patient may elect to have PGD testing:

  1. It can improve the likelihood of a successful pregnancy for patients who are at risk for passing along an inherited genetic disease.  This can be for something passed from either the egg or sperm.
  2. It can also be helpful for couples experiencing recurring miscarriages – it can rule out embryo competency as a factor for failure, or alert couples if a higher than expected number of embryos have chromosomal defects to allow for futher testing. 
  3. It can be used to help older women select the best embryos.  In patients with advanced maternal age (starting as early as our late 20s, but really making an impact after our mid-30s), we know the possibilities for chromosomal abnormalities in a woman’s eggs increases as we get older.  And the older you are, the higher the risk for genetic/chromosomal defects.   This is evidenced in the success rates of IVF in young women vs. older women.
  4. Another reason some patients may choose PGD is for family balancing – aka gender selection.   Note: although this is legal in the United States, many other countries do not allow PGD for gender selection. 

PGD cannot guarantee success.  And because it generally tests only about 5 sets of chromosomes that provide the greatest risk for defects, there still are risks for other genetic defects that may be incompatible with life, or result in a baby with health issues.  Often, even if PGD testing is done, the pregnant patient may be counseled to considered CVS or amnio as part of routine pregnancy screening. 

So, while older patients (who are at higher risk that  their eggs that could result in chromosomal abnormalities) may see somewhat higher success rates by using PGD, when using young donor eggs, the success rates may actually drop slightly.  Ask your clinic if they keep statistics on patients similar to you who use PGD vs. those who do not – this may help with your decision making.

Sounds surprising, right?  The reality is that there can be a small number of embryos that do not survive the biopsy and will be lost in the process.   Additionally, there can be cases of misdiagnosis (where it is unclear whether the embryo is competent or may appear to be abnormal).  Some reserachers even suggest that a day 3 embryo may show chromosomal issues that perhaps would be able to self-correct – but there is very little data to date to support this theory.  Additionally, there is some evidence that would suggest a PGD embryo may have a slightly lower likelihood of implantation compared to an embryo that has not been biopsied. 

Often cost can be a significant consideration in deciding whether to do PGD testing.  In the US, PGD testing can cost around $4000 -$5000 or more (depending on which set of chromosomes are tested), in Europe the costs start around $2000 and increase depending on the number of embryos tested and what testing is done.  This can add a significant expense to an IVF cycle – so it is important to understand the risks and benefits for your specific case. 

For all of these reasons, PGD is a procedure that should be discussed with your RE (reproductive doctor) so that together you can come up with the best plan for your particular case and circumstances.

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