In Vitro Fertilization (IVF) is an extremely cost-effective treatment for most infertile couples, and allows us to do in the IVF lab what is not happening normally in the bedroom - no matter what the medical problem may be!
IVF has now become the "final common pathway" for treating infertile couples. While IVF treatment can be expensive, and IVF insurance is available only for a fortunate few, being well-informed about the IVF procedure can help you maximize your chances of having a baby.
This section of the Web site offers an overview of medications, procedures, success rates and financial issues related to IVF.
IVF Medications
It is necessary to take certain medications during the IVF cycle in order to prepare the body for the treatment. The instructions for each medication vary from patient to patient. Our medical team at Sure Fertility will analyze your case closely to determine which medications to use, what dosage to take, when to administer the medications and how long to take them.
GnRH Agonists
Lupron, taken as an injection just below the skin and Synarel, a nasal spray, allow the body to produce a greater number of high quality eggs during the treatment cycle. They also prevent the midcycle hormonal surge that can result in the cancellation of a cycle.
Antagonists
Antagon and Cetrotide are antagonists of gonadotropin releasing hormone (GnRH) and are used to prevent premature ovulation. These medications are given by injection and the duration of treatment is usually three or four days.
Gonadotropins
Gonadotropins are taken as subcutaneous injections that provide stimulation to the follicles that contain the eggs during the stimulation phase. Gonal F, Bravelle, Follistim, Pergonal and Repronex are the most commonly used gonadotropins.
hCG
hCGs are taken as an intramuscular injection and are used to induce the final maturational changes in the eggs and prepare them for retrieval. The most commonly prescribed hCGs are Pregnyl, Profasi and Novarel.
Medrol
Medrol is a steroid hormone given daily, typically for a period of four days during the cycle, to assist pre-embryo implantation.
Doxycycline
Doxycycline, an antibiotic administered in pill form, is given to the male partner during the wife's stimulation cycle to reduce the low levels of bacteria that may be found in the semen and which may compromise the performance of the sperm during an IVF cycle. It is also given to the female partner to reduce the risk of infection following aspiration of the follicles at the time of egg retrieval.
Progesterone
Natural Progesterone may be taken as a daily intramuscular injection beginning two days after egg retrieval and continuing until the placenta is making adequate amounts of Progesterone. Progesterone can also be given in the form of a vaginal gel or vaginal suppositories or pills (Prometrium).
Success Rates :
Details
Few subjects are as confusing or misleading as IVF success rates - they can be easily manipulated to enhance a particular programs public image. Therefore, reported IVF statistics provide little meaningful guidance for an individual patient hoping to achieve pregnancy with IVF. While experts in the field and statisticians have acknowledged this, the public does not generally understand this and places increasing emphasis on the statistics from individual programs.
A common question in fertility programs is, "What's your IVF success rate?" The quick answer is somewhere between 0% to as high as 50%. Unfortunately, a meaningful answer is a lot more complicated. Obviously, success rates depend on how you define success and calculate the total population. Do you mean clinical pregnancy rate (implantation seen on ultrasound), or ongoing pregnancy rate (fetal heart beat seen by ultrasound) or delivery? Will the denominator in this calculation be the number of couples entering treatment, or those going to oocyte retrieval, or those having pre-embryos replaced into the uterus? But it's even more complicated than that. You are a unique individual with a unique medical history that affects your chance of having a baby. That is why any calculation requires additional information, such as: duration of infertility, severity of infertility, your age, and a host of other factors.
"Success rates" are often advertised or heralded by the media showing that a particular program has the "best success rates" in a given area, supporting their claims with comparative data from publicly available data sources. Unfortunately few reporters or patients ask "How is this really calculated?" and instead choose to believe in miracle workers. While there are many talented individuals in the IVF field, there are no individuals, neither physicians nor embryologists, with supernatural powers.
What is really going on? To understand, we must keep in mind one of the essential principles of statistics - statistics report data from POPULATIONS. Samples are taken, and averages are calculated. But you are a PATIENT, not a POPULATION. You have a UNIQUE set of circumstances that will determine your own likelihood of achieving a pregnancy if you receive your medical care in an experienced IVF center. So, the key to good statistics is to have more ideal patients than difficult patients enter the program. To a large degree, the difference between a program with good statistics and one with less favorable pregnancy rates is more often due to the given mix of patients who present for treatment. Yet by excluding or wait-listing individuals who've failed in other programs, are over 38 years old, have borderline FSH values, have prolonged unexplained infertility, or are low responders, certain programs can improve their statistics. By encouraging ART treatments for patients who are young, have had previous normal or ectopic pregnancies, regular menstrual cycles, limited or no prior treatment, and have normal sperm factors, the advertised pregnancy rates can also be increased. The pregnancy rates also depend on the number of pre-embryos transferred. A program that transfers a larger number of pre-embryos will likely report a higher pregnancy rate than one that judiciously restricts that number, but the latter program will also experience far fewer complications due to multiple births.
So, how can couples with complex fertility problems make an informed choice? Unfortunately, the answer is not simple. You cannot rely solely on published statistics when seeking professional care. The misguided focus on "success rates" has created strong incentives, economic and otherwise, for IVF programs to maximize IVF statistics by adopting some of the "gaming" tactics noted above. A better approach might be to take the following steps:
- Look for experience and track record. Participation in SART and CLIA, as well as embryology certification and state licensure, should be considered.
- Make your own opinion of their integrity, intelligence, responsiveness and compassion
- Learn as much as you can. Review the reputation of the organization and its professionals.
- Try to contact former patients. Talk to your friends with infertility problems.
- Refuse to be directed anywhere by a healthcare plan. Fight for your right to choose. Insist upon alternatives.
- Be willing to spend your own money wisely to get the best health care.
- Distrust waiting lists. Avoid apparent economic bargains. Ignore gimmicks.
- Lastly, think hard and trust your own judgment. Your health care is very important, and the final decisions are yours!