In vitro fertilisation

IVF no longer covered where it all started

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The first IVF baby Louise Brown was conceived near Cambridge, England over 3 decades ago...

Now it turns out that National Health Service in Cambridgeshire will no longer cover IVF treatment in the place where it all began.

It is sad but true according the BBC...

The UK with its single payer government health system, like all other health systems, has limited funds and been forced to make a decision on where to cut. In Cambridgeshire, coverage for IVF was one of those cuts even though ivf treatment is recommended by the nhs' own guidelines.

In the United States, where we have a more fragmented system, some states such as New Jersey where we are located, mandate coverage. While the law remains intact and recently was amended to expand the definition of infertility, health care reform laws such as the Affordable Care Act (ACA, Obamacare) has actually reduced the number of women in our state who are covered for fertility treatment. When faced with multiple mandates, employers and insurers are forced to make decisions where to cut to control their premiums.

While there is plenty of talk these days about advocating a single payer government controlled system, it is not clear that such a change will benefit couples with infertility. While some countries with national health care systems do cover IVF and other treatments, it is often the first item on the chopping block when costs are getting out of control. It is certainly the case in Britain.

For those who advocate for the availability of treatment of infertile couples, be careful what you wish for. Increased access to medical care does not necessarily mean increaseD access to fertility care.

A spoonful of sugar may may the medicine go down, but will it harm your chances for pregnancy?

Sugary drinks, articifical sweeteners and fertility: Princeton IVF blog
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Recent studies suggests that sugary drinks, even those with artificial sweeteners may harm the chances for pregnancy.

Although it is far from conclusive, several recent studies suggest that sweet drinks may have an adverse effect of a woman's chance for pregnancy, including...

  • Harvard doctors found that drinking one sugary drink a day can lower the success rate of IVF by 12% and more than one sweet drink a day by 16%

  • Brazilian researchers found that consuming sugary or artificially sweetened drinks reduced embryo quality and the chances for an embryo to implant. interestingly

Interestingly this effect did not occur with unsweetened coffee.

The reason for this is not totally clear, though we know both obesity and polycystic ovarian syndrome (PCOS), which are both associated with infertility and miscarriage, and associated with changes in how the body handles sugar, can lower the chances for pregnancy.

So, what should I do?

It is a good idea to keep sugary products to a minimum when you are trying to get pregnant, and to minimize artificial sweeteners such as Splenda, Equal or Sweet-and-Low. These sugar substitutes may be just as harmful as sugar itself.

Don't panic. Women who use artificial sweeteners and drink sweet drinks still get pregnant all the time, even if the chances are a little lower. There are many factors that go into your fertility, so it is far from clear that consuming these drinks is actually harms your chances for pregnancy.

Dr Derman discusses IVF and Assisted Reproduction with the Princeton Packet

HEALTH MATTERS: Assisted reproductive technologies available

By Seth G. Derman

What is in vitro fertilization with Dr. Seth Derman

 

This article previously appeared in the Princeton Packet  

Infertility – the inability to get pregnant or stay pregnant – is a common problem in the United States, affecting about 10 percent of women of childbearing age, according to the Centers for Disease Control and Prevention.

Fortunately, many couples can still realize their dream of having a child with the help of assisted reproductive technologies (ART), most commonly in vitro fertilization.

Princeton IVF in Lawrenceville, provides care for couples struggling with infertility and enables many women to deliver happy and healthy babies.

How does IVF work?

When most people talk about ART, they are referring to in vitro fertilization or IVF. IVF has been used for decades to help women get pregnant. In fact, the first IVF baby is now over 30 years old and has a child of her own.

With IVF, eggs are surgically removed from the body, fertilized with sperm and allowed to grow in the laboratory. In vitro literally means “in glass,” as the fertilization and early development happens in a laboratory dish.

Fertilization can occur naturally with the sperm selecting the egg or in cases where there are problems with the sperm, can be assisted with doctors inserting the sperm directly into the egg. After 3-6 days the embryos are inserted directly into the uterus.

While IVF was first developed to help women with missing or damaged fallopian tubes, it is now routinely used to treat infertility caused by many different problems such as sperm problems, endometriosis, unexplained infertility and any other type of infertility that does not respond to more conventional treatments.

Other methods of ART include gamete intra-fallopian tube transfer (GIFT), zygote intra-fallopian tube transfer (ZIFT) and tubal embryo transfer (TET). With these, the embryo is transferred to the fallopian tube through laparoscopic surgery instead of into the uterus, except with GIFT in which the eggs and sperm are inserted into the tube and fertilization occurs inside the body. With ZIFT and TET, fertilization occurs outside the body. These procedures are rarely performed today as their advantages in terms of pregnancy rates have been overcome by modern laboratory technology and improved methods of embryo transfer.

ART also refers to use of donor eggs and gestational carriers, which are variations of IVF.

Who is a candidate for IVF?

The majority of patients who are candidates for ART suffer from tubal problems, sperm problems, unexplained infertility or certain inherited genetic diseases, according to the Society for Assisted Reproductive Technology (SART). Candidates for ART generally have:

  • No evidence of premature menopause
  • At least one accessible ovary, and
  • A normal uterus

Menopause and ovarian function are irrelevant for candidates using donor eggs. SART recommends that all ART candidates should be in good health and have no medical conditions that would pose a serious health risk to themselves or the children they would carry.

How successful is IVF?

Success rates vary and depend on many factors. Some factors that can affect the success rate of ART include the following:

  • Age of the partners
  • Reason for infertility
  • Type of ART
  • If the egg is fresh or frozen
  • If the embryo is fresh or frozen

In addition, the clinic itself can have an impact on success rates, according to the CDC. Princeton IVF's affiliated Laboratory takes advantage of the latest in “clean room technology,” to help improve pregnancy rates.

A specialized ventilation and HVAC system allows for improved air quality, flow and temperature control. Air quality is further enhanced by the use of eco-friendly, low VOC (volatile organic compounds) paints and building materials. This type of technology can have an enormous impact on embryo quality, survival and clinical outcomes of IVF treatment, research has shown.

What are risks of IVF?

The biggest risk factor associated with ART is multiple fetuses, but that can typically be prevented or minimized in many different ways. Other risk factors include surgical risks from the egg retrieval, side effects of the fertility drugs for mom and risks associated with pregnancy.

And while ART can be expensive and time-consuming, it has enabled many couples to have children that would have otherwise not been conceived.

What is pre-implantation genetic testing?

Pre-implantation genetic testing (PGD) and pre-implantation genetic screening (PGS) can be used following IVF to diagnose genetic diseases prior to implanting the embryo in the uterus. Doctors can test a single cell from the embryo to determine chromosomal abnormalities that, among other things, can lead to miscarriage and birth defects.

Talk with your doctor

If you are one of the millions of couples struggling with infertility, talk with your doctor about ART. For many, it is a promising option that can help couples realize the joy of parenthood.

To learn more about Princeton IVF or to our physician from Princeton HealthCare System, call 609-896-4984 or visit www.princetonivf.com.

   Seth G. Derman, MD, FACOG, is board certified in gynecology and reproductive endocrinology. He is a fellow of the American College of Obstetricians and Gynecologists and a member of the medical staff at University Medical Center of Princeton at Plainsboro.

Dr Derman featured in Princeton Packet

Infertility causes and solutions in the Princeton Packet: Princeton IVF blog

YOUR HEALTH: Infertility: causes and solutions

By Stephanie Vaccaro

Dr. Derman talks about the causes and treatments for infertility

This article recently appeared in the Health Matters Column of the Princeton Packet...

   So You Want to Have a Baby?

   Infertility is defined as the inability to conceive after engaging in unprotected sex for one year, according to the Centers for Disease Control and Prevention.

   What causes fertility problems?

It can be a number of factors. Dr. Seth Derman of Princeton IVF and Delaware Valley OBGYN, said that approximately 40 percent of the fertility issues he sees are due to male problems, 40 percent are due to female problems, and 20 percent a combination of both partners.

   ”The exact cause of male infertility is a little harder to diagnose because it’s not well understood,” Dr. Derman said. “With female infertility, the most common cause is ovulation problems, which usually show up as irregular cycles. Polycystic ovarian syndrome is the most common of these.”

   Fertility problems can be caused by endometriosis. They also can be linked to damage to the fallopian tubes, which can be caused by previous sexually transmitted diseases. This is particularly a problem in women who have had prior Chlamydia infections.

   And sometimes infertility has no identifiable cause.

   What options exist for treatment?

   ”Well, it depends what’s wrong,” Dr. Derman said. “If there’s an ovulation problem, usually the treatment is fairly simple with fertility drugs. These are medications that induce ovulation, such as clomid or letrozole.”

   ”For tubal problems — the treatment is usually surgery or IVF (in vitro fertilization),” Dr. Derman said. “IVF is clearly the most effective treatment for these problems.”

   Oftentimes the most effective option involves treating the female partner. IVF allows for the sperm to be injected directly into the egg, and is the most effective treatment for male infertility. “The poorer the husband’s sperm the more likely the couple will need more invasive treatment such as IVF,” Dr. Derman said.

   A less invasive alternative to IVF is insemination, in which sperm is injected up into the uterus. In contrast, IVF involves fertilization of the egg outside of the body, and the transfer of that embryo into the woman’s womb. It is also much more effective than insemination. When patients have unexplained infertility, insemination is oftentimes done first, and if that doesn’t work then they may try IVF, Dr. Derman said.

   What are the odds of success?

Typical fertile couples have a 20 to 25 percent chance of getting pregnant each month. Infertile couples have a 3 percent chance when trying on their own. IVF increases the odds of having a child to twice what it would be in a fertile couple. Those numbers can vary based on age.

   IVF is very often successful in the first or second cycle, particularly in young women. If it isn’t successful, it’s not unusual for a couple to try three or four times, according to Dr. Derman.

   Who pays for IVF?

In New Jersey, the Family Building Act (August 2001) requires companies with more than 50 employees to cover fertility testing and treatment, including IVF. There are exceptions in the law, and since the passage of healthcare reform, those exceptions have gotten even larger.

   Some of the other treatments can be relatively inexpensive. “For instance, treatment using fertility pills and some monitoring is not terribly expensive,” Dr. Derman said.

   When should you go see a fertility doctor?

   ”Generally, over 35, we recommend coming after six months,” Dr. Derman said. “If they are under 35, one year is the right time.”

   What should you expect when you go see a fertility doctor? When patients go to see Dr. Derman for the first time, the first stage in the process is to try to understand why they are unable to conceive. After getting a detailed history, tests will be ordered, which include testing to make sure their eggs are not running out, to make sure their tubes are open, to make sure the ovulation process is going well and that the sperm is normal. After getting a clearer picture of what is going on, they can better determine the next steps.

   ”Not everybody with infertility needs IVF, even though it is the most effective treatment out there,” Dr. Derman said. “IVF is the last thing that we do, not the first thing.”

 

Pioneer of IVF in America Remembered

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The father of IVF in the US and his legacy

This past month the Reproductive Medicine community lost one of the giants in our field, Dr. Howard Jones. Although I never had the opportunity to work under Dr. Jones, my own mentors did train under him in Norfolk and Johns Hopkins. Like all reproductive medicine specialists in the country, not just those who trained under him, we owe a special debt to him for enabling us to do what we do.

In the early days of our specialty, fertility doctors could do little to help our patients. There were medications to help women with irregular cycles ovulate and fertility surgeries that had limited success. Still, many causes of infertility remained remained very difficult to treat. After leaving Johns Hopkins for Norfolk, Dr. Jones' team was the first in the US to perform successful IVF on an infertile couple, and his team's numerous contributions to the advancement of IVF continued for years to come.

Now, built on the foundation by Drs. Howard and Georgeanna (his late wife and partner) Jones, today we can actually help most of our patients have a baby to take home, and that is a truly a life to celebrate.

Veterans and Fertility Care

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US Congress considers improving veterans access to reproductive health care

After faithfully serving our country in Iraq and Afghanistan, many of the brave men and women of our armed forces return home with injuries. While the more devastating injuries such as head injuries, missing limbs and PTSD, make all the headlines, there are other battle scars that remain unspoken. One of those is infertility.

Serving our nation can have an adverse effect on couple's ability to start or grow a family, whether it be from the direct trauma of battle or the inevitable delays that come from prolonged deployments. Appropriately, the Defense Department recognizes the importance of this for our fighting men and women and provides at least some fertility coverage for active service personnel.

The same is not true for our veterans. In fact, federal law prohibits covering these treatments through the VA system. On several occasions, Senator Patty Murray (D-Washington) has introduced bills to address this issue without success. Now, there is also movement on the other side of the aisle. Just this past week, Representative Jeff Miller (R-Florida), Chairman of the House Committe on Veterans Affairs has introduced a bill to correct this inequity. His bill HR 2257, if passed and signed into law, will allow veterans to treat fertility issues that arose during their service even after they leave the armed forces. Hopefully, this legislation will make it through the congress and on to the President's desk.

 

Happy 35th Birthday Louise Brown !

Today Louise Brown the first child born from In Vitro Fertilization(IVF) turned 35 years old. The pioneering work of Drs. Steptoe and Edwards has led to a revolution in infertility care that has led to over 5.5 million births.