assisted reproduction

When is it time to give up on IVF?

Couples continue to get pregnant with IVF put 8 cycles.
When is it time to stop IVF: Princeton IVF blog

Any couple who has gone through IVF knows what a rough and wild ride it can be, both physically and emotionally. For that reason, many couples give up on IVF early on, perhaps too early.

Why do women drop out of IVF treatment?

The reasons why women quite IVF are usually financial, when their insurance coverage or access to funds to pay for treatment run out, or emotional, when the thought of going through another cycle and the prospect of all the drugs, office visits and prospect of disappointment becomes overwhelming.

But, what happens to couples who persist and continue to go through IVF treatment cycles?

Fertility doctors in Bristol in the UK, sought to answer that question and what they found was encouraging. In their program, 1/3 of patients conceived on the first IVF cycle. In the next 3 cycles (1-4) the pregnancy rate was about 20% per cycle. While the rates were lower in cycles 5 and 6, they were not zero. Pregnancies continue to happen.

After 6 cycles of IVF, the cumulative pregnancy rate was 68%. In women between 40 and 42, there were successful pregnancies through the 9th cycle.

We've failed a few cycles of IVF. Should we give up?

Only you and your partner can answer that question. IVF tends to be more successful on the first round, but successful pregnancies do continue to happen with repeated attempts, sometimes even when it seems futile.

 

Rhode Island mandates fertility preservation

First state mandates egg freezing insurance coverage: Princeton IVF blog

First state requires fertility preservation coverage from insurers

Egg freezing insurance coverage

What is fertility preservation?

It refers to obtaining, freezing and storing eggs, sperm or embryos for future use. 

Why would one want to preserve fertility?

There are several reasons:

  • If you are undergoing treatment for cancer or other diseases that require treatments such as chemotherapy, radiation or surgery which are likely to cause infertility.
  • If you need to defer having a baby but are concerned you may be too old when you are ready
  • If you do not have a partner, are concerned about waiting but not ready to use a sperm donor.

What is the signIficance of the Rhode Island law?

This is the first time in the US that fertility preservation insurance coverage has been mandated by law. A number of states do require treatment for infertility but not necessarily fertility preservation. That could change in the future.

Where can I learn more about the mandate?

Here is a link to the Rhode Island law.

What do I do if I am about to get chemotherapy and want to learn more?

This is a discussion you need to have ASAP with your oncologist and a reproductive medicine specialist. Ideally the process should happen before cancer treatment starts, and your oncologist will want to delay treatment as little as possible. If you are in our area and would like to see us at Princeton IVF, please call at 609-896-4984 or 609-896-0777 to set up an appointment.

 

One millionth IVF baby born in the US

One millionth IVF baby born in US: Princeton IVF blog

In Vitro Fertilization US reaches a new record.

The one millionth IVF baby was born in the United States in 2016

The one millionth IVF baby was born in the United States in 2016

This year, the Society for Assisted Reproductive Technology announced that the 1 million IVF baby was born in the United States.  IVF has been around for over 30 years, and performed successfully at multiple clinics in the United States and worldwide since then.  Worldwide, there have been millions of babies born from IVF, but limited coverage in the United States has delayed reaching this milestone.

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.”

 

UK Authorities gives three parent IVF the green light

Several months back, we reported in our blog that the authorities that regulate IVF and other fertility procedures in the UK were considering allowing IVF with mitochondrial transfer to move forward. Mitochondrial transfer is more popularly known as "three parent IVF," because it involves three genetic parents: the woman who provides her chromosomes, the husband who provides his chromosomes and the donor who provides the mitochondria which contain their own DNA.  The HFEA in the UK has now given the green light for tightly regulated research to proceed on mitochondrial transfer. So, now it is likely that fertility researchers in Britain will move forward and learn whether this technique can help couples with mitochondrial diseases.

Abnormal sperm and healthy babies

The advent of ICSI (intracytoplasmic sperm injection) two decades ago has enabled men with very low sperm counts to father children through IVF.  Prior to this, as fertility specialists, we could offer these couples only donor sperm. Despite this "miracle" of modern medicine, one of the lingering concerns was as to whether using sperm from men with very low counts might lead to a more birth defects. Adding to this concern, were some studies suggesting that ICSI or even regular IVF might result in a higher than normal rate of abnormalities. Some good news, however.  A recent study from the NIH suggests that this is not a concern. The researchers found that  couples who conceived with very low sperm counts did not have children with more birth defects.