Recently it was calculated that approximately 125 IVF cases per 1 million capita are performed in in the USA during the course of a year. In most of the major westernized countries in Europe they are performing between 400 – 500 cases per 1 million capita. That is just one fourth of the cases that are done in these other countries! Despite the fact that on average USA IVF success rates are higher than those countries, we do not help nearly as many people. Why? The answer is obvious. IVF is not a covered medical treatment in the USA and so, the overwhelming majority of Americans just can't afford the procedure. In many European countries there is generally some form of coverage, but  if the family has to pay out of their own, the costs are less than half than what they are in this country. With one in seven couples in the USA struggling to build their families, that leaves many people left to fend for themselves.

Two and half years ago, we opened the Fertility Partnership with the goal of providing state-of-the-art reproductive health care in a caring and compassionate environment. As we opened our doors in the heart of the worst economic crisis in 70 years, it was clear that the best way to be compassionate was to make it as affordable as possible. In August 2010 the Fertility Partnership was featured in  Newsweek Magazine describing our efforts to lower the cost of Advanced Reproductive Technology. It was a fascinating article that stirred up some controversy. For example, it touched upon some difficult topics such as the "economic selection" that created by the high cost of fertility procedures . That is to say, only infertile couples with economic means will be able to reproduce. We have learned a lot since we've opened, and so I thought it appropriate in honor of National Fertility Week to reflect on what we've learned during our quest to provide the best care at the most reasonable cost.

The fact of the matter is that the materials and equipment needed to run and maintain an IVF laboratory, staff an IVF clinic, and all that is needed to maintain state-of-the-art clinic in full compliance with all regulatory statutes is just very expensive. So how do you bring the cost down? Some clinics have tried what are called "shared risk programs". That is where you pay for more than one round of IVF upfront and are given certain assurances that there will be a successful outcome. There are even promises or guarantees to return money if all attempts fail. We initially considered pursuing this at Fertility Partnership because there is something to be said about calming the frightened couples with guarantees and opportunities to try more than once. What eventually dissuaded us from pursuing this practice is the simple fact that some of the companies that provide these services are publicly held and annual profits are visible to any and all. They are apparently doing quite well financially with these programs and post millions of dollars of gains each year. This somehow seems too businesslike to us and not in the spirit of practicing medicine. Also, typically patients can only get in on these "shared risk" programs if they meet certain criteria which in fact make them very likely to be successful at IVF, ad so they are "safe bets". I like to use the metaphor of throwing darts at a balloon. IVF is like paying thousands of dollars for a dart to hit a balloon and win the most wonderful of prizes. But, there are no guarantees. I believe that you have to keep your darts very sharp, that is to say the best science and medical/clinical care. You have to engage your patients and keep them focused and calm as they take their shot at being successful. Also, our philosophy has been to provide each dart at the lowest cost possible. We are not going to “sell” you two or three darts at a time with guaranteed results. In the end, we believe that works out better for the patients.

So what about "low intensity" in vitro fertilization? It comes under various names such as "low dose", "micro", and other names that are in fact trademarked and so I will not mention them. It is my understanding that these protocols for IVF were developed with the idea that there are women who would benefit from lower doses of fertility medications during their cycles. Unfortunately it has not panned out. In a recent publication Dr. Norbert Gleicher reported on their results. He states that "with an identical number of embryos transferred, after adjusting for age, patients using standard IVF demonstrated a 7-fold better odds for pregnancy and a cumulative pregnancy rate that was more than six times higher than that achieved in patients using low intensity IVF cycles". He also calculated that the average cost to bring a baby into the world from these technologies i.e. live birth, was “$23,100 when low intensity IVF cycles were used and $20,333 when standard IVF cycles were used (these are cumulative results, meaning multiple attempts may have been necessary). Dr. Gleicher concluded from his research that "low intensity IVF currently lacks clinical and economic foundations, and therefore should be offered only under experimental study conditions". Unfortunately, there are some clinics that are marketing these protocols as low-cost alternatives to standard IVF. I feel certain that there are some couples who could benefit from this approach; however we do not know who these couples are at this time. At Fertility Partnership we don't provide low intensity IVF, but, it's in fact quite easy to do and we are ready to implement these protocols once we are convinced that is beneficial for a particular couple.

So what's the answer? How do you lower the cost of in vitro fertilization? The answer is by doing just that, lower the cost of in vitro fertilization. I believe that physicians need to lower their expectations of what they will ”earn"  from each cycle and be prepared to provide care to the increased number of couples who will come seeking care because it's less expensive. We are only taking care of one fourth of the patients in the USA who require in vitro fertilization and all that goes with it. Clinics need to just lower their prices and roll up their sleeves to work harder and provide good care for more people.

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Ever since the 1930s, science and medicine have been searching for an effective way to collect immature eggs from the ovaries and mature them in the lab so they can be successfully fertilized.  In Vitro Maturation – or IVM – has captured the imaginations of various researchers but results to this point have never been reliable or consistent. Over the years there have been scattered successes, and one estimate is that there are 500 or so babies born this way. Unfortunately, results were so non-reproducible that few programs bothered with it – until now.

Researchers at Brown University report that their IVM technique has produced consistent pregnancy results. Overall, they believe that their IVM technique can achieve a success rate that is approximately 80 percent as strong as traditional In Vitro Fertilization (IVF) rates. Certainly this is great news for those patients who would most benefit from IVM – namely Polycystic Ovarian Syndrome (PCOS) and cancer patients. 

Recently, the Fertility Partnership team was invited to Brown to undergo the training program necessary to bring IVM to our area. In fact, we already have patients who are ready to undergo our very first IVM procedures. We are looking forward to working with patients who understand IVM and want to be a part of this exciting process that may not only give them the baby they’ve been waiting for but also have a major impact on fertility care.

Why is IVM so attractive? There are a number of very good reasons.

Traditional IVF requires the use of strong and expensive “fertility drugs”(gonadotropins) and a long preparation process that lasts weeks before the mature eggs are retrieved in a process called “superovulation.” With IVM, the patient receives little or no stimulation meds, and the patient’s preparation for egg retrieval takes just a few days. The eggs get the fertility stimulation in the lab rather than in the woman’s body, requiring a tiny fraction of the amount of the drugs.

Why is this good and who does it help? When going through IVF, patients with PCOS may be at risk of superovulation and can develop a dangerous condition called Ovarian Hyperstimulation Syndrome (OHSS). PCOS patients represent 12-15 percent of the general population and 20-30 percent of IVF patients, so that means almost one-third of the women going through IVF are at risk for OHSS. Since IVM avoids hyperstimulation altogether, Ovarian Hyperstimulation Syndrome in PCOS patients is entirely avoidable.

IVM also provides a huge benefit to women diagnosed with cancer who want to preserve their fertility. These patients find out suddenly one day they have a disease such as leukemia or breast cancer and need (and want) treatment as soon as possible, but they quickly learn the treatments may destroy their ovarian function. They’re faced with a terrible choice – take the treatments that may save their life but leave them infertile, or avoid the cancer treatments and gamble with their life. Normally with IVF, we go ahead with the collection and freezing of eggs for later use, but this traditional approach delays their cancer treatment by several often critical weeks. IVM allows the eggs to be retrieved quickly - within just a few days; in fact, the retrieval probably is done before the work-up for the cancer is completed.  

Perhaps the greatest feature of In Vitro Maturation is that it can potentially eliminate the danger of superovulation for everyone since patients do not need to be given daily injections of powerful and expensive medicines. This will end the need for women to inject large doses of hormones, and it also should dramatically reduce the cost of infertility treatments. IVM should cost one third of IVF with minimal medication costs, and I am looking forward to offering it as another option for our patients at Fertility Partnership.

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I was pleased to see my former longtime mentor, Dr. Sherman Silber, on KTVI-TV tonight discussing the latest techniques in preserving fertility for women who have or are battling cancer. The advances that have been made in procedures such as ovarian tissue freezing are simply amazing and will give many women a strong chance of having a baby where no hope existed before. This is a vital health topic in an era when the odds of surviving cancer are much better than in the past, and I’m glad to see the issue being addressed so effectively.

As important as it is to get the word out about preserving fertility for female cancer patients, it’s also important for men to know they have fertility preservation options available if they are diagnosed with cancer. At Fertility Partnership, we’ve already had a number of men facing a cancer diagnosis take steps to preserve their fertility.

In one case, a man who’d received a testicular cancer diagnosis in the morning was able to come straight to the Fertility Partnership office from his urologist and immediately give us samples to preserve. From our office, we followed him to the hospital for surgery, and we were able to perform a testicular sperm aspiration (TESA) during his cancer surgery to obtain even more samples. Fortunately, we were able to obtain enough viable sperm so that his entire reproductive needs are frozen for future use. Having a capable, local fertility center with the willingness and ability to respond quickly can make all the difference for people facing the sudden misfortune of a cancer diagnosis.

Unfortunately, preserving a woman’s fertility can be more challenging than for a man. The woman in the KTVI segment tonight had her ovary removed, sliced into pieces, frozen for 10 years, and then replaced back into her body after being sewn back together. While a tremendous breakthrough, this technique will not be useful for many of the most common cancers afflicting women of this age group. Leukemia, lymphoma and breast cancer can actually sequester, or harbor, cancer cells in a women’s ovary. We would not be able in those cases to use intact ovarian tissue for fear of reintroducing the cancer into the woman. Luckily, in those situations we have other options such as the proven method of freezing individual (cancer-free) eggs, or the newer science of taking those very same ovarian pieces and performing in vitro maturation in the lab, then harvesting the cancer-free eggs directly from a dish.

Woman or man, if you are diagnosed with cancer and wish to learn more about your options to help preserve your fertility, please contact Fertility Partnership anytime. We can move quickly to ensure every available option is considered in giving you the opportunity try conceiving after you win your battle with cancer.

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