Most people don’t realize how expensive there medications are because they usually don’t need much medications or they have there medications covered by insurance policies.

That is except for people needing IVF medications.  People needing IVF medications know very well that medicaitons such as Follistim, Gonal F, Menopur and Endometrin are not just expensive – they are damn expensive.

Then comes the most basic question – WHY?

Take a look at this article for some insight: Americans pay 300% more for this prostate cancer drug than much of the rest of the world

 

Is infertility really on the rise? And if so, why? And whom does it affect? A British study showed that in the past 60 years, the sperm counts of the average British male has decreased by almost 50%. No one has a clear-cut answer to the question of why this is happening. However, it has been suggested that environmental chemicals such as DDT are to blame. They have weak estrogen effects and may mess with the male hormonal balance. Another suggestion was that the increase in estrogen levels in the general water supply due to the wide use of the contraceptive pill is to blame. What is clear is that if the trend continues this way, many more men will find that they are infertile.

In women, infertility is also on the rise, though not as drastically as in men. There seem to be two main factors affecting female fertility. On one hand, 1 in 14 women suffer from a chlamydia infection. Unfortunately, many don’t experience symptoms or realize they have them when it is already too late. This sexually transmitted disease can spread from the cervix to the womb and the fallopian tubes. The resulting inflammation and the subsequent scarring can permanently damage and block the tubes, leading to infertility.

Another cause for infertility is the increased age at which women today try to conceive. Fertility naturally declines with age and the misconception that woman can become pregnant at the age of 35 as easily as at the age of 25 is somehow not to be eradicated. Many women postpone having children in order to pursue their career or maybe because their partners may be reluctant. After all, “that friend or colleague had her child at 37”. Everyone seems to have a friend or neighbor who had a child at 37 or even 42….However, the statistics show a different picture.

The statistics show the fertility rate according to age among fertility patients. Here another chart to show the fertility rate for natural conceptions in the US:

Thus, while it is not clear why male infertility in regards to sperm count and quality is rising dramatically, the reasons for an increase in fertility issues in women is known. However, the age factor is also affecting men. For a long time, it was believed that men could father children at the age of 78 just as fine as at the age of 18. Now researchers know that this is a myth.

In a study published in 2004 in the American Journal of Gynecology, it was found that male fertility decreases by 11% each year. The decrease in sperm quality and quantity with age seems to also have other negative effects. Another study found that in the case of children born with Down Syndrom, in 50% of cases, the problem could be attributed to the sperm. There is also a higher risk for schizophrenia in children with older fathers. Men aged 45 to 49 are twice as likely to have a child with schizophrenia than men aged 25 or under.

Despite the above mentioned facts about male and female infertility, fertility awareness is only growing very slowly in the wider public and especially men seem to be in denial when it comes to their role in a couple’s fertility. Fertility awareness may not solve the problem completely, but it may help reduce at least age-related fertility issues. Some IVF medications can be used for male infertility as well.

 

VI) Pregnancy Test (Beta-Test)

14 days later, a blood pregnancy test will be performed. This is the earliest test that can be made to assess if you are pregnant or not. It measures the so called beta hCG (human Chorionic Gonadotropin). It is a hormone that indicates a pregnancy. If the value is over 100, the test is considered positive. However, there can be both false positives and negatives. More important is the same test 2-3 days later. The increase of the beta hCG is what matters most. It should approximately double every two days. A third test may be ordered to confirm a pregnancy. Then, in week 6-8, a transvaginal ultrasound will be performed to see if there is a heartbeat and a gestational sac. Only then are you really considered pregnant. But hold your horses! It is important to keep in mind that 1/3 of all pregnancies (also naturally conceived) are terminated naturally before week 12. This is how nature often works to prevent the development of embryos that would otherwise have malformations for example. Many women who conceive naturally don’t even notice that they were pregnant, as the embryo is “flushed out” at the time of their regular period. In case of IVF, you will know that you are pregnant earlier that it would ever be possible with a natural pregnancy. Thus, it is better not to get your hopes up right away, as it may lead to disappointment. But with each day after a positive beta test, you are surely a step closer to a successful pregnancy.

What are the risks associated with IVF?

  • Ovarian hyperstimulation syndrome: A condition when the ovaries overreact to the IVF medications such as Follistim, Gonal-F or Menopur. They become swollen and painful. Symptoms are abdominal pain, bloating, nausea and vomiting. It needs to be treated right away, otherwise it can develop into a life-threatening condition.
  • Egg-retrieval complications: just like with any other medical intervention, there is a risk of infection and a risk in connection with the anesthesia. Other than that, there is the risk of damage to the bowel, the bladder or a blood vessel by the fine needle introduced to retrieve the eggs.
  • Ectopic pregnancy: the risk for an ectopic pregnancy with IVF is slightly higher than with natural conception. Overall, there is a 2-5% risk with IVF that this will occur. However, it should quickly be detected as specific monitoring in this regard is performed.
  • Multiple births: there is no increased risk of multiple births with IVF unless you decide to transfer more than one embryo.
  • Premature delivery and low birth weight: Research suggests that there is a slightly higher risk for premature delivery and low birth weight with IVF.
  • STRESS: this is not a risk, but virtually a guarantee. At least with IVF patients who are undergoing IVF due to problems with fertility, I’ve never heard of a relaxed IVF patient.

As you probably realized in the course of this summary, IVF is not a vacation trip to the spa. It is a complex medical procedure that puts a strain on the body and the soul. However, with the correct professional care, the risks it involves are manageable in most cases. It is a medical procedure that needs to be taken seriously and avoided if possible. However, if this is what will give you the best chance for a pregnancy, I think that fear of the procedure should not be in your way to become pregnant. If everyone involved behaves responsibly, the chances for it causing you physical harm are rather low.

IIII) The Test-Tube Phase

After both eggs and sperm have been collected, the fertilization process can start. There are two different types of fertilization processes nowadays in IVF treatments.

  • The regular fertilization process: a single egg is placed in a petri dish (a flat glass dish) and the sperm is added. The sperm is left there to naturally fertilize the egg. This procedure can be used in cases where sperm quality and quantity is normal or good. It would be used in couples where the fertility problem lies only with the woman, for example in the case of blocked tubes. If the sperm quality is not good or there is simply not enough sperm in order to fertilize the egg, a newer procedure is now available.
  • ICSI (Intracytoplasmic Sperm Injection): this newer procedure allows for the injection of a single sperm into an egg. The sperm is sucked up by a fine needle and then placed inside the egg. This procedure was an amazing breakthrough and has solved a great issue for many couples. Considering that in 50% of infertility cases, there is a male-factor infertility involved, it has boosted IVF success significantly. With ICSI, men with poor sperm motility, sperm that is not able to get into the egg or even men who need to have a testicular extraction for sperm can father a child.

After the fertilization process, the embryos are kept in the lab to develop and are being monitored for quality and growth. Three to five days later, the embryo transfer will take place.

  1. V) Embryo Transfer (ET)

The embryo transfer is the easiest part of the IVF procedure. Once you’ve gone through the stimulation phase with IVF medications such as Follistim, Gonal-F or Menopur and the egg retrieval, you’ll undergo the embryo transfer. It is a 5min procedure that is completely painless (if done correctly). A catheter is introduced in the uterus and the embryo released. The number of embryos that will be transferred is a decision that you will make together with your physician and depends on the embryo quality, your age, your health and other factors that have to be considered. You can usually follow the procedure on a monitor and you can go home right after it. For the next 14 days, you will have to wait. It’s called the 2WW (2 week wait) and it is probably the most nerve wracking part of IVF as there is nothing you can do to improve your chances for a pregnancy at that point and no way you can tell that you are or are not pregnant.

  1. II) Ovarian Stimulation and Monitoring

In a normal cycle, one egg per month matures during ovulation. In an IVF procedure, the goal is to obtain as many eggs as possible in order to have a higher chance of finding good quality eggs for fertilization. Therefore, the ovaries have to be stimulated with stimulation drugs containing FSH (Follicle stimulating hormone) and/or LH (Luteinizing hormone) such as Follistim, Gonal-F or Menopur. Other drugs are necessary in order to control the stimulation process in other ways such as for example Lupron or Cetrotide.

During the approximately 10 to 14 days of the stimulation period, you need to be monitored approximately every other day. This includes:

  • Transvaginal ultrasounds to measure the size and number of the developing follicles and the thickness of the uterine lining (if the uterine lining is not thick enough, the embryo won’t be able to implant)
  • Blood work to measure the estrogen level: this is an indicator for the number of follicles that are growing as cells in the follicles produce estrogen. Hence, the more estrogen, the higher is the number of follicles present.

In the afternoon, you will get a call from the nurse who will give you instructions in regard to your medication and when you need to go back to the clinic for monitoring.

III) Trigger Shot and Egg Harvesting

At the end of your ovarian stimulation, you will be given a so-called “trigger shot” which induces ovulation – the final maturation of the egg. But actually, even though the shot causes the final maturation of the egg, the egg needs to be retrieved just before ovulation actually takes place. The timing for the retrieving or “harvesting” of the eggs is determined based on:

  • Follicle size 18 mm or larger (most likely to contain eggs)
  • Estrogen (estradiol) level. Follicle cells produce estrogen, thus, many follicles will produce a high estrogen level

Egg harvesting will take place about 36 hours after the trigger shot. You will be given a sedation that acts quickly, but is not a general anesthesia (although it puts you out completely for a short time). The procedure lasts only 20-30 min. A needle is introduced into the ovaries to retrieve the eggs. You will be able to go home the same day. You may experience light bleeding and some pain (it’ll go away with an over-the-counter pain killer). Just don’t plan anything for the day. Go home to rest. The next day, you’ll feel perfectly normal again.

To be continued in part III….

What is IVF?

Invitro Fertilization means literally “fertilization in a glass”. It is a procedure used in fertility treatments where eggs and sperm are collected outside of the body and brought together in a test tube/dish (=petri dish) in order to produce an embryo. This embryo is then placed in the uterus.

What fertility problems are treated with IVF?

Usually, IVF is not the first step in fertility treatment. Oftentimes, surgery, artificial insemination or fertility drugs like Clomid are tried first. However, in some cases, IVF is necessary right away or the fertility problem is severe enough to warrant for IVF treatment. The following are some reasons why your physician may suggest IVF:

  • Sperm problems
  • Antibodies attacking the eggs or sperm
  • Problems with the uterus or the fallopian tubes
  • Endometriosis
  • Ovulation disorders
  • Unexplained infertility

What are the different steps of an IVF treatment?

  1. Check-ups, consultation and preparation for ovarian stimulation:

Most clinics will want you to have a full blood work done. This may include testing for IVF, Hepatitis B and C, Rubella, your iron, folic acid and vitamin-B levels and hormonal levels. If appropriate, you might have to do genetic testing for genetically transmittable diseases. Your uterus should be checked with an ultrasound and if something out of the ordinary is detected, you may have to undergo another test where a camera is introduced into your uterus. Some clinics make a mock embryo transfer before starting the treatment in order for the doctor to familiarize himself with your specific anatomy. Then, the treatment protocol based on your blood test results and the general consultation with your doctor is determined.

In most cases, the treatment plan starts with the woman taking the birth control pill for a certain number of days. This is done mainly for two reasons:

  1. It decreases the chances for cysts that may interfere with the treatment
  2. To make sure that the follicles start maturing at the same time and according to the time plan for the treatment. This way, the physician has better control over cycle timing and the treatment.

To be continued in part II…

 

Sometimes, it just doesn’t work. In order for infertility treatments to work, the basis is of course that the woman can produce healthy eggs and there is adequate quality sperm available. Of course, this is just the first step that is crucial to any fertility treatment. However, for some couples, it’s an insurmountable hurdle. Other couples may have both eggs and sperm, but they carry a serious genetic disease they don’t want to pass on to any offspring. For a long time, in such cases, a couple’s only chance to parenthood was adoption. Adoption is a beautiful way to start a family. However, the challenges that come with it may not be for everyone. But now, there is another option available: embryo adoption.

Usually, in an fertility treatments, many embryos are created and by far not all of them are being used. In the US, there are over 600 000 healthy embryos frozen. Some of them are being donated. Not only is this a cheaper option than domestic or international adoption, but the experience is a completely different one, both for the parents, as well as for the children.

In case of the adopting parents, the huge difference is that the woman can go through a pregnancy. This unique experience begins the bonding process and can guarantee a safe and healthy environment of the fetus during the pregnancy. The bonding process continues right after birth and the couple will be able to enjoy the pleasures and challenges of having a newborn in the house.

In case of the adopted child, the big difference is that he or she will not have to go through the trauma of separation. Cradled and loved from the first moment on, their first experience of the world can be one of warmth and love. Oftentimes, in case of a regular adoption, children experienced suboptimal or bad conditions both in the womb, as well as in their first months or years of life. This experience can leave them with a life-lasting trauma. In case of embryo adoption, this type traumatic experience does not take place.

 So how does it work?       

Once the donors and the adopters are matched by an agency or clinic, the woman will undergo an embryo transfer as in regular IVF. Although she will be given hormones to prepare her uterus for a pregnancy, the big difference to regular IVF is that she won’t have to undergo hyperstimulation of the ovaries. This means that many stimulation drugs used in IVF, such as Follistim, Menopur, Cetrotide or Lupron won’t be necessary in case of an embryo donation.

Two weeks after the embryo transfer, a blood test is performed in order to see if the embryo implanted.

This new type of adoption is not yet as common as it could be, but awareness is growing and more and more couples decide to start their family with the help of this option.

Sometimes, science is just so amazing, it is hard to believe that it is humanly possible to accomplish the things that modern medicine manages to accomplish at times. Infertility treatments have come such a long way – one of this accomplishments is the birth of a healthy baby boy in Sweden. He was carried in a transplanted womb!

The boy delivered via C-section in week 31 due to his mother’s preeclampsia, a pregnancy complication involving high blood pressure and protein in the blood, is healthy and weighs 1.775 kg. What is so special about this pregnancy is that the uterus the boy developed in was donated. The 36-year old Swedish woman suffered from a genetic disorder due to which she was born without a uterus, but with functioning ovaries. A friend of hers, aged 61 and 7 years after menopause donated her uterus to her. A year after the surgery, the 36-year old woman had an embryo implanted into the donated womb after having previously undergone  regular fertility treatment with medication such as Gonal-F, Menopur, Lupron, or Ovidrel. The treatment was immediately successful and she conceived during the first IVF cycle.

In order to make this pregnancy possible, researchers had been working hard for 10 years and practicing on animals. Surgeons also underwent special training.

This medical breakthrough means that women who could previously only have biological children through surrogacy now have a chance to carry a child. There are many uterine abnormalities that may make bearing a child impossible. In some cases, regular IVF treatment can help, however, depending on the abnormality or the problem, that may not work. Uterine problems can include polyps, endometriosis or malformations of the womb such as uterus didelphys, cornuate uterus, septate uterus, bicornuate uterus or even a completely missing uterus as is the case in the genetic disorder called Müllerian angenesis.

The surgery performed in Sweden is still in the trial phase, but in the future, it will probably become available to more women. This said, it will still require a donor and the surgery is not a simple one. But at least there is hope now even for women born without a uterus.

 

A new breakthrough IVF technology has been developed in Australia at the Adelaine University. In the pre-trial phase, 7 out of 16 women became pregnant thanks to BlastGen, a technology using a special molecule to mimic the conditions in the womb.

This new treatment was designed to help women conceive who were not able to become pregnant with conventional fertility treatments due to bad embryo quality, failure to implant or miscarriages. The key to success with BlastGen is that the embryo is being cultured in an environment that has conditions resembling the ones in the mother’s womb during conception. Thanks to a new molecule, the embryo can now grow in a more natural environment than with usual IVF. The embryo is also cultured for a longer time there. This results in better embryo quality and thus higher chances for implantation and a full term pregnancy.

The other steps of the IVF procedure actually remain the same. The woman still needs to undergo hyperstimulation of the ovaries with fertility drugs such as Follistim or Menopur and trigger ovulation with Ovidrel or related drugs. Also the embryo transfer and the monitoring remains the same. The new technology all happens in the lab.

In the actual trial, a 100 women with previously failed IVF will participate. The trial is open for couples where the woman is between the age of 25 and 41 and where there were at least 2 previous embryo transfers without implantation, poor embryo development or at least 1 miscarriage. The trial is currently still open for applications.

As the medication and procedures women undergo actually remain the same and only the technology used to let the embryos grow changes, this is certainly a great chance for couples. Despite the fact that it is a trial, the risks involved with the IVF procedure are the same as with conventional IVF.

What are women scared off when they hear IVF? In part I, we discussed the fear of abnormal babies, the fear of injections and the fear of pain. What other factors keep women from having IVF?

  • The fear of side effects of the medication: Many women fear that fertility drugs such as Follistim, Menopur, Ovidrel, Lupron or Cetrotide will have serious side effects. Most likely, this fear is the most founded of all. Despite the fact that the drugs administered are naturally occurring hormones, the high doses do pose a certain risk and therefore, close monitoring is a must. However, it must be said that serious side effects occur rather seldom, especially when the patient is monitored correctly. In very rare cases, situations can occur where the hormones cause ovarian hyperstimulation syndrome (severe cases happen in 1% of cases) or (even rarer) ovarian twisting. Some women will also react quite sensitively mood wise (this will resolve by itself). But again, the risk in comparison to the potential gain is quite low. It is statistically speaking more dangerous to drive in a car than to undergo IVF treatment. Some women also fear that the hormones given will lead to ovarian cancer. Many studies have shown that this fear is not founded. No correlation between an increased risk of ovarian cancer and IVF treatment could be found.
  • The fear of multiples: That depends on your decision. There is no better way to guarantee a single pregnancy than with IVF. In natural conception, there is a chance for twins occurring naturally. In IVF, the number of embryos transferred into your uterus is a decision you make. If you do not want to risk having twins, you and your doctor can decide to only transfer one embryo. The reason why many people have twins after IVF is that they decided to transfer more embryos in order to increase the chance that at least one will implant in the uterus…and well, in those cases, both embryos implanted.
  • The fear of expenses: yes, in the US, infertility treatments is outrageously expensive if you don’t have an insurance that covers the costs at least partly. But many fertility clinics now offer special financing plans. Think of it that way: in 90% of cases, IVF can ultimately help couples conceive. If children are a priority in life for you, this high chance can be a motivation to make other sacrifices. Think of IVF treatment like of a mortgage – it’s a major investment, but one for a lifetime. And there are also other options like IVF abroad (South Africa, Israel) that might be cheaper.
  • The fear of failure: Yes, there is a 10% chance that even after several cycles of IVF, a couple may remain childless. However, if you don’t try, you won’t be better off than you are presently. You may forgo your best chance to become pregnant. For some couples, having to face IVF means having to face that they really have a fertility problem. However, if IVF is medically necessary, time will not make the situation better, but rather worse, as increased age reduces the chances for getting pregnant.

Thus, it is better to confront your fears and set priorities. You can still decide to have the treatment, but at least you informed yourself properly and thought about it thoroughly.