I wanted to thank all of those that follow this blog for your continued support and guidance. Some of you are aware of the fact that I have been changing positions over the last several months. I appreciate very much the patience that you’ve extended to me during this time period. The terms of my leaving my former position required that I remain discrete. As a result, I was not allowed to notify you of my planned departure or assist you in your transition. I apologize to you for that. It was not my choice nor was it how I would have preferred to depart. I want to now welcome you to contact me so that I can provide you with the support and guidance that you so deserve on your pathway to parenthood. Let me please explain further so that everyone understands why I am so very excited to now be a member of the Conceptions Reproductive Associates team!
Our specialty is very success driven. My efforts have always been to bring the latest and greatest techniques to patients in each and every community that I’ve lived in. When I’ve been unable to do so, I’ve chosen to move to where I was able to confidently offer women the most comprehensive range to treatment options available. With my current relocation to Denver, CO I’m pleased to say that I’m done moving. Although not every patient needs the most high tech assistance, I’m finally at a location that is able to do it all. The result is a center with one of the highest pregnancy rates documented as well as one of the lowest miscarriage rate. That is what the technology has to offer. However, on the flipside we are also able to offer basic supportive care as well as everything else in between. Bottom line is that I couldn’t feel any better about the group that I am now working with.
For those of you that have been readers of this blog and have not been patients of mine, please forgive this post if it seems self promotional. I decided to write this post in response to the many emails that I have received wondering where I was and how they could reach me. To anyone interested, I would welcome the opportunity to meet with you in person, over the phone or on the internet for a consultation. Rest assured that if you choose to come to Denver we will offer you the same hospitality and success that the patients in this area have enjoyed for so long now. You might even like it so much that you too might choose to stay!
In gratitude to all,
Robert Greene, MD, FACOG
Conceptions Reproductive Associates of Colorado
With more than 1.5% of the babies born in the US conceived through IVF, it’s time to review the latest data on Clinic Success Rates .
Ever since the first report issued in 1997, the Center for Disease Control (CDC) has partnered with the Society for Advanced Reproductive Technology (SART) to create the premier example of a medical specialty openly reporting the outcome of their treatment. For nearly twenty years now they have issued a joint annual account of how center’s fair individually as well as collectively in treating infertility through Advanced Reproductive Techniques. Each year this summary provides a wealth of information to track trends emerging in fertility treatment as well as set standards-for-care. This latest report is no exception.
The current summary reflects all of the babies born from ART treatment in 2013. The data reporting is delayed in order to include the pregnancy outcome from embryos transferred prior to the end of the year. Currently there are 380 SART Member Clinics included. They collectively performed nearly 175,000 IVF cycles that resulted in the birth of 63,286 babies. This reflects a substantial increase in both access to treatment as well as an increase in live births from the previous year.
Another encouraging finding was an increase in the number of Elective Single Embryo Transfers (ESET). This reflects a greater effort to reduce the number of multiple pregnancies born through ART as well as a boost in patient confidence. Best of all was that even though the number of babies born went up; the twin rate fell by 3% and the triplet rate was reduced by nearly 10%. Nearly 80% of the successful treatment cycles resulted in the birth of a single baby!
The summary data report for the nation provides many useful insights into the field of reproductive medicine. Now this data is incorporated into a patient prediction model that allows couples to create an individualized estimate of what their anticipated pregnancy rate would be for one cycle of IVF. This model does assume that your clinic of choice is achieving IVF conception rates that are around average. As a healthcare consumer, you can access the data base to view your clinic’s success rate and compare it to the national average. If you find that your center is well below average, don’t make any assumptions. Instead ask questions to determine if they have made changes that you find reassuring before moving forward with treatment.
[r1]Link to https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0
[r2]Link to https://www.sartcorsonline.com/Predictor/Patient
[r3]Link to http://www.sart.org/find_frm.html
One of the greatest challenges that we face in treating couples with infertility, is what options to offer beyond the typical treatment protocols. Clearly, most of our patients are well served with the basic ovarian stimulation methods but in some patients that may exacerbate or simply ignore an underlying hormone imbalance that’s compromising success rates. Therefore, one of the greatest challenges is to figure out how and when to tweak the typical combination of meds in order to shift the hormone balance back to a more favorable outcome. This is the reason that we should now reconsider the use of human growth hormone (hGH) for patients that have failed previous IVF treatment.
I trained under Dr. David Meldrum at UCLA-Harbor Medical Center in Los Angeles. Back in the early 1990’s he was advocating the consideration of adding hGH to the protocol of certain patients. His reasoning was good. First of all, we know from previous research [u1] that healthy developing eggs produce a growth hormone analogue known as IGF-2. Better still, other studies [u2] have demonstrated that hGH could possibly increase the ability of eggs to repair damaged DNA. Finally, several studies have found that growth hormone can improve the response of the ovaries to stimulation during an IVF cycle. Given that all of this information has been available for quite some time, it may be surprising to a patient that there hasn’t been wider use of hGH during IVF treatment. Recently, Dr. Meldrum and several other experts [u3] suggested that this was because there remained too much confusion amongst specialists on which patients would benefit from the use of this somewhat expensive but also possibly game-changing hormone.
The good news is that recent studies [u4] have more carefully defined the characteristics of the patients that were receiving hGH. As a result, we have some new data to better guide us as to which women may be most likely to benefit from hGH. Here is a summary of what they found:
- In women >40 years of age, they found a higher implantation rate and better on-going pregnancy rate in women treated with hGH during ovarian stimulation.
- In women that are poor responders to ovarian stimulation—defined as three or fewer eggs produced per IVF cycle—there was a marked improvement in pregnancy rate with growth hormone supplementation. They also found an improved outcome in FET cycles from embryos created during these cycles.
- In women that have poor embryo quality and low pregnancy rate in otherwise encouraging ART cycles, there is not be a clear benefit of using growth hormone. Instead, other causes of poor embryo quality should be explored. Once those have all been addressed, reconsideration of hGH is worthwhile.
Robert Greene, MD, FACOG
The most common and unanswerable question posed is that which follows one failed IVF cycle. Although our success rates continue to improve, on average about 1 in 3 couples is successful after one IVF attempt. However there are a growing number of studies that show that that success rate at least doubles when couples undergo at least 3 cycles. This is according to a just released report out of Sweden. A larger study published in the New England Journal of Medicine earlier this year was even more optimistic. In a study which followed more than 6,000 women through nearly 15,000 IVF cycles, they found that the live birth rate on the third attempt was between 65% and 86% in younger women and between 23% and 42% for women beyond age 40. Yet despite these advances in success rates, many couples drop out after only one attempt.
I regularly counsel my patients that a single IVF cycle can provide valuable information that can be used to plan future treatment; yet rarely does a single cycle serve to definitively identify those that will not conceive with one or more additional attempts. As a former IVF patient I personally understand the frustration at receiving a negative pregnancy test. That’s why I feel it is essential that good communication occurs throughout the treatment process.
Current estimates from the National Center for Health Statistics indicate that over 6 million women between the ages of 15 and 44 are affected by infertility. Yet many either never seek treatment or don’t complete enough therapy to be certain of their potential benefit. As our treatment attempts become increasingly more successful, I think it’s important to realize that a single cycle of IVF might only be the beginning of treatment and should only rarely be considered the end of the line.