Some women have no symptoms of endometriosis!!
NO symptoms of endometriosis?? How?
Endometriosis is a debilitating disease for some (ie. painful periods, bleeding and pain during ovulation, uncomfortable intercourse, heavy bleeding and chronic pelvic pain). However, many women don’t know they have it, they just can’t fall pregnant.
When uterine endometrium is located in places other than the uterus, thats endometriosis. Want to know all science? Then technically speaking, endometriosis is a pelvic inflammatory process with altered function of immune-related cells and increased number of activated macrophages in the peritoneal environment that secrete various local products, such as growth factors and cytokines. What does all that mean? The endometriosis cells implant and respond to the body’s hormone before becoming endometriotic lesions and then scars.
As horrific as all that sounds, there is “sub clinical” endo.
“Sub Clinical” means a disease is not severe enough to present definite or readily observable symptoms. The incidence of “subclinical” endometriosis is thought to be around 42%. It doesn’t seem to matter how healthy you are or what your BMI is.
What we call Endometriosis is probably several different diseases lumped together, not just “one” thing. We suspect it is caused by multiple factors. Unfortunately, much more research is needed!! There are several theories as to why endometriosis occurs. We have not yet found a definitive answer.
Want to know something truly alarming??? There is an average delay of four to 11 years from the onset of symptoms to diagnosis.
Women who are unaware of their diagnosis (obvi) can’t get it treated!!
Untreated Endometriosis and Infertility
Fertility is impacted by endometriosis in many different ways. Scar tissue and adhesions can block the fallopian tubes and uterus. Therefore, the uterus is inhospitable for embryo growth and egg quality is damaged.
During the time you go untreated, the symptoms can get worse and multiply. Pain increases, further negatively impacting fertility.
One reason for this delay, is that endometriosis (many times) needs to be diagnosed through an invasive surgical procedure. Additionally, you may have to CONVINCE your doctor that the pain is not just “normal” period cramps.
Women report that when their OBGYN, or fertility doctor is not the same gender, race, or sexual orientation as as them, they are belied less, and have a hard time convincing. In psychology, this is called “affinity bias” but there are other reasons of historical racial prejudice too.
Women are believed less about their pain, and some minority women have reported being endlessly questioned for “drug seeking” behavior, or essentially accused of having an STI (STD) i.e. pelvic inflammatory disease (PID).
How is Sub Clinical Endometriosis Diagnosed?
How is sub-clinical endometriosis diagnose? There is one test, called ReceptivaDX.
ReceptivaDx is a first of its kind test for the detection of inflammation of the uterine lining. Women who test positive for ReceptivaDx are 5 times less likely to succeed in IVF.
IVF stress and infertility go hand in hand. Research has found an increase in sexual dysfunction—for both men and women—when assisted reproductive technology and IVF are pursued. Infertility is often the first major crisis that couples go through together.
The repeated doctor’s office visits for infertility treatments can be somewhat traumatizing when you aren’t used to having so much focus on your vagina, uterus, hormones, and body weight and overall health. Dates with “wanda” for follicle scans and embryo transfers, pessaries and suppositories of progesterone, bruises and bloating from repeated injections, can all conspire to make you feel less than sexy, or downright traumatized!
You may be reluctant to add one more person into the mix, but therapists that specialize in infertility, sex, and couples therapy could help guide and support you through the isolation and despair that infertility can bring. You can learn to use the power of the mind-body connection to reduce stress, and guided visualization programs are a great way for couples to reconnect, they are scientifically designed to improve your fertility by helping to reduce anxiety and reconnect with your body’s natural rhythms. One popular program for this is the Natural Cycle For Fertility Program, by Circle and Bloom.
Because sex is also a way to feel closer to your partner, IVF stress and infertility can lead clearly lead to tension in your overall relationship. Add to that, the financial burden of infertility.
Sources of Financial Stress in IVF:
-Disagreements over whether to pursue treatment (due to costs)
-When and how to borrow money
-To ask friends and family (or not) for financial help (like through crowdfunding)
-Whether to skip treatments and go straight to adoption (which is also expensive).
While some research has found that men and women faced with infertility may be more likely to feel dissatisfied with themselves and their marriages, other studies have found that it can bring couples closer together.
Couples that grow closer together don’t just “breeze through” infertility and they DO struggle.
I is the struggle—and the need for mutual support—that leads to a more secure bond.
Strategies and Tips for managing Couples Stress in IVF
We found some great tips and strategies for managing relationship stress on the Resolve website, and here are a few others: don’t isolate yourself, keep romance alive, relax together AND apart, be mindful, ask for support.
Support groups – such as those facilitated by Lori Metz can be invaluable for helping to cope with the biological, psychological, and social impact of infertility.
Do you know how to broken by infertility and TTC?
It’s NOT funny how cruel we can sometimes be to ourselves.
1 in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. (2006-2010 National Survey of Family Growth, CDC)
7.4 million women, or 11.9% of women, have ever received any infertility and TTC services in their lifetime. (2006-2010 National Survey of Family Growth, CDC)
Approximately one-third of infertility is attributed to the female partner, one-third attributed to the male partner and one-third is caused by a combination of problems in both partners or, is unexplained. (American Society For Reproductive Medicine)
A couple of ages 29-33 with a normal functioning reproductive system has only a 20-25% chance of conceiving in any given month (National Women’s Health Resource Center). After six months of trying, 60% of couples will conceive without medical assistance. (Infertility and TTC As A Covered Benefit, William M. Mercer, 1997)
That makes you pretty “normal” actually. you are in plenty of good company- we can’t all be broken, can we? It almost seems like infertility is a common and normal part of the human condition, Infertility and TTC doesn’t it?
Stop blaming yourself.
Stop feeling hopeless.
Stop basing your self-worth on your fertility.
Stop suffering silently.
Get solutions from here, broken by infertility and TTC
I’m afraid to ask… what are the worst things you have said to yourself in your darkest moments?
Infertility research priorities have been proposed for 2021. Healthcare professionals, people with fertility problems and infertility researchers (healthcare funders, healthcare providers, healthcare regulators, research funding bodies and researchers) were brought together in an open and transparent process resulting in an article that was published in Human Reproduction in November 2020 outlining the top future infertility-related research priorities. The initial survey was completed by 388 participants from 40 countries, and 423 potential research questions were submitted. Fourteen clinical practice guidelines and 162 Cochrane systematic reviews identified a further 236 potential research questions.
The top 10 infertility research priorities for the four areas of male infertility, female and unexplained infertility, medically assisted reproduction and ethics, access and organization of care for people with fertility problems were identified. These top ten research priorities in each topic area outline the most pressing clinical needs as perceived by healthcare professionals, people with fertility problems and others, to assist research funding organizations and researchers to develop their future research agenda.
Blog Series: Top Ten IVF Research Priorities
- An article was published in Human Reproduction in November 2020 outlining the top future infertility-related research priorities. The top ten ART research priorities are;
- What are the causes of implantation failure?
- What is the optimal treatment for women undergoing IVF who are poor responders to increase live birth rates?
- What is the optimal method of sperm selection in IVF cycles?
- In couples with unexplained infertility, does IUI increase live birth rates when compared with other ARTs, including IVF?
- In couples with unexplained infertility, what is the optimal number of IUI cycles before moving to IVF?
- What is the optimal method of embryo selection in IVF cycles?
- What are the factors that affect cycle to cycle variability in the number and quality of oocytes produced in an IVF cycle?
- What is the optimal time interval between ovulation and IUI?
- What is the emotional and psychological impact on children born using donor gametes?
- What is the emotional and psychological impact of repeated fertility treatment failure?
The first of the top ten infertility research priorities for medically assisted reproduction is “What are the causes of implantation failure?” In this post we will dissect the various hypotheses, tests, treatments and potential avenues of research.
The placental paradox
The riskiest moment in any human pregnancy is when the fertilized egg attaches to the uterine wall and tries to establish a link between embryo and mother. About half of IVF pregnancies fail during this implantation stage, and we all know how many natural pregnancies end at that time as well.
At some stage in the evolution of animals, we went from mammals that lay eggs, like the monotreme family (the platypus and echidna are the living members of), to marsupials or pouch gestating mammals like kangaroos, koalas and possums, to placental mammals like us. But even among placental mammals NOT all placentas are the same.
For example, in cows there are specific spots of attachment between the fetus and the mother called cotyledons, and this is so different than in humans where we have a total attachment between the placenta and the uterus. That is why you do NOT see cows bleeding out form a uterine rupture or suffering from, for example gestational diabetes or high blood pressure. Their blood supply is just not that connected to the developing fetus. We really see that our complex placenta developed evolutionarily to protect the embryo from our own immune system.
There is a kind of paradox that perplexes researchers of infertility, a mother’s inflammatory reaction to the embryo is the biggest threat to pregnancy, it also seems necessary for the pregnancy to be successful.
Implantation Failure
Implantation failure or RIF is an imprecisely defined clinical disorder characterized by failure to achieve pregnancy after repeated embryo transfers with genetically normal embryos. multicomponent, bidirectional signaling between the embryo and endometrium. A healthy uterus, free from endometriosis, polyps, fibroids, and with a thick lining is one piece of the puzzle, a euploid, or chromosomally normal embryo is another piece, less than 60% of euploid embryos result in pregnancy.
There are 4 main culprits or areas of active infertility research investigations. The 4 are; progesterone resistance, shifted window of receptivity, decreased integrin expression, and immune system disturbances.
Infertility researchers are identifying all of the biological components involved, developing tests to definitively say if that process is in a disease or abnormal state, and then drug treatments that work!
Progesterone resistance and infertility research
Estrogen stimulates endometrial proliferation, estrogen also causes an increase in progesterone receptor expression, enabling the establishment of the “window of receptivity”. Progestogen is directly responsible for the timing – the opening and closing of the window of receptivity. Endometriosis can actually cause progesterone resistance, disrupting the establishment, and opening or closing of the window.
There is a gene called BCL6 and its expression in the endometrium has been correlated in patients with unexplained or endometriosis-associated infertility. There is a test to see what the activity of this gene is called the Receptiva DX test.
Shifted window of receptivity
The window of receptivity itself has a molecular signature – meaning certain genes are expressing certain proteins- and this can be determined with a test called the ERA test. Implantation itself is actually a tightly controlled inflammatory response that coordinates the embryo “invasion”.
The embryo is essentially a foreign invader. It is half NOT your own DNA but the partner or sperm source. So the uterine lining and muscular wall must allow invasion by this foreign entity, without alerting your immune system to attack, and establish a vascular blood supply that can support pregnancy.
Decreased integrin expression and infertility research
Integrins are cell to cell adhesion molecules. They are the principal receptors on animal cells for binding most extracellular matrix proteins. They are basically a little ladder that crosses the membranes of both cells, in this case the embryo’s and the uterine endometrium.
Endometrial integrins are key molecules that promote embryo attachment. Right now, we have one good drug candidate to increase integrin expression, called letrozole. Letrozole is known as an “aromatase” inhibitor there is another very common mild aromatase inhibitor – Aspirin! Aromatase, is also called estrogen synthetase or estrogen synthase, because it is an enzyme responsible for a key step in the biosynthesis of estrogens.
There are so many features of embryo implantation that are consistent with the hallmarks of cancer and tumor invasion. In fact, it is often noted that “all the tricks cancer knows, were learned from the embryo”. The tricks here being invading tissue, establishing a blood supply for uncontrolled cell growth, and evading detection by the immune system. There are dozens of drug molecules from the cancer treatment world that can inhibit aromatase.
The immune system and infertility research
Two immune system components cytokines (which are generally associated with inflammation) and uterine natural killer cells have important roles in successful implantation.
Excessive and altered inflammatory signaling has long been suspected in implantation failure and recurrent pregnancy loss. Natural killer (NK) cells are members of a rapidly expanding family of innate lymphoid cells (ILCs). During pregnancy, NK cells are the most abundant lymphocytes in the uterus at the maternal-fetal interface and are involved in placental vascular remodeling. So discovering the complete set of cells and all their functions is still necessary.
We had one good drug molecule called glucocorticoids to investigate – they are a type of corticosteroid hormone that is very effective at reducing inflammation and suppressing the immune system. Glucocorticoids were selected to study, based on the biologic plausibility of restoring a normal immunologic response in the endometrium to promote healthy embryo implantation- however many gold standard clinical trials and meta-analysis of the data have failed to show improvement. For this reason, ASRM guidelines currently recommend against the routine use of glucocorticoids to improve implantation rates.
But there are dozens of other suspected immune pathways and drug molecules to explore.
Wait hold up. Isn’t a gestational carrier a surrogate? The answer to that question is yes-and-no. Both persons perform the same job: helping a couple have their miracle baby by carrying a child for them. However, a surrogate will be the biological mother of the child because she has donated her egg to make the baby she is carrying. A gestational carrier is not the biological mother of the child she is carrying.
Image by Brodie Vissers
Who requires a gestational carrier?
There are a variety of reasons for wanting to have a gestational carrier.
- The woman’s uterus is not able to carry a baby
- The woman may be experiencing certain disorders that hinder her ability to carry a child such as “extensive fibroids, scarring of the uterine cavity or adenomyosis” (Yale Medicine)
- The woman might have had several failed pregnancies, stillbirths, and miscarriages, which indicate another pregnancy might not yield good results.
- The woman has experienced complications while giving birth that is a cause for concern and may indicate another pregnancy could be fatal for the mother or baby.
What is the procedure for a gestational carrier?
It might differ slightly from one clinic to another. Essentially, it is the same. In this article, we will include what the process is like at Yale Medicine as described by the clinic itself! It begins with an evaluation of the gestational carrier. This evaluation is both psychological and physical. This is to ensure that the gestational carrier is ready to take on the overwhelming job of carrying another individual’s baby. The woman then undergoes a practice embryo transfer. By undergoing a practice run, the specialists are able to gain a better understanding of how the GC’s uterus will respond to the medications required to prepare the uterus for the transfer. Once the GC’s ovulation is aligned with the biological mother’s, the embryo is transferred and the hard part is essentially over! From there onwards it’s simply a regular pregnancy.
Gestational Carriers are Growing in Popularity
As the scientific field progresses, more and more gestational carriers are being used by infertile couples. In fact, the CDC has some data that can help put it into perspective!
- During the period of 1999 to 2013, 2% of all artificial reproductive technology cycles involved a gestational carrier. This equates to 30,927 cycles.
- The couples using a GC were often older.
- GC cycles had better rates of live pregnancy when compared to the cycles which did not have a GC.
- Multiple births were more common among GC cycles
How to Find a Gestational Carrier and Things to Keep in Mind
One of the first steps is finding a surrogacy agency. Steps after that involve choosing the GC and reviewing the abundant legal matters that surround the situation. These govern every aspect, from the extent of involvement of the intended parents during the pregnancy and whether the child will have contact with the GC when he or she grows up.
Knowing whether a GC is right for you is a conversation involving you, your partner, and your fertility doctor. People may have their own opinions about your use of a GC. They might see it as unnatural and belittle you for the choices you have made. At the end of the day, they don’t have all the information to be making claims about your fertility. Check out some of the articles we have referenced to explore more aspects of having a GC!
References:
- “Surrogacy: Who decides to become a gestational carrier ….” 5 Mar. 2020, https://www.health.harvard.edu/blog/surrogacy-who-decides-to-become-a-gestational-carrier-2020030519052. Accessed 18 Sep. 2020.
- “ART and Gestational Carriers | Key Findings | Assisted … – CDC.” 5 Aug. 2016, https://www.cdc.gov/art/key-findings/gestational-carriers.html. Accessed 18 Sep. 2020.
“Gestational Surrogacy > Condition at Yale Medicine.” https://www.yalemedicine.org/conditions/gestational-surrogacy/. Accessed 18 Sep. 2020.
It is common to change our minds about things. We might decide we want spaghetti instead of tacos for dinner. We might even decide on spaghetti tacos (that is a thing). However, it becomes a little more complicated when the decision is regarding having children and permanent birth control has already been put in place. A common form of permanent birth is tubal ligation or as most people refer to it “tying your tubes.” In this procedure, the fallopian tubes are cut and tied. By doing so, eggs can no longer travel down the fallopian tubes and no sperm can climb up the fallopian tubes to reach the egg. This will prevent any contact from occurring between the two gametes.
Is it permanent?
You might have noticed we said “permanent.” For the most part that is true. Once a woman undergoes tubal ligation, she does not need to worry about an unwanted pregnancy from that point onwards. Is it possible to reverse this procedure? In fact, it is! This does not necessarily mean that you are guaranteed a pregnancy after reversal. In fact, only approximately 50-80% of women become pregnant after reversing the ligation.
Why might IVF not work after tubal ligation?
There are several reasons for this. One of them is that when trying to undo the procedure, the stumps left after the procedure are beyond repair and scarred. Another reason is the development of another condition such as pelvic inflammatory disease or endometriosis. Lastly, it might not have anything to do with your body. Your partner’s sperm count or motility could be very low. Yes, male factor infertility is a thing. Infertility is not only a woman’s problem.
Ectopic pregnancies might occur after the reversal procedure. This is when the egg implants itself in the fallopian tube rather than the uterus. The chances of this happening post-reversal is 10% and the consequences could be fatal. Age is another factor. Women in their 40s have lower chances of conceiving and IVF is not recommended. Even if there are no complications witht he reversal, low egg reserve may end up preventing a pregnancy. Nevertheless, IVF will increase the chances of a successful pregnancy after tubal ligation rather than trying to conceive naturally.
Our final thoughts
IVF is expensive and tubal ligation is essentially a surgery that will also cost money. When making these decisions, make sure you are financially planning ahead of time. Whether you think the risk is worth it is completely up to you. No one is able to gauge the benefit of taking risks regarding your fertility except you. You will know what choice is right and not another individual. IVF after tubal ligation is a complicated topic. Every woman’s body is different and as we have seen even with a successful reversal of the ligation, the development of certain conditions and as a woman ages, the chances of pregnancy may decrease. Make sure you confide in your reproductive endocrinologist to find what is best for you. If you have not had ligation done yet, and are not sure if you want it, also confide in your doctor and they can walk you through the pros and cons of the different options. It’s a tricky road to navigate, but not impossible!
References:
- “IVF After Tubal Ligation: University Reproductive Associates ….” https://www.uranj.com/blog/ivf-after-tubal-ligation. Accessed 18 Sep. 2020.
- “Tubal Reversal vs. IVF? | Shady Grove Fertility Blog.” 4 Feb. 2020, https://www.shadygrovefertility.com/blog/diagnosing-infertility/tubal-reversal-vs-ivf-0/. Accessed 18 Sep. 2020.
“Tubal Ligation | Johns Hopkins Medicine.” https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/tubal-ligation. Accessed 18 Sep. 2020.
A message from our CEO on embryologists
July 25th is World Embryologists Day. It is the birthday of the world’s first IVF baby- Louise Brown! It signifies the importance of embryologists as they are the primary caretakers of your babies! On Denver fertility Albrecht women’s care blog, our CEO Dr. Carol Curchoe, Ph.D. TS wrote a post all about embryologists titled Profession of Embryology: Years of training and a lifetime of Learning! She delves into the educational requirements for an embryologist and also the experience needed to be able to work in a clinic!
One of the most important topics she explores, however, is staff training and competency assessments! ART Compass offers a great way for clinics and labs to implement a continuing education program for their employees! The assessments on the ART Compass app enable individuals to test their knowledge on a wide array of areas such as embryology, andrology, quality control, and assurance, etc. She also talks a little bit about herself and why ART Compass was born in the first place!
Denver Fertility
Denver Fertility Albrecht Women’s Care is a facility that tries to give you the best experience possible!
“We pride ourselves on finding the root cause of infertility with the most affordable and least invasive method possible.”
Though they have a state of the art IVF lab, they prioritize trying to provide you with the least invasive option possible and the least expensive as well. Some of the ways they attempt to improve a patient’s fertility include less invasive fertility treatments, nutritional counseling, lifestyle changes, and mental wellbeing. The fertility specialists Dr. Bruce Albrecht and Dr. Dana Ambler makes sure that when you are at Denver Fertility, you feel welcome and find yourself in a safe and trusted environment. Dr.Albrecht is board-certified in reproductive endocrinology, as well as obstetrics and gynecology. Dr.Ambler is board-certified in both obstetrics and gynecology, as well as in reproductive endocrinology and infertility. They are both some of the best fertility specialists you can find in Denver!
Denver Fertility’s IVF Lab
Like we said, they have an amazing IVF lab! It boasts a
- State of the Art Laboratory
- Fully skilled and experienced embryologist
- Latest cutting edge protocols and research
- Two of the most highly skilled REI physicians
- Extremely affordable IVF pricing
They have a 70% IVF success rate in 2019 compared to the national average of46.8%! This is attributed to tailoring their treatment plans around you-the patient! Fertility treatments are never one size fits all, and Denver Fertility understands that. Every TTC journey is different and Denver Fertility celebrates that rather than shy away from it.
Services
They offer a wide range of services including:
- Fertility Evaluation
- Female Pelvic Surgery
- Infertility Treatment
- Ovulation Induction
- Intracytoplasmic Sperm Injection
- Intrauterine Insemination (Artificial Insemination)
- In Vitro Fertilization
- Frozen Embryo Transfer
- Comprehensive Chromosomal Screening & Diagnosis
- Pre implantation Gene Screening
- Donor Egg/ Donor Sperm/ Gestational Carriers
- Elective Egg Freezing
- Fertility Preservation For Cancer Patients
- LGBTQ Family Building
- Psychological therapy and Support
- Stress Management
- Acupuncture
- Health and Wellness
It doesn’t end there though! They often hold FREE seminars for existing and new patients about a variety of topics including Fertility 101, IVF and learning the principles of exercise that can help improve your fertility.
Our final thoughts
You have to check out our guest blog post on Denver Fertility Albrecht Women Care’s website! If you want to learn how embryologists train, what their education requirements are and why the profession is essentially a lifetime of learning, head on over to their page! While you’re at it, explore the services that Denver Fertility has to offer and why they are easily one of the best fertility clinics you can stumble across in Denver! When you are choosing a fertility clinic, it is important that you spend a lot of time thinking about what you are looking for and whether the clinic you are looking at promises to cater to YOUR specific needs. It is also important to mention that this clinic is LGBTQ-friendly! They offer LGBTQ family building services. They greet everyone with open arms!
Always remember to never rush this decision!
Link to Post:
Reference:
Denver Fertility Albrecht Women Care
Artificial intelligence is often not really associated with reproductive health! We always hear a lot of talk about medicine evolving and incorporating AI into its operations, as we live in a technology-filled world. I’m sure when you’ve heard this the first image that might pop into your head is robots replacing surgeons! However, Scientific American about Artificial Intelligence’s role in treating infertility? How does that work? Well, we’ve got some good news for you. Our CEO Dr. Carol Curchoe and one of our scientific advisory board members, Dr. Charles L. Bormann break it ALL down for you in a Scientific American post titled “What AI Can Do for IVF”!
Image by Matthew Henry
All about the post
Check out the article if you’re interested in what big-name companies have been incorporating AI into fertility treatments, and medicine in general. You can also gain some insight into what stage all of these ideas are in. Scientific progress is not an overnight feat, so it’s important to always stay updated with where discoveries are and how they are doing! As most AI ideas for fertility treatments are in the experimental phase, you might also want to look into what the accuracy rates are looking like right now. Our post covers that too!
Scientific American
Scientific American about Artificial Intelligence’s is All. Things. Science. It is one of the best ways to stay updated about all the new scientific discoveries and endeavors in our rapid-paced world! It’s not only limited to medicine. SA covers a broad range of fields including biology, chemistry, physics, math, space, and even politics among others!
We are honored that they decided to feature our article about up-and-coming AI strategies in assisted reproduction technology (ART).
We definitely want to help play our part in keeping the scientific community updated! We also want to note, SA doesn’t only have articles and publications but they’ve got podcasts and videos if you’re more into auditory and visual learning! I know I’m more of an auditory learner myself!
The importance of staying updated
Reading the newspaper or watching the news when you can is always important! It is also crucial to do so regarding scientific news regardless of whether you pursue a career in science or not. For example, exciting discoveries in medicine might concern you if they perhaps have to do with a condition a family member is suffering from. Medicine affects every one of us! And that applies to us now more than ever during this Covid-19 pandemic. At ART Compass, we try to play our part in sharing crucial information about infertility that doesn’t really get the spotlight it deserves.
Many people suffering from infertility are misunderstood or not really paid attention to. Their struggle is seen as “dramatic” and because of that, people don’t see the need to share important facts and information about infertility. We’re here to change that. For all the infertility warriors out there-we hear you and we’ve got your back! Always check our blog because we post constantly! And check out Scientific American too while you’re at it to get the latest information on what science is up to!
Reference:
Curchoe. C, Bormann. C, “What Can AI Do for IVF” Scientific American, Jan 2018, https://blogs.scientificamerican.com/observations/what-ai-can-do-for-ivf/
What are the Warning Signs of Low Quality IVF Clinics?
IVF clinic quality is so important. How can you spot red flags? How do you choose a fertility clinic? What questions can a lay person ask to begin to understand the quality of an IVF Lab? Quality goes beyond pregnancy success rates to new technologies, inspections and accreditations, staff experience and more!
In the industry, we alway say, START with SART! The federal government requires fertility clinics to report IVF treatment cycle success rates, and you can find those statistics on the SART website. It also has a tool that allows prospective patients to search for fertility clinics by ZIP code, state or region; plus, women can plug in information such as their age, height, weight, and how many prior births they’ve had to predict their chances of success with assisted reproductive technology.
Most IVF programs are proud of their results and may list them on their website, however, whatever they are advertising should match the number of cycles and the outcomes reported to SART or found in the CDC Assisted Reproductive Technology Fertility Clinic Success Rates Report.
Verified IVF Lab Accreditation
One way to determine IVF clinic quality is to look for verified lab accreditation on the CDC report or in the actual facility itself, it will usually be posted in plain site. Find out who the inspecting agency is, the College of American Pathologists? The Joint Commission?
Another possible thing to note is to look at what percentage of their patients are in your age range, or have the same infertility diagnosis as you do.
Consider how the clinic’s staff talk to you, what they say – how professional does the care feel? Use all of your senses. Is the care personalized and professional enough so you feel comfortable?” An example of dehumanizing behavior: some clinics have an application process to decide if you should be treated there.
Failed to call in prescriptions to pharmacy
Lost paperwork
Lost appointments
Failed to call with results
Failed to order appropriate test
Look on Indeed, Glassdoor, or other job sites to get an idea of staff turn over and what staff have to say. The embryologist’s perspective is important! Find out how experienced the providers are, how well-trained they are and how long have they been there? As with other fields of medicine, experience matters in reproductive medicine. Providers should be fellowship-trained and board-certified in the field, both of which are the standard. Also inquire how long the medical providers have been at the facility. If there seems to be high staff turnover, there could be leadership and organizational issues at the clinic.
Does your clinic offer the latest treatments?
IVF clinic quality can be influenced by the techniques used. Look for clinics that can offer the latest treatments and protocols. These might include blastocyst transfer, freeze all cycles, mini or low STIM IVF, preimplantation genetic screening of blastocyst stage embryos and single embryo transfer, ERA or endometrial receptivity assay testing.
The introduction of intracytoplasmic sperm injection (ICSI) resulted in a choice of fertilization methods between conventional in vitro fertilization by insemination (IVF) and fertilization by ICSI. Fertilization by insemination relies on the normal healthy functions of the sperm, and those can be bypassed by injection directly into the oocyte. Severe oligospermia (low sperm concentration), asthenozoospermia (low motility) or teratozoospermia (abnormal morphology) are all good reasons to use ICSI. However, many clinics routinely use 100% ICSI no matter what the diagnosis is. In the case of IVF, unexpected complete fertilization failure (CFF) in an individual cycle is a well-known phenomenon and is a risk to the success of IVF cycles.
A suggestion originated in the early 2000s that the high hormone levels derived from a stimulated IVF cycle would encourage a non-receptive, out-of-phase endometrium. Then, a concept arose that adopting a freeze-all approach would not only minimize the risk of ovarian hyper response syndrome, but maybe even improve pregnancy rates in the general IVF population. Now, the latest clinical “meta-analysis” of fresh vs frozen transfers, (involving 5379 eligible subjects and 11 trials!), found eFET associated with a higher live birth rate only in hyper-responders. There was no outcome difference between fresh and frozen in normal responders, nor in the cumulative live birth rate of the two overall groups. Now, here is where it gets complicated.
Fresh vs. Frozen Embryo Transfer?
The CDC described the increase in the number of elective FET cycles between 2007 and 2016 as ‘dramatic’. They went from zero to more than 60,000 cycles per year. In its summary of US activity for 2016, the CDC seems unequivocal – at least, based on its observational registry data – that rates of pregnancy and live birth are higher after frozen transfers than after fresh. Yet the (published, peer reviewed or randomized clinical trial) so far has not shown a large difference. It seems to be a case where the clinical trials have not caught up with clinical practice. Because there is clear evidence that for hyper responders outcomes are better, many clinics now rely on a freeze all strategy to reduce this detrimental outcome.
Financial Aspects: Less may not mean more.
IVF clinic quality is not always tied to cost, but it can be. Experts say not to choose your clinic based solely on insurance coverage. Base your decision on the performance of the individual clinic. Clinics that have higher volumes will naturally have embryologists who get to participate in a lot of procedures. Fertilization rates should be above 70% and 40-50% of fertilized eggs should make it to the blastocyst stage.
Weigh the cost of the treatments with the CDC success rates. Good clinics with high success rates may cost more up front but may get you pregnant faster and at a lower cost in the long run instead of paying for multiple treatments.
High Tech IVF Clinic Management
Consider inquiring about the technologies the clinic uses. Do they use an EMR? Does it have a patient Portal for easy communication? Is there an electronic consenting process? Does the lab have state of the art cryo-storage monitoring systems? Does the lab use “electronic witnessing”? Quality control and assurance are of utmost importance in an IVF lab.
We hope you found this post helpful!
The question that runs through almost everyone’s mind, is IVF expensive?. To put it without sugarcoating it-yes. It can be expensive and because of that financial planning is crucial. Thinking about how you want to pay for IVF and looking at whether you’re eligible for any grants is a great way to start! (And yes, there are grants!) These grants have certain requirements however so it’s always good to double-check those before you apply for them. In this blog post, we’re going to cover how much it costs, how to plan for IVF, the places where you find grants, and how to cope with the financial stress. So let’s get right into it!
How much does IVF cost?
Is IVF expensive? It’s certainly variable. But on average one cycle can cost $12,000. This is without the medications which cost an additional $3,000-$5,000.
It is then about another $3,000-$6,000 for pre-implantation genetic diagnosis (PGD) . Neither the medications or PGD are optional. The medications are what prepare your body for the IVF cycle and the PGD is what helps identify any genetic abnormalities in a sample of an embryo. This way, the embryologist knows that if there are any abnormalities, then that embryo might not implant successfully and not lead to a pregnancy. They then will not implant it into the patient. In simplest terms, it will at least cost around $18,000 for the whole thing.
How to plan for it
It’s definitely good to start planning well ahead of your cycle. It’s not easy to jump right into IVF as it can be a big task to take on financially. Take at least a month to sit down with your partner, best friend, or family member and start researching! Look into different financing options. Find the organizations that provide grants and loans, read their eligibility requirements. Find out whether your insurance plan covers IVF.
Look at the best-case scenario, the worst-case scenario, and everything in between, and asks yourself are you financially ready to take them on? If you have a significant other involved in this, make sure you effectively communicate with one another what you feel is best. All of this might seem daunting at first, but don’t worry! Planning is key when it comes to finances. If you set aside some time to do so, it is all smooth sailing regarding financing your TTC journey!
Image by Shopify Partners
How to pay for IVF
Believe it or not, there are a BUNCH of programs out there that understand the financial hardships of IVF and other fertility treatments. They offer different kinds of packages, different types of loans and you can find what best fits you! Because there are too many, listing them here would be super long! Fortunately, there is a website that has done that for you! Now you can have all the organizations in one place. Here is the website. Still, you’re thinking is IVF expensive?
Do keep in mind however, that many of these programs have various requirements and they differ from one company to another. These eligibility requirements may be concerning:
- Age
- Income
- Number of cycles
- Type of fertility medications
- Medical screening
The Harsh Reality
You’re probably asking the same question I am. Why are fertility treatments so expensive? An infertile individual or couple is simply trying to conceive a child of their own and be able to experience the joy that other fertile individuals feel. Why is it that such a basic desire such as wanting to have a child of your own requires great financial burdens? It is all upside down. Fertility treatments should be accessible to anyone who needs them. Having finances get in the way of you and a little bundle of joy is unacceptable. This is a problem worldwide and we should work towards a change. We should work towards a world where a grieving mother after a miscarriage must not lose hope because she can’t afford fertility treatments. One step at a time.
References:
Uffalussy J, “The Cost of IVF: 4 Things I Learned While Battling Infertility” Forbes
Pooja is the content manager at ART Compass and works on the blog and social media content. She is an undergraduate student at Drew University pursuing a major in Biochemistry and Molecular Biology and minors in Business and Sociology. She has undertaken a literary research project on stem cell treatments for multiple sclerosis and wishes to continue stem cell research during her time at Drew. She is an associate member of the Tri-Beta Biology Honors Society and volunteers on an EMS squad and at the Red Cross. She hopes to attend medical school in the future.