I just finished re-filming “Journey to The Crib” a series of conversations between Dr. Dave Kreiner (Founder of East Coast Fertility) and myself about infertility. The older versions of the series is still on line if you want to check it out. But I am not writing about the series – I am writing about what opened up for me during the shooting of “Journey to The Crib”. And it is going to take more than one blog to get this all out! It began like this…..
Dr. Kreiner was answering some very simple straight forward questions for me – and his answers stunned me. Like a fire starting in the dry California woodlands, that old familiar feeling of burning anger that fueled me into becoming a patient advocate in the first place took hold.
We were talking about Micro IVF, which is a better alternative than Intra-Uterine Insemination’s (IUI) for patients under the age of 35 who are paying cash for treatment, concerned about the rigors and side effects of fertility medications, cost, success rates and high order multiple births. You see, Micro IVF costs about the same as a typical IUI cycle – only with less medication and a higher success rate than IUI. So, I asked Dr. Kreiner what seemed like a logical question to me:
“Why are there so few fertility specialists across the country offering Micro IVF?” It seemed to me that fertility doctors in every center would be offering this technique what with patient concerns about taking fertility drugs, fears concerning multiple births, and a higher success rate than IUI’s. Micro IVF is not after all rocket science! It leaves in ecological terms less of a carbon foot print in the world. And thats a good thing…right? Five days of Clomid and in most cases only two injections of gonadotropins…..if I was a patient I would be asking about Micro IVF at my center!
I mean how many patients have had to go through three IUI cycles before being encouraged to do IVF? And IUI’s in most cases require very similar quantities of fertility injections, blood test and monitoring as IVF. So why hasn’t that paradigm shifted?
Dr Kreiner smiled while he was shaking his head in his reply “Well, Pamela – All IVF cycles have to be reported to The CDC and SART – which means that patients will be looking at all of the numbers in choosing an IVF center for treatment.
Standard IVF involves more medication and therefore the likelihood of more embryos being produced. If you have more embryos to transfer your success rate will be higher than if you are doing a lower stimulation cycle and creating fewer embryos to transfer. Look at the numbers like this: an IUI cycle has approximately a 10 to 15% chance of working. But it doesn’t get reported to The CDC or SART. There is no public record of it’s success rates for patients to look at. A Micro IVF cycle has approximately a 30% success rate (younger patients may do better), and a Standard IVF Cycle may have a 50% success rate.
Micro IVF and Standard IVF are reported to The CDC and SART in the same way – so if a clinic does Micro IVF they will lower their success rates based on the limits of the procedure rather than their skill. Most clinics don’t want to lower their success rates for any reason because of marketing”.
So this comes down to marketing and competition among IVF centers rather than what may be in the best interest of the patient? During my years at RESOLVE and The American Fertility Association – this complaint – that doctors were more concerned about their SART and CDC Success Rate numbers than giving lower success rate patients a chance at trying with their own eggs was always a huge patient concern.
The high order multiple birth rate was also fueled by competition in the field to have the highest success rates. It was no surprise that once upon a time – the clinics with the highest success rates also had the highest triplets rates.
it is the great rub of the CDC Report and The SART Report. These publically published success rates were put into existence in 1992 by the passage of The Wyden Bill.
The Wyden Bill was meant to help infertility patients – and in some ways it has – but in many ways it has become an unfortunate marketing tool used by IVF Centers who need to be concerned how patients view their center’s success rates. The unfortunate part of all this – is what sometimes creates the best IVF statistical outcomes in pregnancy rates is not always what is in the best interest of the mother, child and family.
Dr. Kreiner is not the first doctor to question how The Wyden Bill has adversely affected patient care in the United States. In Dr. Sherman’s Silber blog he recently commented on how the bill has contributed to the high multiple birth rate in the United States due to IVF in this country:
“Firstly the regulatory law passed in the early 90’s known as the Wyden bill, has fostered this irresponsible transfer of too many embryos that some clinics do to increase their reportable pregnancy rate. This government mandated public reporting is used as a marketing tool by many IVF programs that artificially inflate their pregnancy rates so that they look to the unaware consumer as though they are performing for their patients better than they really are. They will cancel any IVF cycle in women with a low number of eggs and just do insemination for them, even though their best chance of pregnancy would have been with IVF. Furthermore they will transfer more embryos than they safely should transfer just to increase the reportable pregnancy rate for marketing purposes that are mandated by the Wyden bill. This gives incentive for physicians to transfer too many embryos, and to withhold IVF treatment from otherwise deserving patients who are in a lower success rate category”.
Interestingly enough – I believe that Dr. Silber also offers Micro or Mini IVF!!!!
Something to think about huh?