FROM US TO YOU    2007 IVF Pregnancy Rates

Pacific Fertility Center (PFC) is pleased to share our in vitro fertilization (IVF) pregnancy rates for 2007. Our outstanding IVF pregnancy rates are made possible thanks to our team of ABOG* board certified specialists in Reproductive Endocrinology and Infertility, as well as, highly trained embryologists. *American Board of Obstetrics and Gynecology

PFC's investment in enhanced methods of embryo culture has improved outcomes with IVF. New incubators, culture media, and procedures have increased embryo quality and embryo implantation rates.

These improvements have lead to excellent success with single embryo transfers and have significantly reduced the risk of multiples. Frozen embryo success rates also improved in 2007. We attribute this success to the new method of freezing day 5 embryos called vitrification. This is the same process that has resulted in the birth of our first baby conceived from a frozen egg.

2007 IVF HIGHLIGHTS:
Single Embryo Transfer (SET)
Of the patients using donor eggs, 66% (24 of 36) became pregnant with a SET. Of the patients using their own eggs, 48% (12 of 25), became pregnant with the transfer of a single embryo.

Improved Frozen Embryo Success:
Pregnancy rates with frozen embryos have never been better. This program requires the utmost skill and quality control in the laboratory to keep embryos viable using the new vitrification process. In women under 40 years old using their own eggs frozen on day 5, 43% became pregnant (49 of 113). We expect these pregnancy rates to continue to improve as the vitrification process is used to freeze more of our embryos.

Day 5 (Blastocyst Transfers)
Selecting day 5 fresh embryo transfers, we achieved a 52% pregnancy rate per transfer for women under age 35 and 58% for women 35 - 37 using their own oocytes (eggs). Also, remarkably, we achieved a 49% pregnancy rate per transfer (135 of 277) for women of all ages using their own oocytes (eggs).

Outstanding Oocyte Donation Pregnancy Rates:
Oocyte donation pregnancy rates are one of the best indicators of an outstanding IVF program. Last year we achieved a 69% pregnancy rate per transfer in women using donated oocytes. This is especially impressive since 23% of all fresh egg donor embryo transfers were single-embryo transfers.

* Pregnancy rates are reported as clinical pregnancies per transfer. Delivery rates per transfer will be available near the end of 2008 when all babies have been born. More information is available by contacting Pacific Fertility Center.

Notes on Pacific Fertility Center (PFC) statistics:

1. PFC does not restrict IVF to only those patients most likely to succeed, (a practice which often leads to higher pregnancy rates). Our less restrictive approach is confirmed by our high percentage of Decreased Ovarian Reserve, DOR (a basal FSH level of 10 mIU/mL or higher). As reported by SART/CDC in 2005, 24% of PFC patients were diagnosed with DOR.

2. Pacific Fertility Center performs a substantial volume of IVF and oocyte donor cycles. This allows for better statistical accuracy of our data, (the fewer number of patients - the less statistically significant the rates become). We feel it keeps all of us well attuned to the practice of assisted reproductive technologies or ART.

3. Although we individualize treatment to each patient's diagnosis and prognosis, our goal is to adhere to ASRM guidelines on the maximum number of embryos to transfer, in order to lower the risk of high order multiples.  Eldon Schriock, MD

Eldon Schriock, MD, has been at the forefront of assisted reproductive technology since 1981. He was a member of the team that performed the first in-vitro fertilization treatment in Northern California. His compassion and expertise is evident while caring for couples whose IVF treatment has been unsuccessful at other clinics. He works to sensitize the medical community to a psychologically informed approach to patient care. He is repeatedly recognized as “Best Doctor” in peer surveys (see www.BestDoctors.com).

               
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ASK THE EXPERTS    Pregnancy After Failed IVF

   Pacific Fertility Center Team: Left to Right: Front: Philip Chenette, MD, Isabelle Ryan, MD, Carolyn Givens, MD, Back: Joe Conaghan, PhD, Carl Herbert, MD, Eldon Schriock, MD

Question: A friend of mine recently conceived a couple of months after two failed IVF cycles. Did she really need IVF in the first place or did the IVF change things to make it more likely she would get pregnant on her own later?

Answer: For some couples, IVF is necessary because the woman’s tubes are blocked or because the sperm count is drastically low. For these patients, IVF is probably the only way they are going to conceive. For the rest of our patients, those with endometriosis, mild male factor, decreased ovarian reserve, age-related, or unexplained infertility, there is some chance of conception, however low it is. For these patients, IVF is a way to boost (often dramatically) the chances of conceiving sooner than later.

For example, for a couple that has unexplained infertility of one to two years’ duration, the statistical chances that they are going to conceive on their own are probably in the range of 3% per month. Depending on the woman’s age, IVF could increase that to 20-50% per month of treatment. But even if she doesn’t happen to get pregnant with IVF, and the couple continues to try on their own, their chance of conception returns to that 3% per month, so they may conceive, even after a failed IVF attempt. There is no reason that the IVF itself should make that couple more likely to conceive later.  Carolyn Givens, MD

               
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PATIENT ODYSSEY    Everything in Two’s

I met the man of my dreams and had the opportunity to fulfill my dream of having children. I always wanted to have a family, but just had to find the right partner. My husband felt the same way - absolutely. We had a strong relationship/marriage, great family support, good financial base and all the interest in the world in having a family together, so we began trying.

Fulfilling our dream of having a family was a long road with lots of questions, uncertainty, and requiring overwhelming patience! By the time I was 35, we had been trying for six months without results. Fortunately, a friend of mine strongly recommended getting my FSH tested because I was over 35. It turned out that my FSH was on the high side.

Once I got connected with PFC (I urged my OB/GYN for a referral), Dr. Ryan confirmed my elevated FSH levels and discovered that I also had uterine polyps. My OB/GYN did my first out-patient surgery but unfortunately there was still one polyp remaining after the initial surgery. Dr. Ryan did a hysteroscopy and removed the last polyp.

We first did two rounds of IUI without success. We moved on to IVF- the ‘two-fer” deal. We harvested lots of eggs, but transfers did not result in pregnancies. We looked carefully at adoption, but didn’t’ like the long time frame and lack of choices. We decided to move on to the egg donor route. We liked the fact that with an egg donor, we were able to choose our donor. In addition, the time involved and the expenses were less than adoption - a lot less. I also really wanted the experience of being pregnant and giving birth to my husband’s (his DNA) baby.

We selected a donor and did two rounds. We did everything in two’s. We realized this peculiarity afterwards. Oddly enough, we now have two kids!

Our first donor didn’t respond well to the medications and no good eggs developed. Our second donor worked like a charm. Lots of eggs were harvested (23, I think) and lots of great quality embryos developed. We put two in and froze 11. I became pregnant with my daughter!

Two years later – EXACTLY (we realized this on the embryo transfer date. It hadn’t occurred to us before that!) – we did our last transfer of previously frozen embryos. We had already unsuccessfully transferred the other 9 embryos. Then, there was that magical number two again; I got pregnant with our son! He is now 6 months old!

Looking back, lets’ just say I’m VERY, VERY HAPPY to not be the patient any more – but to be a mom!! The whole process was very tiring and very emotional. I felt like a frequent flier for a while, but the nurses were calm, kind and very genuine with me. Dr. Ryan, Olga, Anne and several of the other nurses made such a difference. They were so sweet and friendly.

The best part of the whole experience was growing closer to my husband. We learned to be parents while working to become parents, working together, surviving sleepless nights, working through the stress and worry about our (unborn) babies, and going through the process of making group decisions.

The most difficult elements of this whole experience were the feeling that I was participating in an endurance event that just didn’t’ seem to end, the loss of control, and finally the loss of privacy when your very private matters are placed under the scrutiny of the MDs. It seemed like a laboratory experience of a very loving part of life.

Here’s my advice to others trying to conceive:

1. If you are considering using an egg donor, talk to others who’ve been through it. Ask lots of questions and keep your goal in mind. As my mom used to say, “Sweetheart, it doesn’t’ matter how your baby gets here, we won’t be thinking about that 18 years from now when your child heads off to Harvard for college!! “

2. Don’t waste time. Remember that regardless of how wonderful your MD or nurses are, YOU are your own case manager. There were several points in our process in which if I had not been on it, asking questions, driving the schedule etc., there would have been more delays. Everything works in one-month increments due to menstrual cycles. It is a frustrating reality that requires lots of patience. I believe this “self – advocate” reality is true with any kind of medical treatment. As good as your doctor may be, they are not you. You have the most to gain or lose by being informed and involved!

3. It can get intense, so getting away by taking trips helped us feel NORMAL!

               
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CONCEPTION HEALTH    Mid-Cycle Procedures

For patients making an initial consultation at Pacific Fertility Center, our New Patient Guides (NPG’s) are the first contact the potential patient will have with us. One of the things our NPG’s try to do when helping a patient set up her first in-person visit to the office is to determine the best time of the patient’s cycle to book the appointment.

Figure 1   Figure 2

For women that have regular menstrual cycles, we try to schedule the first appointment just prior to ovulation. At this time of the cycle, using ultrasound imaging, we can best assess the uterine lining (endometrium) for adequate thickness and the proper growth pattern. We hope to see a thickness of about 7-9 millimeters (ideally 9 or 10 mm) and a pattern that we refer to as a “triple line” pattern within the inside of the uterine cavity (Figure 1). The center line of the triple line is the two sides of the cavity itself touching each other. The non-pregnant uterine cavity, then, is a potential space that is normally collapsed upon itself. The two outer lines are the borders of the endometrium (the glands of the uterine lining) and the myometrium (the muscle of the uterine wall). These two parameters help us predict the potential for successful implantation of an early embryo (blastocyst) when it arrives in the uterus.

In assessing the uterine lining, we are also looking for any polyps (abnormal glandular growths) or fibroids (benign smooth muscle tumors) within the uterine cavity that may inhibit embryo implantation. Many women have fibroids within the muscle wall itself but we only worry about them if they are in the cavity or distort the cavity walls.

During this ultrasound exam, we also view the ovaries. Typically, if the patient is nearing ovulation, we will see a “dominant follicle” (Figure 2). Eggs grow in fluid-filled sacs in the ovary called follicles. In a woman’s natural cycle, one egg will develop and the fluid in the follicle will accumulate such that the follicle gets to be about ¾ to one inch in diameter just before ovulation. That fluid helps to push the mature egg out of the dominant follicle at ovulation.

We also look at the remaining ovarian tissue for “antral follicles.” These are runner-up follicles/eggs that began the process of development but got beat out for ovulation by the dominant follicle. The number of these antral follicles present gives us some idea as to the patient’s reproductive potential and whether or not she will be a good responder to fertility medications, should we decide to undertake treatment with injectable fertility drugs.

If we know that our patient is heading to in vitro fertilization, we may go ahead at this visit and do a “mock embryo transfer.” This is a simulation of the step of the IVF process where we replace embryos into the uterus. The mock embryo transfer feels about like having a Pap smear done. We will place a vaginal speculum and visualize the cervical opening. Then we will pass a small flexible catheter (tube) about 2 mm in diameter into the cervix and up to the top of the uterine cavity, gently touching the cavity. This allows us to take a depth measurement and also helps predict if there will be any difficulty with the actual embryo transfer. We then use our notes from the mock embryo transfer to guide us on the day of the real transfer.  Carolyn Givens, MD

               
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-- Best regards from all of us at Pacific Fertility Center.