Dr. Kreiner with Drs. Howard and Georgeanna Jones

In 1987, I completed my Reproductive Endocrinology and Infertility fellowship under  Drs. Howard W. Jones Jr. and his wife Georgeanna Seegar Jones, the two pioneers of in-vitro fertilization in the USA and the entire western hemisphere.

This picture was taken at their house on the Elizabeth River in Norfolk during one of the bimonthly journal clubs.  It was routine for the Joneses to host the journal clubs twice a month during which the entire Reproductive Endocrinology team would discuss interesting cutting edge research in the field.

Learn more about the History of IVF at the Jones Institute here.

Dr. David Kreiner of East Coast Fertility is using his conscience and his expertise to provide solutions in the fertility industry. He is the first in the country to offer an In-Vitro Fertilization (IVF) package using Single Embryo Transfers (SET) at one set price to patients, while still providing high quality care. It can save the healthcare industry $1 Billion.

Plainview, NY, September 23, 2009 –(PR.com)– With all of the negative publicity surrounding the fertility industry in the wake of “octomom” and other sensational news stories, it is no wonder public opinion has turned sour towards the doctors and clinics that perform the services. Society now questions the safety, practicality and costs of aggressive treatments that often result in multiple births. So how do infertile couples pursue a more conservative route to parenthood – one that’s safer for them and their baby, still offers high success rates, yet is affordable? Dr. David Kreiner of East Coast Fertility is using his conscience and his expertise to provide a solution. He is the first in the country to offer an In-Vitro Fertilization (IVF) package using Single Embryo Transfers (SET) at one set price to patients.

In a typical IVF cycle, a doctor will transfer two, three and sometimes more embryos back into the uterus, depending on many factors, in order to achieve the highest chance of success. However, this protocol lends itself to a high risk of multiples, making risky pregnancies, long NICU stays, babies with developmental problems and handicaps, and thus extremely high healthcare costs.

With a Single Embryo Transfer, just one embryo is placed back into the woman’s uterus, nearly eliminating the chance of achieving multiples. The remaining embryos are frozen and can be transferred to the woman in future cycles.

While SET is the optimal choice for many women, the current cost structure favors transferring multiple embryos over this method. Because transferring a single embryo has a lower success rate than transferring multiple embryos, a patient may have to undergo several SET cycles before achieving a successful pregnancy. Clinics charge for each additional procedure. The patients are expected to absorb what could add up to $100 million per year in extra costs. Thus, patients and programs are pressured to transfer dangerously high numbers of embryos. The real irony lies in the fact that research has shown that universal adoption of single embryo transfers could save the healthcare system a total of $1 billion in healthcare costs. Yet, the patients who choose SET are expected to foot the bill.

That’s all changing at East Coast Fertility. Their Single Embryo Transfer Program attempts to take the financial incentive out of this push to put “all your eggs in one basket.” Dr. Kreiner and his staff are making it cost neutral to transfer only one embryo at a time by offering free cryopreservation, free embryo storage and free embryo transfers until a patient achieves a live birth, all for the cost of a single IVF cycle. ECF absorbs the extra costs in cases where successive transfers are needed. So, the patient can choose the more conservative route without having to worry about the financial implications. Dr. Kreiner believes the benefits to the patient and society are obvious, and he doesn’t feel he is sacrificing the success of his practice. “It is with confidence in our highly successful embryo cryopreservation program that we are able to limit the number of embryos transferred without decreasing the number of births that result from IVF cycles at ECF. We are willing to sacrifice some margin in those cases where patients need successive transfers.”

It remains to be seen if other clinics will follow ECF’s lead. Perhaps society should demand that fertility doctors start doing what is best for the patient even if it means having to cut into their profits on occasion. “Hopefully talking about these issues will highlight some of the negative incentives that exist in the world of Reproductive Endocrinology, and bring about change in the industry,” says Pamela Madsen, fertility blogger (www.thefertilityadvocate.com) and founder of The American Fertility Association. She continues, “It is refreshing to see Dr. Kreiner as an ethical standout in the fertility world – a patient activist who is not letting greed get in the way of practicing good medicine.”

The sobering truth: multiple pregnancies — even with ‘just’ twins — are sometimes dangerous to the health and well-being of both mother and babies.

I was on the cutting edge of IVF development in the 1980’s, a time when assisted reproductive technology was so new and inefficient, transferring six embryos in one IVF cycle was the norm.

Since then, thanks to dedicated research to fine-tune IVF, much has been learned about both clinical practice and laboratory technique. IVF is no longer experimental.

One of the most important recent developments — single embryo transfer, or SET — is being consistently backed up by study after study as the optimal IVF method for patients with a good prognosis.

The SET Program

The safest pregnancy with the greatest chances for an optimal outcome — a healthy baby — is a singleton pregnancy. In 2007, East Coast Fertility started leading the field of reproductive medicine by establishing our own SET Program.

Confidence in our high quality embryology laboratory and immensely successful embryo cryopreservation program has afforded ECF the ability to limit the number of embryos transferred, essentially eliminating the risk of triplets or more.

We understand that you’re anxious for fertility treatment to work. Besides your compelling desire to have a baby, you’re coping with worries about the costs — in time, money, and discomfort — of IVF.

So to encourage patients with good prognosis to utilize SET, we offer the following incentive:

For the cost of an IVF cycle, SET Program patients will receive free cryopreservation of their embryos, free storage and free frozen embryo transfers until you have your baby. This represents a savings of up to over $12,000. It also ensures a much better chance of a healthy baby.

Plus, some patients can take advantage of MicroIVF and save even more money and physical discomfort.

Is SET for you?

Each patient’s case is considered individually. Each factor impacting conception and pregnancy is taken into account, such as:
patient’s age
embryo quality
number of prior failed IVF cycles
use of frozen-thawed embryos

Single embryo transfer is appropriate in certain situations where the likelihood of a multiple pregnancy is high. This may include:
women younger than 35 years
women who conceived with first IVF cycle
women with concerns about multiple gestation
donor egg recipients

Single Embryo Transfer is revolutionizing the practice of reproductive medicine, and the team at East Coast Fertility is committed to their collective pledge to lead the way in creating safe, healthy pregnancies.

East Coast Fertility is offering a free seminar: What You Need to Know Now If You Are Trying to Have a Baby: Innovations in the Treatment and Financing of Infertility. There is no charge for attendees, and all are eligible to receive a free fertility consultation with Dr. Kreiner and a discount coupon for some fertility medications. Don’t miss this chance to learn from these renowned fertility experts.

Plainview, NY (PRWEB) September 14, 2009 — East Coast Fertility is offering a free seminar: What You Need to Know Now If You Are Trying to Have a Baby: Innovations in the Treatment and Financing of Infertility. Attend this special night of hope and information and get answers to all of your questions. The seminar is hosted by fertility pioneer Dr. David Kreiner, founder of East Coast Fertility, and Pamela Madsen, founder of The American Fertility Association. They will be discussing topics such as Micro IVF, Single Embryo Transfer, Intrauterine Insemination (IUI), and Grant Programs to help finance treatment. There is no charge for attendees, and all are eligible to receive a free fertility consultation with Dr. Kreiner and a discount coupon for some fertility medications. Don’t miss this chance to learn from these renowned fertility experts.

There are two opportunities to attend the event: Thursday, September 17th at 6:30pm at the Marriott Long Island Hotel & Conference Center in Uniondale, NY and Monday, September 21st at 6:30pm at Danford’s Inn Marina Conference Center in Port Jefferson, NY. Questions about the seminars can be directed to Karen Malamud at (516) 939-BABY.

Dr. Kreiner and Ms. Madsen are offering these seminars to highlight Micro IVF as a more successful alternative to IUI and a more economical choice to IVF. Micro-IVF lowers the cost of in vitro treatment by more than half, and Dr. Kreiner believes that its success rate is much higher than the 10% chance of achieving pregnancy through a single IUI treatment. It is also more favorable for patients, as the procedure usually requires less fertility medications to be administered. Join them for this seminar to learn about what options are best for you. For more information on Dr. Kreiner and fertility treatments, visit East Coast Fertility.

ABOUT East Coast Fertility: East Coast Fertility is the premier center for infertility care on Long Island. Conceived by Dr. David Kreiner, a pioneer of IVF, their program utilizes the most recent developments in reproductive technology and has evolved to become a leader for highly successful and personalized infertility and IVF care. The center prides itself on combining the best technology and expertise with compassion for its patients. They offer many convenient locations throughout Long Island, Manhattan, Brooklyn and Queens.

Embryo

Many IVF programs have reintroduced the concept of utilizing a co-culture medium to improve the quality and implantation of embryos. Co-culture is a procedure whereby “helper” cells are grown along with the developing embryo. Today, the most popular cell lines include endometrial cells (from the endometrium, or uterine lining) and cumulus cells from women’s ovaries.  Both cell lines are derived from the patient, thereby eliminating any concerns regarding transmission of viruses. Endometrial cells are much more difficult to obtain and process, while cumulus cells are routinely removed along with the oocytes during IVF retrieval.

Cumulus cells play an important role in the maturation and development of oocytes.  After ovulation cumulus cells normally produce a chemical called Hyaluronan.   Hyaluronan is secreted by many cells of the body and is involved in regulating cell adhesion, growth and development. Recent evidence has shown that Hyaluronan is found normally in the uterus at the time of implantation..

Co-culture of cumulus cells provides an opportunity to detoxify the embryo’s culture medium that the embryos are growing in and produce growth factors important for cell development 1,2.  This may explain why some human embryos can experience improved development with the use of co-culture.

Preparation of co-culture cells starts with separation of the cumulus cells from the oocytes after aspiration of the follicles. These sheets of cells are washed thoroughly and then placed in a solution that permits the sheets to separate into individual cells.  The cells are then washed again and transferred to a culture dish with  medium and incubated overnight. During this time individual cells will attach to the culture dish and create junctions between adjoining cells. This communication is important for normal development. The following morning, cells are washed again and all normally fertilized oocytes (embryos) are added to the dish. Embryos are grown with the cumulus cells for a period of three days to achieve maximum benefit.

Performing co-culture of embryos has improved implantation and pregnancy rates above and beyond those seen with the IVF advances previously described. More importantly, It promises to offer advantages for those patients whose previous IVF cycles were unsuccessful.

References:
1. Barmat LI, Worrilow KC, Paynton BV. Growth factor expression by
human oviduct and buffalo rat liver coculture cells. Fertil Steril 1997;
67:775–9.

2. Fukui Y, McGowan LT, James RW, Pugh PA, Tervit HR. Factors
affecting the in vitro development of blastocysts of bovine oocytes
matured and fertilized in vitro. J Reprod Fertil 1991;92:125–31.