It was fifteen years ago that I sat listening to a lecture about the hazards of multiple pregnancy and how IVF had increased multiples so drastically in the preceding ten years. What a depressing thought. I loved helping women conceive. I was living my dream, practicing the infertility and IVF I had learned ten years earlier at the Jones Institute with Howard and Georgeanna Jones themselves as well as Zev Rosenwaks and other masters of the IVF craft.
I had seen quadruplets created first hand as a result of our IVF efforts. But, that was a necessary side effect of transferring a sufficient number of embryos to offer a patient a reasonable chance for a successful transfer. IVF was very inefficient back then and our pregnancy rate even in 1995 with transferring 3-4 embryos was at best 40%.
The sobering truth is that multiple pregnancies — even with ‘just’ twins — are sometimes dangerous to the health and well-being of mother and babies let alone the triplets that were still occurring in 7-10% of the pregnancies at the time.
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 and is currently much more efficient so that the live birth rate for women under 35 years of age at East Coast Fertility is greater than 60% per retrieval.
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 analyzed our success with elective single embryo transfer and compared it to our success with elective double embryo transfer since the opening of our lab in 2005.
Fresh eSET was less likely to result in pregnancy than eDET 39/75=52% vs. 342/561=61% though this difference was not significant statistically. When frozen embryo transfer pregnancies were added this difference was 64% vs. 68.3%. There were no multiples in the eSET group but a 27.8% twin rate in the eDET group with 2 cases of triplets. 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 they have a baby. This represents a savings of up to over $12,000. It also ensures a much better chance of a healthy baby.
Is SET for you?
Each patient’s case is considered individually. Each factor impacting conception and pregnancy is taken into account, such as; the age of a patient, embryo quality, the number of prior failed IVF cycles and embryo quality. Single embryo transfer is appropriate in certain situations where the likelihood of a multiple pregnancy is high, including; women younger than 35 years, women who conceived with first IVF cycle, women with concerns about multiple gestation and 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.

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.

My first day of fellowship training in Reproductive Endocrinology at the Jones Institute was the day the Institute moved from the old quarters at the medical school to their new location at Hoffheimer Hall.  Movers carried boxes laden heavy with text books and the physician giants of IVF I had up until now only read about were picking up odds and ends from their recently departed offices.  Howard and Georgeanna Jones looked to me on that auspicious day like someone’s old grandparents rather than the father and mother of IVF.  Dr. Georgeanna, as she liked to be called, reminded me of my own grandmother.  I feared that I had come too late, that they were way past their prime and I would not be able to learn from them.  It was after all 1985 and they had been leaders in infertility since the 1960’s.  Dr. Howard was let go from Johns Hopkins Hospital almost 7 years earlier for reaching the retirement age.

They had planned to settle on the Maryland shore and spend time on their second love after fertility, sailing.  Instead, an old friend of theirs from Johns Hopkins from the 1960’s, Mason Andrews, helped found a new medical school in Norfolk, Virginia and now wanted their help to build the division of reproductive endocrinology, infertility (REI).  Eastern Virginia Medical which later changed its name to the Medical College of Hampton Roads was new and barely known by anyone outside of Virginia at that time.  Mason, a southern gentleman in his 60’s, soft spoken with a sharp wit and former Mayor of Norfolk, was successful in talking them into spending a few more years teaching so they bought a cozy house on the Elizabeth River 10 minutes from the school.

The Joneses hadn’t finished unpacking when the greatest fertility event of all time hit the news.  Patrick Steptoe and Robert Edwards had succeeded in Great Britain with creating a new life through a process known as In Vitro Fertilization.  The Joneses had worked with Professor Edwards years ago and were themselves well known in the field so it was natural that journalists came to their home to interview the erudite couple.  Dr. Howard talked about the genius of Professor Edwards and how he was not surprised that he achieved success.  Almost as an afterthought at the end of the interview, Dr. Jones was asked if IVF could be performed successfully in Norfolk.  In Dr. Howard’s pinpoint precision fashion and with his classic radio announcer voice, proclaimed that they certainly could develop IVF and with sufficient funds they could even create a successful program in Norfolk.  I have seen videotapes of Dr. Howard talking about this moment and it conjures up images of Babe Ruth promising to hit a homerun for the sick boy in the hospital then pointing to the fence just prior to him knocking one out of the park.

Well, the Joneses hit the homerun as predicted and by the time I arrived in 1985, Norfolk was the center of the IVF universe. Experts worldwide travelled to Norfolk to train and to teach.  Prior to the Joneses entering the playing field of IVF, the world averaged one baby a year from IVF.  Dr. Georgeanna introduced the concept of stimulating a woman’s ovaries with gonadotropin hormones in order to produce multiple eggs, thereby increasing the odds of retrieving healthy mature eggs, getting them fertilized and creating embryos that had good pregnancy potential.  Patients travelled from all over to have their IVF at Norfolk where the success rate, in 1985, was a world leading 15%.

I was excited beyond belief that this was my world now.  I arrived early that first day of my fellowship dressed in a brand new shirt and tie eager to learn and impress.  I managed to be accepted to this most competitive fellowship in part because I had been reading reproductive endocrinology for over 5 years.  I went through my ob gyn residency with the intention of specializing in REI and IVF.  In 1980 I began my training in REI mentored by Zev Rosenwaks, who convinced me that I could not possibly learn as much in any other residency as I would with him in Stony Brook.  So, I joined Zev, who had trained with the Joneses at Johns Hopkins, and he helped me start a residency clinic in REI at StonyBrook where I trained until 1985. Those five years I had been preparing for this moment in July 1985, to do my fellowship with Howard and Georgeanna Jones at the world famous Jones Institute in Norfolk, Virginia.

That first day, during office hours, I was following Dr, Georgeanna who was seeing her private patients.  Training begins.  She asked, do I know about the two cell theory to the luteal phase? I was dumbfounded.  I  had never come across such a concept in any of my reading.  Little did I know, Dr. Georgeanna had a knowledge base and theories in reproductive endocrinology that few others could rival.  She explained about the large cell and small cell and how the small cell is activated 10 days after ovulation by the pregnancy hormone, hcg.  In its absence the large cell dies, progesterone decreases and a woman menstruates.  In its presence the activated small cells continue to pump out progesterone and support the pregnancy.  How exciting! I realized that I would spend every possible free moment talking reproductive endocrinology with Dr. Georgeanna. She knew all the REI secrets.  She was the endocrinologist expert of the team.  She was also the heart of Norfolk.  She empathized with her patients and would go out of her way for them to help her patients achieve their dream, and that dream was to build their family.  Dr. Howard was the surgeon, the geneticist and the spokesman in addition to being the leader.  He was able to motivate and direct like a general leading his troops to battle.  Everyone on his team was critical in his view to their ultimate success.  He loved to say, “a chain is only as strong as its weakest link”.  He did what he could to ensure the integrity of each link.

Despite his age which was into his 70’s, Howard exercised regularly, was in excellent shape and in my mind was the original Macho Man.  I remember observing him operate, not always delicate, but experienced in fertility surgery like few others.  He was never intimidated and if the job called for raw muscle he was eager and willing to provide it himself.

I completed my two year fellowship in 1987, having learned an enormous amount of information and prepared to start my own IVF program.  However, the Joneses asked me to stay on as an assistant professor, to help start an embryo cryopreservation program and direct the donor egg program.  How could I refuse such an opportunity? I saw patients next door to Dr. Georgeanna and around the corner from Dr. Howard. Zev Rosenwaks was down the hall.  I could present every patient to whomever I thought would know the most about my patient’s problems.  This became an even better learning experience than my fellowship.  There were four of us in the IVF rotation, Zev Rosenwaks, myself, Suheil Muasher, a fellow who was two years ahead of me in training and Anibal Acosta, the Howard Jones of Argentina.  Rosenwaks and Acosta were often lecturing so Suheil and I performed more of the IVF that year. It was an exciting time.  We started doing retrievals transvaginally instead of laparoscopically.  We were experimenting with lupron and pregnancy rates were exceeding 25%.  I was doing my life’s dream working in IVF, helping women in need of help with conception achieve their dream of making their family.

Times were changing. Successful IVF programs were springing up throughout the nation.  It was the spring of 1988 when I returned home and started the first successful IVF program on Long Island dedicated to Howard and Georgeanna Jones who through their time, efforts and knowledge trained me and in so doing passed the baton of successful family building through the miracle of IVF.  Today, we remember these giants of IVF who started it all.  Mason Andrews and Dr. Georgeanna have since passed on.  Dr. Howard, now in his 90’s and how he describes it as late in the 9th inning is still occasionally involved in trying to make IVF more accessible to the public.  They were erudite medical pioneers who are responsible for the hundreds of thousands of babies who have been born through the technology that they helped create and promote.  They were the original teachers of IVF who selflessly shared their knowledge with others so that they also may help their patients conceive.   I am eternally thankful for the opportunities and training I received there from them, from Zev Rosenwaks, Suheil Muasher and from others at the Institute.

Cryopreserved Embryos

At East Coast Fertility, we are realizing the Jones’ dream of safer, more efficient and cost effective IVF. By utilizing the ability to cryopreserve embryos in 2007, 61.5% (118/192) of patients under 35 were successful in having a live birth as a result of only one egg stimulation and retrieval cycle! In addition, because of our outstanding Embryology Laboratory, we are usually able to transfer as few as 1 or 2 high quality embryos per cycle and avoid risky triplet pregnancies. In fact, since 2002, the only triplet pregnancies we have experienced have resulted from the successful implantation of two embryos, one of which goes on to split into identical twins (this is rare!). By cryopreserving embryos in certain high-risk circumstances, we are able to vastly reduce the risk of ovarian hyperstimulation syndrome requiring hospitalization. At East Coast Fertility, safety of our patients comes first. Fortunately, our success with frozen embryo transfers is equivalent to that of fresh embryo transfers, so that pregnancy rates are not compromised in the name of safety, nor are the babies.

Today, as reported in the Daily Science: “The results are good news as an increasing number of children, estimated to be 25% of assisted reproductive technology (ART) babies worldwide, are now born after freezing or vitrification” (a process similar to freezing that prevents the formation of ice crystals).

The study, led by Dr Ulla-Britt Wennerholm, an obstetrician at the Institute for Clinical Sciences, Sahlgrenska Academy (Goteborg, Sweden), reviewed the evidence from 21 controlled studies that reported on prenatal or child outcomes after freezing or vitrification.

She found that embryos that had been frozen shortly after they started to divide (early stage cleavage embryos) had a better, or at least as good, obstetric outcome (measured as preterm birth and low birth weight) as children born from fresh cycles of IVF (in vitro fertilisation) or ICSI (intracytoplasmic sperm injection). There were comparable malformation rates between the fresh and frozen cycles. There were limited data available for freezing of blastocysts (embryos that have developed for about five days) and for vitrification of early cleavage stage embryos, blastocysts and eggs.

‘Slow freezing of embryos has been used for 25 years and data concerning infant outcome seem reassuring with even higher birthweights and lower rates of preterm and low birthweights than children born after fresh IVF/ICSI. For the newly introduced technique of vitrification of blastocysts and oocytes, very limited data have been reported on obstetric and neonatal outcomes. This emphasises the urgent need for properly controlled follow-up studies of neonatal outcomes and a careful assessment of evidence currently available before these techniques are added to daily routines. In addition, long-term follow-up studies are needed for all cryopreservation techniques,’ concluded Dr Wennerholm.

The use of frozen embryos has become a common standard of care in most IVF Programs. At East Coast Fertility we are able to keep multiple pregnancy rates down – by only transferring one or two embryos at a time – while allowing patients to hold on to the additional embryos that they may have created during the fresh cycle. It is like creating an insurance plan for patients. We developed a unique financial incentative program using the technology of cryo-preservation to encourage patients to transfer only one healthy embryo at a time. In order to ensure the best out come for mother and child – these special pricing plans take the burden off the patient to pay for the additional transfers and the cryo- preservation process. We have eliminated the cost of cryopreservation, storage and embryo transfer for patients in the single embryo transfer program. Thus, patients no longer have that financial pressure to put all their eggs in one basket! We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.