You’ve already crossed the bridge from “We’re going to get pregnant!” to “We need help…” But this other side looks filled with more obstacles, including expensive and risky fertility medications.

How far do you have to go just to have a baby?

Micro IVF (sometimes called MiniIVF) may be your answer.

The primary point of MicroIVF: fewer fertility drugs, less cost.

Plus you get additional benefits: decreased chances of ovarian hyperstimulation syndrome and of multiple pregnancy.

Additionally, East Coast Fertility patients who choose MicroIVF can increase their savings if they also use our Single Embryo Transfer Program — embryo freezing, storage, and future frozen embryo transfers are free.

Why go Micro?

I learned long ago that pregnancies of twins, triplets, and more can bring heartache to what should be a joyous journey for fertility patients. So the ECF team has dedicated our practice to the achievement of safe, healthy pregnancies.

IUI or IVF?

Intrauterine insemination (IUI) is often considered the first order of business for many infertility patients.

Sometimes called “artificial insemination,” the usual protocol — oral and injectable fertility medications to induce superovulation (of more than one egg in a cycle), followed by insemination via exam room procedure — is believed to be simpler and, therefore, less costly than IVF.

That’s just not true any longer.

The facts now are that success rates can be far better for IVF than for IUI, depending on the individual’s or couple’s cause of infertility. Many women undergo several IUI’s before achieving conception.

Some infertility causes — pelvic adhesions/scarring, blocked fallopian tubes, endometriosis, and severe male factor issues — will not respond to IUI but are treatable with IVF.

Even patients who would otherwise try IUI to get pregnant will find that choosing MicroIVF can result in cost savings and greater safety:

Micro IVF fee (current as of July 2009): $3900

ICSI (if required): $1000

Anesthesia (as requested): $550

IUI with hormone injections: $3500 to $4500

Is MicroIVF right for you?

Each patient’s case is considered carefully and individually. The following are conditions that might respond best to MicroIVF:

Young healthy women with PCOS or who otherwise produce many follicles

Women with pelvic adhesions or scarring, blocked fallopian tubes, or endometriosis

Couples with severe male factor infertility

MicroIVF really is a case of a little treatment going a long way! With it, you can access the world’s most successful assisted reproductive technology at far less cost.

A prophylactic salpingectomy or tubal ligation may be performed laparoscopically, using a tubular scope placed through the abdominal cavity to look inside the pelvis. Other instruments are placed through the lower abdominal wall and are used to remove the tube or close off the tube entrance to the uterus. Laparoscopy is performed under general anesthesia in the hospital.

Recently, the use of a contraceptive device, Essure, has been used to obstruct flow of the inflammatory fluid from the hydrosalpinx into the uterus. The Essure is a small coil that is inserted hysteroscopically through a woman’s vagina without cutting into the fallopian tube. It takes 3 months to induce adequate scar closure of the tube and is as effective as a tubal ligation. A hysterosalpingogram is performed after the 3 month period to prove adequate damming of the flow of inflammatory fluid. This procedure may be performed in an office based surgical unit and is sometimes performed without anesthesia.

Fifty eight percent of infertile couples who chose not to pursue therapy cited cost as the primary reason. About 7 percent of couples with frozen embryos discarded them from October 2008 to March 2009, representing a nearly three time increase from the prior six months. Fifty seven percent of egg donors in 2008 planned to use the money they earned from donation to pay for school, up from 28 percent from 2002-2004.

In the New York Metropolitan area, most programs see only about 20% of patients who do not have insurance to pay for their IVF cycles. Furthermore, it is estimated that for every patient who does an IVF cycle at least another 2 to 3 would also benefit from the fertility therapy. Unfortunately, for those with an insurance cap and for those paying out of pocket there is an enormous financial pressure for these patients to conceive in the fewest number of cycles to minimize the cost and hence transfer multiple embryos with a resulting increase in multiple pregnancies and the complications of premature deliveries; medical, emotional and financial.

New York State offers a grant for patients in need of IVF that is income based and diminishes the entire cost of the cycle for some lower middle income patients to just a few thousand dollars. However, even this rich program does not cover the cost of frozen embryo transfers and therefore still encourages patients to transfer multiple embryos. Other IVF programs, including my own offer our own income based grant programs and IVF studies significantly reducing the cost of a cycle and making it affordable to nearly everyone in need.

The problem remains that none of these programs discourage patients from “putting all their eggs in one basket” and risking the dangerous multiple pregnancies. Two years ago, I proposed an alternative financial program that does eliminate the financial need to maximize one’s chance of conceiving in a single cycle. It is called the Single Embryo Transfer Program at East Coast Fertility. A couple pays the standard $12,000 fee and the egg freezing, storage and frozen embryo transfers are included for an unlimited number of times until they have their baby. I wonder if patients knew about this program if cost would still stand in their way. The beautiful part is we would avoid these risky multiple pregnancies and according to the CDC, in addition to avoiding the medical, emotional and financial hardships caused by the multiple pregnancies, it would save $1billion per year if this program was utilized by all patients who are candidates for it throughout the country.

Yet another side effect of this economic downturn and lack of insurance coverage for IVF has been the fact that patients can have a gonadotropin/IUI cycle for free with a 30 percent risk of multiples and 5 percent risk of triplets or more if their insurance covers it but not the safer IVF alternative where one can control how many embryos to transfer. For patients paying out of pocket many still choose to risk multiples with the less expensive gonadotropin/IUI cycle despite its much lower success rate.

But, all couples don’t need a full stimulation IVF cycle. Many couples could try a lower stimulation IVF known as “MicroIVF”. The cost of MicroIVF varies but at my program it is offered for example at $3900, approximately the cost of a gonadotropin/IUI cycle and a far cry from the average cost of IVF. MicroIVF does not have the affect on the body that a gonadotropin cycle has nor the high risk of multiple pregnancy. It can be combined with the Single Embryo Transfer Program as well.

It is apparent that we have not done a good enough job communicating to patients about how they can afford fertility treatment with insurance or without. Money can be a barrier to having so many things, let’s not make it a barrier for couples to have families. We have to do a better job of letting them know about the solutions that are available to them so that they can afford to get the care that they need to make their dreams of a family come true.

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.

According to the Center for Disease Control, reported in the same NY Times issue, thousands of premature deliveries would be prevented resulting in a $1.1 Billion savings if elective single embryo transfer was performed on good prognosis patients. That brings us to regulating how many embryos to transfer as Octomom went through IVF with transfer of six embryos. At East Coat Fertility, we make 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. Patients are encouraged by this program not to put all their eggs in one basket. Success rates with an elective fresh single embryo transfer with IVF at our program, is 50% and with subsequent frozen embryo transfers it is over 64%. It is possible that East Coast Fertility is the only center in the country doing this. That is the shame of it.

Fertility treatment without IVF is even more hazardous since as many eggs that are developed with treatment may implant and lead to a hazardous multiple pregnancy. In a perfect world, where a patient’s welfare was put before insurance companies, IVF would be a covered service for all people, and the use of fertility medications in an uncontrolled IUI cycle would not be used anymore. In this perfect world, we would also regulate how many embryos are transferred. It is time to put our professional recommendations of the Society of Assisted Reproductive Technology (SART) into law. There is flexibility built into the recommendations taking into account critical factors such as patient age, embryo quality and past experience.

It is not until we discourage the use of gonadotropins without IVF by offering IVF as a regulated covered alternative will we eliminate risky multiple pregnancies. Until then, all of us including society, the government, insurance companies and employers are to blame for letting these dangerous multiple pregnancies occur.

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.

Patients often seek my help, desperate to try In-Vitro Fertilization (IVF) after having a previous cycle cancelled at an outside clinic. These patients stimulated with fewer follicles and therefore due to their lower pregnancy expectations were not allowed to proceed. We presented our data on IVF performed on patients with 3 or fewer follicles at the American Society for Reproductive Medicine (ASRM) (insert hyperlink to www.asrm.org) in 2008. Our pregnancy rate was 15% for this group. Though this is admittedly low, for those who were successful in having a baby using their own eggs it was felt by them to be miraculous because they were either not allowed to cycle at other centers or had their cycles cancelled.

We counseled them regarding their lower odds for success but some elected to give it a try. Previously, most of these patients were offered Intra-Uterine Insemination (IUI), a much less successful option that does not affect the programs reportable pregnancy rates.

Unlike most other fields in medicine, IVF results are subject to public reporting since the passage of the Wyden Bill in 1992. The intent of the CDC (Center for Disease Control) report and SART (Society of Reproductive Technology) report was to help infertility patients by informing them of the relative success of different IVF programs. Unfortunately, what sometimes creates the best IVF statistical outcomes in pregnancy rates is not always what is in the best interest of the mother, child, family and society. Now that prospective patients are comparing pregnancy rates between programs there is a competitive pressure on these programs to produce the best reportable rates. This means that patients with lower odds of success are less likely to be offered IVF retrievals and are diverted to IUIs or donor egg cycles.

The high order multiple birth rate was also fueled by competition in the field to have the highest success rates. The Wyden Bill results in competitive pressure to transfer more embryos to increase pregnancy rate as reported. Despite the fact that there is evidence that a program can achieve similar live birth rates by transferring a single embryo each time, the Wyden Bill creates a disincentive to do so. It is no surprise that the clinics with the highest success rates have also had the highest triplet rates. Live birth rates are reported per fresh cycle and those from subsequent frozen embryo transfers are not included. It is true that live birth rates are reported for frozen embryo transfers separately but again it is per transfer motivating programs to transfer multiple embryos to enhance their success rates. If live birth rates were reported per fresh IVF stimulation and retrieval (that part of IVF with risk) including those conceived from subsequent frozen embryo transfers then programs would be likely to provide the less risky option of single embryo transfer to patients.

William Petok, Ph.D the Chair of The American Fertility Association’s Education Committee reported on Single Embryo Transfer (SET) “Single Embryo Transfer: Why Not Put All of Your Eggs in One Basket?” He stated that “at the ASRM meeting in November of 2008 … data was reported that looks favorably at SET. A Center for Disease Control researcher said that although multiple rather than single embryo transfer for in-vitro fertilization is less expensive in the short run, the risk of costly complications is much greater. Universal adoption of single embryo transfer would cost patients an extra $100 million to achieve the same pregnancy rates as multiple embryo transfer, but this approach would save a total of $1 billion in healthcare costs.”

The risks of prematurity and pregnancy complications are far higher in multiple pregnancies than in singleton pregnancies. The financial and emotional costs to families and society are enormous. These multiple pregnancies result in much longer hospitalizations, NICU admissions, complications resulting in handicapped children and occasionally death. They often do not have a happy end including increasing the incidence of divorce. So does it not behoove insurance companies to make IVF available in such a way that encourages SET? Should not the government enforce the recommendations of SART regarding the number of embryos to transfer?

At ECF, we have, since 2006 offered our Single Embryo Transfer program to cover the financial cost for transferring one embryo at a time. For the fee of one IVF cycle, we offer free cryopreservation, embryo storage and unlimited frozen embryo transfers until a patient achieves a live birth.

We offer MicroIVF, minimal stimulation IVF, for $3900, less than the cost of 2 IUIs with three times the success rate and ¼ the risk of hyper stimulation syndrome. Since minimal stimulation does not result in as many eggs, many programs are uncomfortable offering it and therefore lowering their reported pregnancy rates.

If we are going to report pregnancy rates with IVF as is required by the Wyden Bill, let us put all programs on the same playing field by enforcing the number of embryos to be transferred and promoting minimal stimulation IVF as a safer and more efficient treatment than IUI.

The Wyden Bill without the teeth to regulate such things as the number of embryos transferred and reporting success per stimulation and retrieval and not by isolated embryo transfer does more harm than good. Let us support efforts to reduce the number of embryos transferred by removing the added costs to the patient of cryo-preservation, storage and subsequent frozen embryo transfers and by absorbing them ourselves as a profession. This will go a long way in eliminating multiple birth pregnancies, and will do the right thing for the patients, their families and for society. It’s time for us doctors to “Man Up”.

This is one husband’s story about living with a woman on hormones. It is not always this dramatic but the stress can be very difficult for a couple and many relationships benefit from professional support when going through fertility treatments. Imagine dealing with the stress, frustrations and cyclic disappointment couples feel when trying unsuccessfully to start a family. Add to this that your wife is being pumped up with hormones that have the potential to lower her threshold of rationality and sanity. Outbursts of anger directed at especially those closest to them are very common. Under normal circumstances most of us can control our reactions without letting our emotions get in the way. Hormones can greatly diminish our ability to control our behavior when circumstances become tense and stressful. Hormones have even been used as a defense in murder cases. My recommendation is to get rid of any guns in the house and not respond to apparent emotional outbursts. This should pass when the cycle is completed and the hormones have faded from the system. If not…?

Octomom was a result of IVF with an embryo transfer of six embryos. This far exceeds the number that the Society of Assisted Reproductive Technology (SART) has recommended as the limit. Physicians have known for many years the dangers of multiple pregnancies and have worked steadily to formulate evidence‐based guidelines for the number of embryos to transfer in IVF cycles. The current rate of triplets in IVF cycles nationally has dropped in 2005 to only 2% of cycles. At East Coast Fertility our triplet rate has been below 1% since 2002 and not one of these occurred from transfer of more than 2 embryos..

However, the Tunisian woman who is expecting six male and six female babies conceived using gonadotropins in combination with insemination. Unfortunately, one does not have the same control with insemination as you do with IVF. As many eggs as is stimulated by the gonadotropin injections can implant with intrauterine insemination (IUI) or without the benefit of retrieval of the eggs as one performs as part of the IVF procedure. With IVF one can limit the number of embryos transfered to a woman’s uterus. Insuance companies do not typically cover IVF but are more likely to cover IUIs. However, if one considers the cost of multiple pregnancy; including hospitalization for mother and babies born prematurely requiring the neonatal intensive care unit (NICU) and care for babies born handicapped, it would be a lot cheaper for insurance companies and employers, the government and society to cover IVF and have the control to prevent these high risk multiple pregnancies.

The dozen babies happened because the safer alternative, IVF was not performed. Gonadotropins without IVF are dangerously risky due to this lack of control over how many eggs may fertilize and implant. Society, the government and insurance companies in partnership with employers discourage IVF yet encourage gonadotropin therapy without the protection of IVF. They are at fault since they deny women coverage of IVF services. If IVF was covered by their insurance, physicians would not need to administer gonadotropins in such a dangerous and risky way. Perhaps gonadotropin treatment without IVF should be illegal or at least have very strict regulations regarding its use. Again, if IVF is a covered alternative who would not choose the safer more successful treatment?

That brings us to regulating how many embryos to transfer as Octomom went through IVF with transfer of six embryos. At East Coat Fertility, a financial incentive is offered to patients to transfer a single embryo. Cryopreservation of embryos is offered for free as well as storage for up to 1 year for patients in the Single Embryo Transfer Program. In addition, patients may return for their frozen embryo transfers for free until a baby is born. Patients are encouraged by this program not to put all their eggs in one basket. Success rates with a fresh single embryo transfer with IVF at our program, is nearly 50%.

If IVF were a covered service as I recommend to avoid the dangers of uncontrolled gonadotropin use without IVF than we need to regulate how many embryos are transferred. The SART recommendations regarding the number to transfer should be law to prevent such aberrations as Octomom from happening. There is flexibility built into the recommendations taking into account critical factors such as patient age and embryo quality. One can even factor in past experience.

I believe it is not until we discourage the use of gonadotropins without IVF by offering IVF as a regulataed covered alternative will we eliminate risky multiple pregnancies. Until then, all of us including society, the government, insurance companies and employers are to blame for letting these dangerous multiple pregnancies occur