Eight is Too Much

I am a child of the '80s. I still listen to Fleetwood Mac (yeah I know they really are a '70s band) and Supertramp. I like the Back to the Future movies and I still remember how I felt when Darth told Luke he was his father...whoa! I never really liked the TV show "Eight is Enough" and clearly the recent events on the Left Coast have those of us who practice reproductive medicine scratching our heads.

My patients know that I am not a big fan of twins. The problem with twins is the risk of preterm labor, preterm delivery and prematurity. Although many patients brought the recent NY Times article about birth defects and IVF to my attention, nearly all of them went on to state how wonderful twins would be...."two for one deal....buy one get one free..." This line of thinking ignores the forest for the trees as the biggest risks facing IVF babies are not those from birth defects but the risks from prematurity... and almost all of the prematurity is from multiple gestations. Of course, it follows that the multiples come from replacing >1 embryo in an effort to improve the pregnancy rate.

As one would expect, there are now cries calling for more regulation of the IVF "industry." We are already extremely regulated. Clinics have to undergo inspections, the FDA is involved in donor egg, donor sperm, donor embryo and all gestational carrier cases and our own professional associations publish clear practice guidelines. However, this does not mean that certain individuals cannot practice in ways that are beyond the norm.

Ultimately, a physician should aim to follow the dictum of Sir William Osler of "First do no harm." Whenever I go into the room to perform an embryo transfer I ask the couple how they feel about twins. If twins are not desired then they get a single embryo back. The possible situation where the government legislates the number of embryos to be replaced eliminates any consideration of an individual patient's clinical history. However, I agree that if the government agrees to pay for all IVF cycles then they can determine the number of embryos to transfer. Until that time, we should not make sweeping changes in the practice of reproductive medicine because of the events in Beverly Hills.

Remember that you can always ask for a single embryo transfer or consider Natural Cycle IVF where there is only one available for transfer. If you get twins with a single embryo back...well, I can't be blamed for those twins as no one has yet been able to transfer <1 embryo!

So how do all of you feel about the octuplets....freak show or medical miracle? You know where I stand.

DrG

Read More

Natural Cycle IVF - Vote Early, Vote Often

Readers of this blog know that we believe in Natural Cycle IVF. Although some of our colleagues think that this is akin to believing in the Easter Bunny, Santa Claus, Alien Abduction and in the recently passed Economic Stimulus Package.....we really do practice what we preach.

We receive calls from all over the US asking about Natural Cycle IVF and I usually encourage patients to ask their local RE to see if they can do it rather than traveling to VA. Usually they are told that it is not an option and no one does it here in the US. They are wrong and we are trying to change attitudes about Natural Cycle IVF.

Last week a survey was sent to all IVF clinics in the US asking REs to weigh in on Unstimulated IVF. For those interested here is the survey. I hope that the results help us to change how Unstimulated IVF is reported as I view this as a real stumbling block to getting more clinics to pursue Natural Cycle IVF. The other factor is you, dear readers. "If you build it, they will come." So if you are interested in Natural Cycle IVF, then make calls, send letters, call in to talk shows, get us on Oprah...This is the antidote to the octuplet disaster! (Almost certainly not IVF by the way).



SO can Natural Cycle IVF really work?? Yes indeed and here is a real patient's story to show it!

Clinical Vignette#4: Natural Cycle IVF Works!

RT is a 24 year old who initially came in for consultation over the summer. She and her husband had been trying to conceive for over 2.5 years without success. All of her testing had been totally normal but his semen analysis was extremely abnormal with a perm count of 1 million/mL and very poor morphology and motility. He had undergone genetic testing (normal) and a urology evaluation (normal). The couple had been informed (correctly) that IVF with ICSI was the best option unless they were interested in using a sperm donor (which they didn’t).

However, financially IVF was a reach for them and they looked at a variety of options. They traveled to NJ where a clinic was doing a research study on IVF but they did not want to participate and RT was concerned as well about using fertility drugs. They learned about Natural Cycle IVF on the internet and drove 2.5 hours to have a consultation with me.

We discussed Natural Cycle IVF vs. regular stimulated cycle IVF and the couple was really excited about trying natural cycle IVF. Every day of monitoring they drove 5 hours round trip to come to Arlington and on day 10 she had a 17x14 mm follicle with an E2 of 141. We gave her HCG, did the retrieval and got a mature egg. It fertilized with ICSI and she underwent ET with a beautiful compacting 8 cell grade I/early morula on day 3. Her first beta was 1422 and was sent off to her Ob after fetal cardiac activity was seen on sonogram.

In a lovely letter she thanked us for providing Natural Cycle IVF stating that it was an answer to their prayers for a treatment option that was ideal for them.

Read More