September 26, 2013

Do Rock-Bottom IVF Prices Lead to Rock-Bottom Success Rates?

Louise Brown is perhaps the most famous all of children born the result of IVF. Two of the greatest pioneers in the field, Dr. Patrick Steptoe and Dr. Robert Edwards, worked diligently to afford this first success. Prior to the conception of Louise Brown, eighty (80) other attempts of pregnancy had failed.

From these foundations, scientific advances, technology and our ability to generate pregnancies and healthy babies flourishes. Pregnancy rates in good prognosis patients can exceed 50%. It is an impressive stride from the approximate 1% of thirty years past. However, these advances also have advanced the costs associated with IVF (medicines, clinics and technologies).

It is always prudent to examine these costs as we try to provide the most economic and efficient means where people can build upon their lives. The more affordable the treatment, the more people are candidates. However, it is important to recognize realized and unrealized costs.

Do rock-bottom IVF prices lead to rock-bottom success rates? Are the more inexpensive techniques providing equivalent results? Sadly, at this juncture the answer is no.

Minimal stimulation IVF has been touted as a modicum to reduce costs and multiple pregnancy rates. The idea is solid, the foundation not as steady. Previously oral medications such as clomiphene citrate have been used alone or in conjunction with injectible medications to booster follicular growth. Once the mainstay of therapies (the early 2000s), these protocols have been replaced by more efficient modicums for the generation of multiple follicles and more mature numbers of eggs. More efficient treatment protocols utilizing recombinant gonadotropins (injectible medications) result in a higher medication costs, without doubt. However, a larger cohort of embryos allows for natural selection of the strongest embryo(s), the ability to selectively transfer one embryo (eSET) and reduce multiple pregnancy rates. Additionally, patients with a competent pool of embryos may elect to cryopreserve remaining, competent embryos for use in the future. The cryopreservation, more specifically, vitrification of these blastocysts allows for patients to transfer the embryos in the future.

Sadly, often minimal stimulation IVF protocols are suggested for women whose issues are related to ovarian reserve (the ability natural gonadotropins to stimulate egg growth). In these cases, often a minimal numbers of eggs can be harvested regardless of the medications used, high or low dose. As can be anticipated, these success rates are minimal too.

However, the goal to bring ultra-cheap IVF to market (particularly, to the rest of the world) is not unfounded and deserves support. Currently, in Sub-Saharan Africa and Egypt, oral clomiphene citrate has been used to help the body to produce multiple eggs (fewer eggs obtained than injectible medications) in women with anticipated tubal infertility. These pregnancy rates are anticipated to be between 15-20%. (compared to 50% with standard IVF).

Tags: , ,
Danielle Vitiello, Ph.D., M.D.

Danielle Vitiello, Ph.D., M.D. Board-Certified in Obstetrics and Gynecology, Reproductive Endocrinology and Infertility