Individualization is Important for IVF Treatment
David Barad, MD discusses why individualization is crucial in order to achieve the highest IVF success rates for pregnancy.
Learn More About In Vitro Fertilization (IVF)
Title: IVF: In Vitro Fertilization
Individualization is Crucial/ IVF Success Rates Explained
Speaker: Dr. David Barad, Board Certified OBGYN for 26 years
“IYou can think of IVF first as procedures that we do to help a woman produce eggs. IVF has changed very much over the last thirty years that we have been doing it. When we started maybe 10, 12 percent of women would get pregnant from a cycle now we’re 4, 5 times that much in selected patients, so it’s a big change in the technology. We have methods of trying to help women who other centers would say cant make an egg, to produce eggs. In IVF, one of the advantages are that if we can make a lot of eggs we can choose among those eggs to try to find the strongest embryos and then only put back the appropriate number of embryos for a women’s age to help her achieve her maximum chance of pregnancy.”
Who needs IVF?
“IVF directly addresses the issues for very low sperm counts, where its far too low to have success even with something like IUI. With tubal disease, which we mentioned before, so if your tubes are blocked the only way you’re going to get pregnant is if you’re taking eggs and sperm putting them together and making them into embryos and then putting them back into the uterus.”
How much individualization of IVF treatment is necessary for each patient? What are some of the factors that influence the individualization?
“Many large IVF centers, the ones that are doing thousands of cycles a year, when a patient comes there they’re put into the centers’ protocol. So the center has a particular way that they deal with people and everybody gets dealt with in that fashion. It’s kind of like McDonald’s, you know, you always get a hamburger. On the average the hamburger comes out okay but it’s different than what you would get if you go to a fine restaurant. We like to think we’re more like the second. We’re looking at patients; we’re looking at a lot of individual factors that go into them. Many of the patients that come to us are people who have been told already that they can’t do IVF because their ovaries are just not going to respond, they have to do donor egg, they have to forget about having children. And we pay a lot of attention to those people to try to find the way that we can tease out those eggs and help them to find their way to a successful production of embryos and thereby a chance of pregnancy. So we think one fo the things that really distinguishes CHR is our ability to look at patients as individuals, to understand what is going on with their reproductive function, and to really tailor our approach to maximize their response.”
What makes one IVF center different from another?
“Many places you’ll sit down you’ll talk to a nurse, you’ll spend a few minutes with a doctor that you wont see again, ever until maybe you do a retrieval or a transfer. At CHR you’ll spend, with Dr. Gleicher or myself, something like an hour or more at the first visit. We’ll talk to both the husband and the wife; hopefully the husband is available as well, and get a detailed medical history. Really understand what is going on with them and try to understand their prior fertility experience, so we can bring all that to bear as we formulate how we are going to take care of them.”
Are IVF success rates a good, objective measure of a given center’s skills?
“IVF centers will sometimes pick and choose their patients. So, many IVF centers who won’t accept a very difficult patient for fear of changing their published success rates and we all use our success rates to help attract patients. At CHR we believe we are here to try to help the patients, not just our published rates. And so we’ll take on women, as I said before, take on couples where the woman has been told she needs donor eggs. If she wants to try to get pregnant with her own eggs, and you can’t take away the fact that most of us would rather have babies that come from our own gametes, we’ll give her an opportunity. But it is an informed opportunity. We’ll explain to her what her chances are, we’ll explain to her what our experience is and she has to understand that at best her chances are going to be much lower than it would be if she did do the alternative of donor egg.”
What are IVF success rates? How are they calculated?
“Everybody who comes to an IVF center wants to know what’s the success rate, what does this mean? And there is no simple answer to that question because expected success will depend on how old the patient is, what the particular problems that they are dealing with are. We can talk about if a patient comes to me and I get to know them, then I can predict what I believe their success rates are going to be. But I cant talk about a blanket answer because what is true for a 25 year old with tubal problems is going to be different than for a 44 year old with decreased ovarian function. So we have to be very careful as we look at that. When we talk about success rates we talk about pregnancy that is live birth, so you can talk about baby per cycle. How many cycles do I have to go through at a particular age to bring home a baby? And that is the most important thing that people want to know. But not everybody reports their success in that way. So, some people will talk about pregnancy, which just means, I got pregnant but doesn’t account for whether you might miscarry. Per transfer, now some people who have transfers, will get pregnant but some people who start cycles wont get to a transfer because there are people who get cancelled because they don’t respond to medications. So as you looks at published success rates you have to say is this pregnancy pre cycle, pregnancy per retrieval, pregnancy per embryo transfer and the numbers change as you look at it. Also, is it live birth per cycle, live birth per retrieval, live birth per embryo transfer? So you have to be a little bit sophisticated and look at these things carefully to make sure you’re comparing apples and apples.”
What else should a patient consider when comparing IVF centers?
“Many patients ask me what do they have to look at when they’re choosing an IVF center, and there are all kinds of IVF centers in the world. Some are very large, some are doing thousands of cycles in the course of a year. I think you have to look at yourself and say what are my issues. If you have got some unique sets of issues, If you have had failures at other IVF centers, you need a little bit more expertise you need a little bit more attention to who you are and what your problems are and you need somebody with experience. Dr. Gleicher and I, together, have more years than I care to count of experience. We also are on the cutting edge of developing new procedures to take care of these problems. We’re sought after speakers. We publish probably more than the average academic fertility center does. We’re really bringing to bear some very original thinking on how to deal with these individual problems. So, if you’ve got a unique set of issues, you want to go somewhere where people are going to pay attention to them and take them into account and not just throw you into some cookie cutter approach, one size fits all. And I think that’s really what we can provide here at CHR that makes it unique. We’re providing experience, really cutting edge research and an individual approach.”
TEXT: Dr. Barad joined the Center for Human Reproduction in 2003 as Director of clinical ART.
Dr. Barad has been active in clinical research, including his role as investigator in a major menopause study conducted by the Women’s Health Initiative (WHI).
Together with Dr. Gleicher, Dr. Barad has published many peer-reviewed scientific papers in medical journals.
In addition, Dr. Barad has been recognized by the American Infertility Association for his, “continuing dedication and support to individuals experiencing infertility.”
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