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In Vitro

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In Vitro Fertilization

September 15, 2014

Class: MA111

In Vitro Fertilization (IVF) is a process of fertilizing an egg with sperm outside the body. It’s a major infertility treatment when other methods of assisted reproductive technology have failed. The process of IVF involves monitoring and stimulating a women’s ovulation process, removing an ovum or ova (egg or eggs) from the women’s ovaries, added the sperm to fertilize the egg or eggs. Once the egg has been fertilized it becomes a zygote and will be cultured for 2-6 days, when will be transferred into a women’s uterus with intention of establishing a successful pregnancy. IVF can be used to overcome female and male infertility. According to NICE guidelines IVF is indicated in unexplained infertility for women who have not conceived after 2 years of regular unprotected sexual intercourse. For IVF to be successful it requires a healthy egg, sperm that can fertilize and a uterus that can maintain a pregnancy. With the large cost of IVF it is generally attempted after less expensive treatments have failed. Some couples use donor eggs or sperm to achieve a pregnancy, but some use IVF with a surrogate where another women carried the pregnancy. With IVF there are some risks like ovarian hyperstimulation which is routinely used with IVF. Ovarian hyperstimulation is where the ovaries are stimulated to develop multiple follicles, two common drugs used are Pergonal and Repronex which are injectable gonadotropins, with the above drugs a women risks getting ovarian hyperstimulation syndrome (OHSS) which is a life-threatening complication. IVF has two methods Natural and Mild. Natural IVF is less expensive than conventional IVF and has a reduced risk of multiple gestation and OHSS. Mild IVF is a method using small amount of fertility drugs for ovarian stimulation for a short time. Once the egg has reached a certain degree of development it will be retrieved. Eggs are retrieved from the women using a transvaginal technique called transvaginal oocyte retrieval, using an ultrasound-guided needle piercing the vaginal wall to reach the ovaries. Through the needle the follicles can be aspirated and the follicular fluid is passed to an embryologist to identify an egg with this procurer it’s common to remove between 10-30 eggs. This whole retrieval process takes between 20-40 minutes, but it depends on the number of mature follicles. When it comes time to fertilize the egg it is prepared by stripping all the surrounding cells. An oocyte selection may be performed to select eggs with optimal chances of successful pregnancy. The semen is prepared by removing inactive cells and seminal fluid in a process known as sperm washing. When it’s time for co-incubation the sperm and egg are added to a Petri dish with a ration of 75,000 sperm to 1 egg. Sometimes the sperm is injected directly into the egg using Intracytoplasmic Sperm Injection (ICSI). Since the egg is fertilized it will be passed to a special growth medium and left for 48 hours till it is 6 to 8 cells. Now that the egg is 6 to 8 cells it will be left to complete the cleavage stage (day 2 to 4 after co-incubation) or a blastocyst stage (day 5 or 6 after co-incubation) once the blastocyst stage confirms a significant increase in live births the embryo is transferred. Once the embryo is ready for transfer a laboratory will use the developed guidelines to judge oocyte and embryo quality. This is done to optimize pregnancy rates, when the embryo passes all the test it can be transferred into the women’s uterus. The number of embryos that can be transferred depends on the number of available embryos, the age of the women, other health and diagnostic factors. In countries other the United States such as Canada, United Kingdom, Austria and New Zealand the maximum of two embryos can be transferred except in unusual circumstances. The transfer is done by using a thin, plastic catheter to place the embryos into a women’s uterus. The success rate of IVF is better today than it was just a few years ago because of advancements in reproductive technologies. In the United States the live birth rate is: Under 35 years of age 41.4%, 35-37 years of age 31.7%, 38-40 years of age 22.3%, 41-42 years of age 12.6%. In Canada the rate is 27%. Now when it come to the fee for IVF in the United States a cycle of IVF costs around $12,400 but it could be cheaper depending on if your insurance company offers coverage for infertility treatments and the amount of your co-pays and deductible. Just be sure to ask the clinic to quote you a price and be sure to ask what that amount includes. Sometimes you will have to pay for treatments that are not included like * ICSI (intracytoplasmic sperm injection) $1,000-$1,500 * Assisted hatching * IUIC (intrauterine injection) $275-$2,500 * PGD (pre-implantation diagnosis) $3,200-$3,600 * Egg donation * Sperm donation * Gestational/Traditional surrogacy
If you’re lucky to live in the of the following fourteen states that requires insurance companies to cover infertility * Arkansas * California * Connecticut * Hawaii * Illinois * Maryland * Massachusetts * Montana * New Jersey * New York * Ohio * Rhode Island * Texas * West Virginia
Many fertility centers offer loan programs to help couples afford the cost of IVF, Some even offer a IVF refund program that cover 3 or 4 IVF attempts and if pregnancy is not achieved they will refund some of your money but the cost is $20,000-$30,000 for the refund program. Many Americans travel to other countries like Czech Republic were the cost is dramatically lower.

What I have learned from this paper is the cost for IVF is so expensive and not all couples that can’t conceive naturally can afford this treatment. Yes your GYN can offer come help with medication like Clomid but it still has to let nature happen. Living in the United States I have seen the cost of medical treatments cost thousands and thousands more then it would could in some other countries. I can kind of understand why IVF is so expensive but I think infertility treatment should be something that all insurance companies in all states should cover. I just have to wonder how many couples travel to less medicals advanced countries for IVF because they can’t afford to get the treatment her in the United States, is the cheaper cost really worth the help risk you take by going to another country?

References www.wikipedia.org www.conceiveeasy.com
www.fertilitynation.com

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