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Infertile patients cannot afford to wait for treatment while their eggs get older.

Dr. Sherman Silber, Infertility Center of St. Louis, is offering video consultations for patients who need to plan now for their treatment while stay-at-home orders are in place. He is talking to and evaluating patients in their home to comply with social distancing measures.

Dr. Silber is discovering that patients actually prefer this method of telemedicine consultation over the conventional office visit. Patients have conveyed that “it is so much more convenient and less stressful” to have a telemedicine personal consultation than to take a day off from work to travel to the doctor’s office and sit with other nervous patients in the waiting room.

The COVID-19 pandemic is thus changing much of the way we will do things in the future, and for the better. “Our patients are surprisingly much happier with this approach. Of course, at some point we need to perform hands on treatment. But with this new manner of seeing patients, we can come to the right diagnosis and treatment plan for most patients more efficiently, quickly, and painlessly, with no loss of personal one-on-one communication.” This is a very welcome new era of telemedicine that has been forced on us by the current difficult times.

The Cost of IVF

Reducing the Cost of IVF

Although IVF is expensive, our methods achieve the best results at almost half the cost of most IVF centers. In fact, if you need another cycle, as many older women do, with our mini-IVF you wind up getting two cycles literally for what one cycle would cost in almost all other centers. Furthermore, if you do not mind twins, we are willing to transfer two embryos instead of one, which reduces in half the number of cycles and cost you need to achieve your pregnancy. We also make sure not to charge extra for unnecessary testing or ineffective preliminary treatment approaches. We only recommend what we feel is necessary to help you achieve a pregnancy as soon as possible. Furthermore, we have no hidden extra charges added on which in some clinics might result in much higher costs.

For example, there is no additional charge for office visits, semen analysis and/or sperm freezing, embryo freezing, assisted hatching, blastocyst culture, or ICSI, which we always do in every case to give you the greatest chance for pregnancy. Also, we will not order an expensive list of purely remunerative tests with procedures that just delay the most cost effective treatment.

IVF Vitrification

Mini-IVF Does Not Reduce the Number of Eggs

For women with a good ovarian reserve, Mini-IVF gets lots of eggs. It’s only for women with a low ovarian reserve that we get a low number of eggs. In any event, withMini-IVF we get the best quality eggs, whether a high number or low number.

At any given age, the baby rate per egg is 4 to 5 times higher with mini-IVF than with routine standard stimulation protocols.

Mini-IVF: Minimal Stimulation IVF Technique

In addition to IVF with conventional stimulation, we also offer IVF with minimal stimulation (mini-IVF), which is a new, dramatically lower cost option with comparable results. Our mini-IVF protocol, first conceived in Japan, is truly an amazing breakthrough.

When patients contemplate IVF, their first reaction is often the fear of daily injections of hormones for months, the incredibly high cost of the drugs, the risk of multiple pregnancy and consequent prematurity, side effects related to high levels of estrogen resulting from large numbers of eggs, hyperstimulation syndrome, and the prospect of painful daily progesterone injections for a full ten weeks even after the IVF procedure. Mini-IVF is a very unique approach developed by our colleagues in Japan (and then perfected in our clinic) to circumvent these problems and to simplify IVF for patients, reducing the cost while maintaining the same success rates. For older patients, the success rate is even higher than with conventional IVF. With the refinements we have added to mini-IVF, the pregnancy rates are startlingly high.

Concept of Mini-IVF

Mini-IVF is designed to recruit only a few (but high quality) eggs, thus avoiding the risks of hyperstimulation, reducing the number of injections and dramatically reducing the cost of medications. In many patients who had very poor quality embryos with conventional IVF stimulation protocols, mini-IVF dramatically improved their embryo quality and resulted in pregnancy in otherwise “useless cases.” This approach is not just a simple-minded reduction in hormonal stimulation. It is an ingeniously conceived and completely different approach to IVF that saves the patient much of the complexity and cost associated with more conventional IVF protocols. Here is how it works:

Step by Step Summary of Mini-IVF Protocol

On Day 3 of the menstrual cycle, you start on a low dose of Clomid (50mg), but you don’t stop the Clomid in five days as is usually the custom. You just keep taking the Clomid until ultrasound monitoring shows the follicles to be ready for ovulation. A very low “booster” dose of gonadotropin (just 150 iµ of FSH), is added on Days 8, 10, and 12. Clomid not only stimulates your own pituitary to release FSH naturally (by blocking estrogen’s suppressing effect), but also staying on the Clomid (a unique new approach) blocks estrogen’s stimulation of LH release, and so also prevents premature ovulation. Thus, with this simple change in protocol, the old-fashioned, cheap Clomid is able to stimulate the development of smaller number of better quality eggs for IVF.

Another advantage of this protocol is that you did not have to go on Lupron first to suppress the pituitary. Staying on Clomid blocks estrogen from stimulating your pituitary to release LH, and this prevents premature ovulation without your having to be suppressed. This means that you can be induced to ovulate with just a simple injection of Lupron. This causes a more natural LH surge, and avoids the luteal phase defect caused by HCG that would otherwise require months of progesterone injections.

The remarkable effects of using Clomid wisely in combination with Mini-IVF:

The next step is to recognize that Clomid has a negative effect on the uterine lining (because it prevents estrogen from stimulating the endometrium). That is one reason why results in the past have been so poor with the use of Clomid for ovarian stimulation. The embryos are less likely to implant in such endometrium. But that problem is solved by using the Japanese protocol for embryo freezing, “vitrification.” Using this approach, we can now very safely freeze embryos with virtually no risk of loss. Frozen embryo transfers can then be performed in later natural cycles.

Even for poor prognosis cases of older women with low ovarian reserve, there is an advantage to mini-IVF over high dose stimulation. Such patients normally yield very few eggs even with huge megadoses of gonadotropin. Mini-IVF is just as likely to yield as many eggs (very few, of course) as giving huge megadoses of gonadotropin. But the egg quality is better and they can afford to do more cycles if that is what is required. Even in the worst case scenario, when there are no eggs left at all, then at least the patients can discover this with only $1,700 spent on drugs instead of $7,000 (cost of maximum dosage).

Think of this simple parable: If you are sitting under an apple tree, and wish to eat the most ripe and ready apples, you have a choice. You can chop down the tree, and look at every apple on the fallen tree to see which ones were ready. Or you can simply try to shake the lower branches and eat the one or two that have fallen. That is the idea of mini-IVF. For many patients, it will remove much of the aggravation and complexity associated with IVF, and also dramatically reduce the cost. But it requires a great deal of sophisticated ability to do well.

Mini-IVF and Embryo Freezing Coverage

Improvements in Embryo Culture

A major improvement in embryo culture was realizing that the oxygen content in the air we breathe is much too high for eggs and embryos. In fact, most cells in the body are exposed to a much lower concentration than the air we breathe. Too much oxygen delivered to these cells can, in a sense, overheat the cell. So it is much better to culture the embryos, not only in 5% CO2, but also in only 5% oxygen (not the 20% that is in air). This is difficult to do. Large amounts of pure nitrogen gas have to be blown constantly through the incubator at a carefully controlled rate to lower the oxygen concentration in the incubator. But it is worth that extra effort to get higher pregnancy rates.

Classically, most IVF labs have cultured embryos at a pH of 7.4 (the normal acid-base of blood concentration), and at an oxygen concentration of 20% (the same as in the air we breathe). However, these are not the acid or oxygen concentrations that are most favorable for embryo growth and development. In fact, the acid concentration inside the embryo is normally much greater than that, and the oxygen concentration is much lower. Conventional IVF culturing conditions, therefore, are too alkaline and too oxygen-rich. In fact, oxygen concentration in the Fallopian tube is only about 8% (not 20% as in air), and in the uterus, it is as low as 2%.

This type of optimal culturing of embryos requires a lot of extra attention. To reduce the oxygen concentration in the incubator from 20% to 5% requires blowing through a huge amount of nitrogen (95%), and to keep the pH acid at 7.2 (but not too acid below 7.2), requires careful monitoring of the acidity of the media. This represents a lot of extra work, but it is well worth the effort. The better your pregnancy rate per cycle, the less is your eventual cost.

In a high quality referral hospital setting such as ours, the most rigid air quality system is in place, preventing particles of volatile organic compounds from entering the environment where your embryos are growing in culture. The air around all of us is filled with these toxic compounds in low concentrations that don’t seem to affect your body’s overall health in any obvious way, but do seriously affect the growth and development of your eggs and your embryos in culture. We can see the obvious negative effect of non-perfect air quality in an IVF lab on the evolution of poor quality embryos that give lower pregnancy rates than the good quality egg and embryo growth from those same women whose embryos are cultured in high air quality environments.

Only large IVF centers in high quality hospitals that invest many millions of dollars into “clean room” air quality, can insure the proper environment for the growth in vitro of your eggs and embryos. Even older women in their late 30’s and 40’s, whose embryos cannot tolerate the slightest stress, develop good quality embryos in a laboratory environment like ours that is free of these common toxins in the air that pervade most office based settings.

Summary of IVF Cost Reduction

There are several ways in which to lower the costs for IVF and improve quality in which we are leaders. There are some clinics that simply charge less by doing slipshod work, and we abhor that. There are many relatively poor quality OB-GYN doctors who have been kicked off of hospital staffs who are opening cheap IVF clinics with the idea or making an easy dollar by cutting quality, and who have little depth of knowledge. We recently performed a successful low cost IVF on a patient who had gone through eleven previous IVF cycle failures at such a bargain rate clinic. She wound up spending a fortune on all these failures before we finally achieved her goal in just one properly performed cycle. We have also seen many patients come from such office IVF settings to our hospital with life threatening hyperstimulation syndrome from poorly managed IVF stimulation and of course they endured a huge hospital bill for the intensive care required to save her life. To avoid such charlatans, you will need to understand and research IVF carefully.

The first requirement is to have the most perfect industrial-grade laboratory conditions. This results in better quality embryos with high pregnancy rates even in patients with otherwise lower prognosis. The second is that with our remarkable freezing technology, considered the best in the U.S., subsequent frozen embryo transfers, which cost very little, will give you even higher pregnancy rates because your endometrial uterine lining is more perfectly synchronized to the stage of embryo development than in a fresh stimulated cycle. Thus you have more chances per retrieval of eggs for pregnancy. The third is that we have developed a novel method of ovarian stimulation that is very mild and less drug intensive called mini-IVF.

Mini-IVF is not suitable for all cases, but it is clearly the least expensive and most comfortable way to undergo IVF. Its only disadvantage is less frozen embryos for future babies, but for many couples that is preferable anyway. But even when conventional stimulation IVF is required or preferred (because of the greater number of embryos), overall cost is reduced because of the technical perfection of our freezing protocol, which results in many more embryos transfer opportunities at dramatically lower cost than a fresh IVF cycle.

The American College of Pathologists (CAP) inspects American IVF labs every two years and issues reports on the IVF laboratory’s quality. Our lab has been rated as one of the very best in the U.S. It is our compulsive attention to quality and detail that produces our great results in some of the most difficult cases, and is why our CAP inspection reports are at the highest possible level. Ultimately these better results are the best method for cost saving.

More details of costs for these different approaches can be discussed with our office personnel after your initial consultation, which is completely complimentary.

If you have any questions, you may call us at (314) 576-1400.

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