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Options Besides Donor Egg IVF

Posted Sep 25 2009 3:34pm
I made it back to DC from Boston, thanks for asking. However, the journey was not easy. I boarded my AirTran flight at 6:15pm and at 6:35 pm the pilot announced that the plane was grounded for mechanical problems. Not to worry, advised the gate agent....another plane would arrive and take us to Boston at 8:30pm. Having heard this story one time too many, I hopped on the internet (than you Verizon for my wireless modem) and saw that there was a JetBlue flight to Dulles leaving at 7:50PM. My wife and I discussed the options and decided that I would stick with AirTran....big mistake.

At 7:30 pm the gate agent announced that the plan that was supposed to take us to Dulles was grounded in Newport News and we would now hopefully depart around Midnight! I grabbed my laptop and ran for the JetBlue desk. They confirmed that there was a seat on the plane but that the plan was boarding as we spoke. The nice lady called the gate and they agreed to hold the plane while I ran through security. Mercifully, there was no line at the security checkpoint and I made it on board with 1 minute to spare. By 9:45pm I was home in Maryland! When I called AirTran they informed me that I was on board the earlier flight and could not figure out how I was calling them from the DC area! Still had to get my car at BWI, but no plan is perfect!

Sometimes the road to our destinations takes us places that we didn't anticipate or desire. Life is a journey that is filled with twists and turns. In many of our patients that path leads towards family building options that they had never really considered.

Clearly, most patients are not thrilled when their RE announces that the only option remaining is donor egg IVF or adoption. Such a recommendation represents the end of a dream for those patients who wished to be the genetic parents of a child. The good news is that clearly donor egg IVF is very successful for many patients. However, not all patients are willing to consider egg donation. PB was one such patient and her story is rather revealing.

PB had successfully conceived with IVF back in 2005 and delivered her daughter without complication. When she returned to her clinic in 2007 she anticipated a good chance of success as she was < 40 years old and had an IVF baby already. However, after 2 FET cycles failed she attempted another stimulated IVF. Unfortunately, her FSH was 20 and her stimulation was poor and the cycle failed. She was told that although she was 38 years old that donor egg IVF was her only option. A friend told her about Natural Cycle IVF and she came to see me to discuss her options.

Meanwhile, our enthusiasm for Natural Cycle IVF remained very high and we made the decision in December 2008 to consider offering this option to older patients and/or those with a history of poor response to IVF stimulation meds. PB enthusiastically chose this option and underwent Natural Cycle IVF. She conceived on the 2nd attempt and is now >23 weeks pregnant. Needless to say, we were all thrilled for her and for the chance to offer another option to those patients who are not ready to pursue donor egg IVF.

We call this our IVF Hope Program to distinguish it from our standard Natural Cycle IVF Program (as we anticipate that the chance of success will be much lower in these patients who are looking to pursue a non-egg donor option). Interestingly, the use of Natural Cycle IVF in poor prognosis patients was the subject of a recent paper in Fertility and Sterility (see below). In this report, an Italian IVF clinic performed Natural Cycle IVF on those women who had failed to respond to fertility shots in THEIR OWN CLINIC! So clearly this was by any definition a group of low responder patients. Amazingly, their Natural Cycle IVF delivery rate was very good (all things considered) even in the older patients! At the Journal Club, Dr. DiMattina was placed in the position of defending Natural Cycle IVF while many of the other REs in attendance ridiculed the paper...even going so far as to physically rip the article into tiny shreds! Unfortunately, I was in Atlanta trying to convince my son to attend Georgia Tech and could not assist DrD in his defense of Natural Cycle IVF.

I think that patients should be allowed to make choices about their fertility treatment. Natural Cycle IVF is simply another choice. It does not work as well as stimulated IVF in good prognosis patients. It may be equally effective compared with stimulated IVF in poor responders...and may be the only ART option open to such patients who have failed to respond to stimulation previously. For those patients open to donor egg, donor embryo or adoption the role of Natural Cycle IVF is less clear as all those options work better so I would encourage patients to build their family through those means. However, some patients are not comfortable with Donor Egg/Embryo or adoption so for these patients a program such as the Hope IVF Program allows them to pursue another path.
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