VCRM’s ART Results for 2004

Virginia Center for Reproductive Medicine (VCRM) is pleased to share with you our IVF/ICSI results from January 1 - December 31, 2004. Our success rates continue to be well above the national average success rate (see Table below). Since August 2003, we have implemented the use of blastocyst (day 5) transfer for the vast majority of our patients (mean 2.3), and restricted the number of embryos transferred to 2 in most cases (only two triplet pregnancies were noted ). Our other results such as donor egg (57% ongoing pregnancy rate), and frozen embryo cycles (20.0% ongoing pregnancy rate) as also available on our website.

IVF/ICSI	<35	35-39	40-41	42-43
Number of cycles	36	37	14	4
Number of Transfers	36	32	13	2
Cancellation rate (%)	0	5/37 (13.5)	1/14 (7.1)	2/4 (50.)
Clinical Pregnancies (%)	21/6 (58.3)	12/32 (37.5)	9/13 (69.2)	1/2 (50.0)
Miscarriage Rate (%)	2/21 (9.5)	2/12 (16.7)	6/9 (66.7)	0/1 (0.0)

At VCRM, we have initiated our Egg Freezing program more than 2 years ago. The program is intended mainly for women who desire to store some of their eggs when relatively young (< 35) if they have no immediate plans to start a family and are worried about the impact of aging on egg quality and number. This program is also available to women recently diagnosed with cancer, before undergoing chemotherapy or radiation treatment. There has been more than 150 deliveries from frozen eggs in the world, with no increase in genetic or developmental abnormalities in the resulting children. For more information, please visit our website or call 703-437-7722 to schedule an appointment.

Our 100% IVF and Donor Egg Refund Plans Now Cover 7 Cycles

In an attempt to circumvent the expensive nature of assisted reproduction, we have been offering our IVF refund plan and Donor Egg Refund Plan for eligible patients who do not have insurance coverage for ART for over a year. This program now offers eligible patients up to seven (7) fresh IVF or donor egg cycles, including cryopreservation of resulting embryos. If there is no live birth after the transfer of all the fresh and frozen embryos from these 7 cycles, patients will have 100% of their money back to pursue other options such as adoption. We feel so confident in our superior rates that we are willing to offer such a program to our qualifying patients. For more information please refer to our website at www.vcrmed.com, or call our office at 703-437-7722 for a consultation.

How Fast is Your Biological Clock Ticking?

In contrast to healthy men whose sperm continuously divide and renew themselves well into later life, healthy women are born with all the eggs that they will ever have. A female fetus contains approximately seven million eggs, but by the time that fetus has become a baby girl and is born, the number of eggs in her ovaries is down to between one and two million. By puberty, a normal girl will have lost all but 400,000 of those eggs, and she will continue, throughout her adult life, to lose approximately 1,000 eggs each month. Although a woman's reproductive age may not correspond to her biological age, women are most fertile when they are younger (late teens and twenties) making getting pregnant more difficult by the mid-to-late 30s. To date, the most specific and important test to measure ovarian reserve is the measurement of ovarian volume and antral follicle counts as measured on transvaginal ultrasound. The ultrasound is performed using a vaginal probe on the third day of the patient's menses. Both ovaries are examined, measured in three dimensions, and the small follicles in each ovary are then counted. Women with small ovarian volumes and fewer than five follicles per ovary are much more likely to have an earlier menopause and have a much higher incidence of failed treatment cycles. In contrast, women whose ovaries are determined to be larger than average and have more than five follicles per ovary are likely to have a later menopause. The daily application of this test at VCRM has enabled many women to move aggressively with treatment once their ovaries have been noted to be compromised, and therefore avoid losing very precious time. It is important to note that small ovarian volumes and low antral follicle counts have been seen in all age groups, and therefore being young should not be a reason to delay this very important but simple and non invasive test.

Single embryo transfers at VCRM: taking the lead in preventing multiples

In an effort to decrease the high incidence of multiple pregnancy with ART, we have begun offering the transfer of a single embryo transfer (SET) for couples who do not want to, or have medical contraindications to carrying a twin pregnancy. For the last 9 months, only 10 women agreed to a SET and all conceived (9/10 are ongoing). The biggest obstacle facing us has been patient acceptance. A large majority of our patients (80%) want twins, and most couples are resistant to accepting SET for now. We have devised new strategies to increase patient acceptance for this cutting edge procedure.
Recent published data, including our own, and data presented at the last ASRM meeting last October are very encouraging; and show a pregnancy rate (PR) of 50-80% with SET. SET is increasingly the norm in Australia, Belgium, and some Scandinavian countries where SET accounts for 50-75% of all transfers, and is currently enforced in women < 38 in Sweden. Belgium is likely to follow suit.

The effects of weight on pregnancy success

Currently in the US, over 60% of the population is overweight (BMI > 25) and 30% are obese (BMI > 30). The negative effects of both being underweight (BMI < 19) and overweight/obese on pregnancy rates have been proven in multiple studies, including our own that we published in 2001. In our study, the pregnancy rates were decreased by 50% when the BMI is > 25 compared to normal weight women. The same results are noted when IUI is performed. It is imperative that women contemplating pregnancy be informed of the significantly negative impact of being over/underweight on their odds at getting pregnant.