Mini-IVF or low-intensity IVF, using a milder ovarian stimulation protocol, that is gaining in popularity, significantly reduces the chance of pregnancy, according to data from a pilot study by Norbert Gleicher, M.D. Mini-IVF or low-intensity-IVF is allegedly more cost-effective and patient friendly while hypothetically producing better embryo quality, say its advocates. But in a poster presentation at the 2011 meeting of the American Society of Reproductive Medicine (ASRM), Dr. Gleicher offered data showing that fewer cryopreserved embryos were produced, resulting in fewer live births, using mini-IVF protocols. Patients using mini-IVF protocols definitely used less gonadotropins (HMG or FSH) but had fewer oocytes retrieved (2.7 vs 15.6) resulting in fewer cryopreserved embryos (0 vs 4.7) compared to women using standard IVF protocols. With identical number of embryos transferred, after adjusting for age, patients using standard IVF demonstrated a 7-fold better odds of pregnancy and a cumulative pregnancy rate that was more than 6 times higher than that achieved using mini-IVF. The costs per live birth (cumulative) were similar in both groups but the significantly reduced chances of pregnancy with mini-IVF eliminated the potential cost advantages. Dr. Gleicher concluded, “even with normal ovarian reserve, therefore, low-intensity IVF can be considered neither patient friendly or cost-effective”. With decreased ovarian reserve (BAF), mini-IVF should be even less successful. ACFS agrees with the findings of Dr. Gleicher, and it has been our experience since mini-IVF protocols were introduced, that overall success rates for cumulative on-going pregnancy rates were significantly reduced. However, having once explained and the patient understanding this data, it is her choice as to which protocol she will choose; and ACFS will support her 150%. For more information about ovarian stimulation protocols for IVF, visit us www.acfs2000.com
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Estrogen-Only HT (Hormone Therapy) Increases Breast Cancer Risk
According to the annual meeting of The American Association of Cancer Research, long-term use of estrogen-only therapy increases the risk of postmenopausal women developing breast cancer, according to new data from the Nurses’ Health Study.
The findings suggest that opting for progesterone-free hormone therapy for the treatment of menopause symptoms should not be considered the risk-free alternative to combination progesterone plus estrogen formulations. Dr. Chen of Brigham and Women’s Hospital in Boston also showed that being on HT increased the risk of developing breast cancer relative to those women not on hormone therapy.
For our patients of have premature ovarian failure (POF) and/or need hormone replacement therapy and have no uterus, this newer data should be considered and discussed with your gynecologist, as to whether or not to add progesterone to the treatment regimen. The use HT was to always be weighted for the risks versus the benefits, especially on bone and cardiac function. Importantly, although breast cancer incidence was increased in HT groups, there was no increase in the risk of fatal breast cancer, either in the combined or estrogen-only therapy, Dr. Chen stressed. This is something we are continuing to investigate.
These findings have the potential to increase the confusion regarding HT and perhaps reignite the hormone therapy debate. However, they should be considered in their proper context. “While the relative risk of developing breast cancer is increased, the absolute risks associated with HT are low”.
From OB.GYN. NEWS, May 2012 @ www.obgynnews.com
For more questions, visit us at www.acfs2000.com
ACA’S (Affordable Care Act) Uncertainties Loom Large for Practices
The fate of the Affordable Care Act (ACA) won’t be known until at least June- and that adds a significant element of uncertainty for physicians trying to manage their practices. The Supreme Court is expected to issue an opinion on the law’s- and its components- constitutionality some time before its current term ends in late june. Given the complexity of the issues heard during oral arguments in late March, most observers do not expect an opinion any earlier.
The tenor of the four conservative leaning justices’ questioning during arguments suggested at all, or at least some, of the law might be struck down. Justice Clarence Thomas, who generally is silent during arguments, is seen as being in the conservative camp, as well. But there needs to be some caution, because questions by the justices don’t necessarily predict what they’re going to do and how they’re going to vote.
The court will decide on four questions:
1. Is it within Congress’s authority under the Commerce Clause to require Americans to buy insurance?
2. Can Congress levy a penalty if they don’t?
3. Can the reminder of the law outside the mandate be upheld separately?
4. Is the federal requirement that Medicaid be made available to Americans up to 133% of the federal poverty line an acceptable use of federal powers?
Some physicians might not even be aware of the potential ramifications of a partial or full appeal. If they throw the whole thing out, its like throwing a hand grenade into a crowded room. I don’t think many physicians have given thought to the confusion and huge chaos that would be created if the ACA is overthrown. If it is then put back together on a piecemeal basis, it’s going to take a long time, and there will be a lot of confusion along the way. One area of confusion will be Medicare offering patients free preventive services. What about the health insurance exchanges? It is costing the states millions of dollars to set up and many are not doing it until they heard of the Supreme Court’s ruling. For the states that have already begin the process of setting up the exchanges, they could lose millions of dollars that could have been put to better use.
Some above excerpts are from OB.GYN. NEWS. May 2012
While there are many potential benefits to the ACA, there will be a number of long lasting disadvantages. In the next 25 years or less, you will no longer recognize today’s health care in the US; and it will look, and probably be, identical to the European health care system. Socialized medicine only works in countries with small populations, between 20-50 million people, and than barely. How can it possibly work in a country of 350+ million people. Lines for health care will be staggering and people will start to embrace the thinking, “if it is free why should I pay for it”, which is true in countries where there is socialized medicine. The quality of health care will plummet significantly and access will be difficult at best. We have the best health care in the world. Most of the new technologies, medications and advanced treatments come from the United States. Clearly the system is broken and needs to be fixed. The ACA is not the answer and will change the way medicine is practiced in the United States forever. Physicians and health care providers will be reduced to laborers providing a government sponsored service and many may become less than enthusiastic about providing that service, let alone even deciding to go into medicine.
One idea getting a lot of attention and championed by Paul Ryan is replacing traditional Medicare with a premium support model. The premium support model would limit government’s Medicare spending by offering a defined contribution per beneficiary. Beneficiaries would use the voucher to purchase a plan of their choice, paying higher co-insurance for additional coverage; but at the same time forcing insurance companies to lower their premiums in order to be more competitive and thus giving a choice between a private plan and a premium support-style Medicare program. There are a lot of smart people in this country that, in a bipartisan fashion, if given the courage and commitment for change, can profoundly alter the current system and create a modern and efficient health care model that benefits ALL the citizens of this great country.
For more on this topic visit us at www.acfs2000.com
IV Acetaminophen (Tylenol) Improves Pain Management and Reduces Opiod Requirements in TVA Patients
Multimodal analgesia strategies for postoperative pain after TVA (transvaginal aspiration of eggs), including use of non-opioid analgesia medications, in conjunction with opioid therapy have been shown to decrease opioid use and improve postoperative analgesia. The results of a retrospective study using IV acetaminophen (Tylenol) suggest that the adjunctive administration of this non-opioid may reduce opioid consumption after surgery and improve postoperative analgesia and patient outcomes.
ACFS has been giving IV acetaminophen 15 minutes prior to transvaginal aspiration of eggs and has seen a significant reduction the patient’s post-operative discomfort, much less use of narcotics, quicker recovery times and patients going home much quicker after the egg recovery. Appears to be making a big difference in the overall comfort of egg recovery.
For more information visit us at www.acfs2000.com
Save the Adoption Tax Credit
Save the Adoption Tax Credit
If you are a professional working in the adoption community, we would like you to join with RESOLVE and a number of organizations to help save the Adoption Tax Credit. The adoption tax credit is due to “sunset” at the end of this year unless Congress and the Administration act. RESOLVE is part of a group called the Adoption Tax Credit Working Group (WG), a national coalition to advocate for the adoption tax credit, and we want you to join us. To be a part of this coalition, send an email to [email protected], and be sure to visit the new Facebook page for the Working Group at facebook.com/adoptiontaxcredit.
For more information visit us at www.acfs2000.com
Last Ditch Effort to Pass Personhood Legislation Fails in Oklahoma
Last Ditch Effort to Pass Personhood Legislation Fails in Oklahoma
Legislation to define an unborn child to include “the offspring of human beings from the moment of conception until birth at every stage of biological development” never made it to a final vote in the Oklahoma House. SB1433, was approved by the Oklahoma Senate in February and later amended by a House committee, but Republican House leaders refused to bring the controversial bill to a vote late last week after an unprecedented number of amendments were filed on the bill in attempts to protect vital forms of reproductive care.
The refusal to allow a vote riled the bill’s supporters and Personhood USA, the pro-life organization backing the bill. A petition circulated on the House floor to force the leadership to bring the bill up for a vote also failed.
In an unusual political development, leadership granted a vote on a House Resolution today which includes language similar to the personhood bill. However, a resolution basically expresses the temperature of the institution on a particular issue, but importantly, does not have any binding application to current law. It was approved 74-13.
ASRM and SART, as well as the infertility patient community, were instrumental in helping to defeat this personhood measure and we are pleased to report another victory in blocking legislation that has as its goal the restriction of reproductive rights. Dr. Eli Reshef served as an influential spokesperson on the harms the bill would create for infertility doctors and their patients and was particularly involved in efforts to educate lawmakers and the press in Oklahoma. We are grateful, too, to the brave lawmakers from both sides of the aisle who worked to defeat this harmful measure.
Visit us at www.acfs2000.com to learn more.
Pregnancy Loss and Miscarriage
“Some people know I’ve had a miscarriage — my family and a few friends — but mostly no one has a clue. I wasn’t far enough along to show. No one can tell from the outside how devastated I feel on the inside. So when someone asks me, ‘How are you?’ I say, ‘Fine,’ but actually I feel like I’m falling apart.”
— Jane, miscarried at 11 weeks
When you have a miscarriage, not only do you lose your pregnancy and baby, you also lose your hopes and dreams of the future. Your body isn’t working the way you always expected it would; you lose control of feeling healthy and ‘normal.’ And it feels so unfair that everyone else can have babies — you want to shout, “what’s wrong with me?”
No matter how far along you were, when a pregnancy fails, you lose a part of your reproductive story. You have experienced a reproductive trauma and this loss needs to be grieved.
A miscarriage is such a statistically common event (at least one in five pregnancies end in a miscarriage) that it is often overlooked or minimized, but it was your baby that didn’t survive, and the pain you feel is real. Your self-esteem may plummet and you may feel alone in your grief. By sharing your story and hearing the story of others, you will learn that you are not alone.
Excerpt from: J. Jaffe, M. Diamond and D. Diamond, Unsung Lullabies, Understanding and Coping with Infertility, St Martin’s Press, 2005. Copyright © 2004-2005 by the Center for Reproductive Psychology. All rights reserved.
Visit us at www.acfs2000.com or download for free the chapter on the Emotional Aspect of Infertility from Dr. Nemiro’s new book – Overcoming Infertility.
When Assisted Reproductive Technology Decisions Are Difficult
When the ‘old-fashioned way’ of making a baby isn’t working, you are faced with many options. Your next steps for creating a family have increased with the fast paced development of assisted reproductive technology.
Choosing to use donor technology or a surrogate is not easy. Your original reproductive story has changed — and how you feel about these changes is critical to the decision you now face.
Here are some helpful questions to consider/ask yourself:
1. Is the act of conception the most important piece? In other words, are you only comfortable becoming a parent if you and your partner can conceive ‘the old fashioned way’ without any medical intervention or assisted reproductive technology?
2. Is having a biological child the most important part? If so, then you might be willing to relinquish your wish to conceive ‘naturally’ and use IUIs or IVF.
3. Is having the experience of pregnancy and birth the most essential piece of your story, even if the child is not genetically both of yours? If so, then donor technology, of sperm, egg, or both, may be an option.
4. If having a biological child is more important than experiencing pregnancy or birth, then you might consider using a surrogate to carry your genetic embryos.
5. Or, if the most important thing is to have a baby to parent, regardless of its biological roots, then adoption might be the answer.
These are not easy questions to answer — and what is right for one couple may not be right for another. It is normal to change your mind and waffle between options. Sometimes couples will differ on the route they wish to pursue causing strain and tension within the relationship.
Whatever you decide, you still must grieve what you have lost to clear the way for your new experience — with or without children. No matter what choice you make, you must rethink your reproductive story, decide what are the most important elements in it for you and your partner, and then ‘re-write’ your story to incorporate these changes.
Excerpt from: J. Jaffe, M. Diamond and D. Diamond, Unsung Lullabies, Understanding and Coping with Infertility, St Martin’s Press, 2005. Copyright © 2004-2005 by the Center for Reproductive Psychology. All rights reserved.
Visit us at www.acfs2000.com or download the chapter on the Emotional Aspect of Infertility from Dr. Nemiro’s new book – Overcoming Infertility.
National Infertility Awareness Week Is April 22-28, 2012
National Infertility Awareness Week is April 22-28, 2012
National Infertility Awareness Week® is a nationwide campaign intended to educate the public about infertility and the concerns of the infertility community.
This year’s theme is “Don’t Ignore Infertility.” We chose this important message because every voice that speaks out about the realities of infertility, and every act that acknowledges infertility as a medical condition with far-reaching social and emotional implications, helps tear down the wall of ignorance and silence that surrounds this devastating disease.
What You Can Do
Don’t ignore opportunities to talk about infertility. Take advantage of opportunities in your daily life to share information about or bring attention to the cause of infertility.
Don’t ignore legislation affecting infertility patients. Several pending and existing laws encroach upon the rights of the infertile to freely build their families. Help change policy and protect your rights by writing to your representative or attending RESOLVE’s Advocacy Day in Washington, D.C. on April 25.
Don’t ignore infertility support available. Infertility is a lonely road, but no one has to travel it alone. Join an online infertility forum or local support group to find a warm, welcoming environment.
Don’t ignore people struggling with infertility. Reach out to friends or family members struggling with infertility. Ask how you can best support them in their journey.
Don’t ignore the impact of making a donation. Every cent donated helps bring needed programs and services to women and men with infertility. Sign up for the Walk of Hope or create your own fundraising event in your location.
Don’t ignore family building alternatives. You can build your family through many paths. During this week, open your mind to options that you had not previously considered.
Don’t ignore your own strength. If you’re engaged in the fight against infertility, take a moment to recognize your courage and determination, as well as that of the sisters and brothers fighting alongside you.
What won’t you ignore about infertility during National Infertility Awareness Week? Come tell us about it on our Facebook page!
Thank You National Infertility Awareness Week Partners.
Did You Ever Think You’d Have to Rely on Congress to Help Build Your Family?
Did you ever think you’d have to rely on Congress to help you build your family? I know I didn’t. But today it’s our reality.
Right now there are two major bills in Congress that need our attention.
The Family Act—a proposed tax credit for the out-of-pocket expenses associated with IVF.
The Adoption Tax Credit—already law, this credit is set to expire in December 2012. It MUST be saved.
RESOLVE fights to protect the rights of the infertility community. We believe it is YOUR right to have access to affordable family building options—whether that is IVF or Adoption. We need you to join us on Wednesday, April 25th in Washington, D.C. for Advocacy Day and make sure that Congress understands what the infertility community needs—access to family building options!
I know travelling to Washington, D.C. to talk to members of Congress can seem overwhelming. But I am making a promise to you—you will not be alone during this day. RESOLVE will make your appointments and will provide pre-event training so you feel comfortable speaking about the issues. And if you are the only one attending from your Congressional District, we will make sure a RESOLVE staff person or another advocate is with you.
Time is running out! We are just a few weeks away from Advocacy Day!
You may register to come to Advocacy Day by yourself, but I promise YOU, you will not be alone.
Best regards,
Jay S. Nemiro, M.D.
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