My RE affirms IVM isn't beneficial, compared to IVF

Wouldn't you know that AFTER my husband and I thoroughly discuss the positives and negatives of IVM and decide that it's just not for us, I ran across a show produced by the infertility radio show I listen to discussing new infertility technologies and one of the subjects was IVM. The guest on the show was none other than my own RE, Dr. Peter Ahlering. What's funny is that his position on IVF vs. IVM is pretty much the exact reasoning we arrived at - that ultimately it's not effective enough, or cheap enough, to be sensible. We were worried that if we went down that road and didn't end up with a baby, we'd have no money left to try what I call the "end-all-be-all" for infertility - IVF. Anyway, it was just good to hear a trusted medical opinion on this topic and I wanted to share it with the rest of the world.

As usual, below are my notes from the show.

Disclaimer - Please note that the information below is my personal synopsis of the free online radio program hosted by Kim Haun, founder of Conceive Magazine, with guest Dr. Peter Ahlering, an ob/gyn and medical director of the Sher Institutes for Reproductive Medicine in St. Louis. It is in no way meant to quote the either of the parties mentioned above.

Listen for Yourself

Scroll down in the archive to:
Date: 1/29/09
Title: "New Fertility Technology".

Dr. Peter Ahlering's thoughts on In Vitro Egg Maturation (IVM): IVM is where you stimulate the ovaries with drugs when they are very small. Egg retrieval of immature eggs, probably two steps behind where you'd be with IVF. In order to be competent for fertilization, they have to mature these immature eggs in the lab. This procedure has been around for many years and it's an extremely complex process still that involves maturing an egg to the point that it's capable of being fertilized. With the process of IVF, you wonder if people really need to do IVM. Yes, successes have been reported, but not that many because it's not that applicable to that many people.

Is IVM safer for PCOS patients?
People talk about how it's safer for women who have polycystic ovaries because they can avoid hyperstimulation... this is true, but there are other ways to avoid this through IVF and still have very high outcome. Prolonged coasting and other types of protocal medication alteration to avoid hyperstimulation. In Dr. Ahlerings opinion, less than 1% of patients would suffer from hyperstimulation.

Is IVM more affordable than IVF?
What about cost? Isn't it more affordable? Isn't it easier on the woman? Yes, the process itself is cheaper, but if you're trying to save money on the goal of having a baby, it just won't work because you'll have to try more times, so the cost goes up and is most often higher. Do we even know how the eggs will respond to this outside of the body? You have to get a lot of eggs to make a baby with IVM (25-30 mature eggs), compared to IVF (10-12 mature eggs) because a lot of them are lost through the process. An article about IVM where success rates are in low teens. That same young PCOS patient would have a 50-60% single cycle chance.

Egg retrieval for IVM
How do you retrieve the eggs given they're so small? It's just like IVF in a lot of respects. A mature follicle at the time of ovulation is 18-22mm, whereas an immature follicle is much smaller - more like 5-6mm because it's an immature egg. Those immature follicles are always there in a PCOS patient. You can go get eggs and you retrieve just like you would during IVF. During an IVM retrieval you might get 30 immature eggs. And after 24-48 hours you would have a certain number of mature eggs.

Genetics of the egg following IVM
Have we seen enough babies yet to know if we're harming the baby? There haven't been enough studies done. It's doubtful that the process itself would increase birth defects. The problem is that most eggs won't make it to the point of baby.

Is hyperstimulation deadly?
Can women die from hyperstimulation? Maybe that's why a lot of women find IVM appealing. No, practically speaking I don't know how it's possible where you would run into a circumstance where hyperstimulation would be so bad that she would end up in the hospital and be close to death. People who have lots of follicles and eggs are prone to a condition called ovarian hyperstimulation syndrome. For all women who undergo IVF, to a large degree we create a controled hypersimulation of sorts in the sense that they are creating lots of follicles (not just one like you would during a typical non-IVF cycle). The common rule of thumb is that you get a lot of follicles and there is no illness from it.

IVM success rates too small, so we're back to IVF

Our basic, personal conclusion on doing IVM in Canada or the UK is this: Looking at statistics, at the end of 4 tries of IVF with Dr. Peter Ahlering, we would have an 80% chance of walking away with a baby. It sounds weird to put it in those terms, but it's true. Those odds are pretty high if you think about it and it really doesn't get any better than IVF, in terms of mecical infertility capabilities.

"What if" IVM didn't work?
With IVM in Canada (I can't speak for the UK, because they don't provide very detailed success rates), you would have to try about 7 times to have those same odds. Seven times! That is a heck of a lot. If they were next door it might not be as big of a deal, but by the time you add in travel seven times over, it is just as expensive as IVF. PLUS, and this is my big hang up, say we did 3 rounds of IVM, but were unsuccessful, would we have the stamina to stick it out to 7, or would we get scared that we'd "waste" all our money on something that just doesn't have as good proven success? Trying to think way in advance, I personally think I'd get a little worried that in the end, after 7 rounds of IVM, if we still didn't have a baby in our arms, that I would have wished and would wonder if IVF would have been the thing to do the trick.

Having only one ovary most likely makes our odds even smaller
Then, there is my own personal health issues that have to factor in. Given that I only have one ovary, that isn't even accessible from all sides (remember it's glued to my uterus on one side), they might not be able to retrieve all of the eggs they need for the maturation process. When I e-mailed the clinic in Oxford, their reply was "Mr Child has said that for IVM you would need a total antral follicle count of 20-30 with all being reached with a needle via the vagina." While I've had many internal ultrasounds, I have never "officially" had my antral follicles counted. Even my RE just said you you have a "good number of follicles in the one ovary" - obviously that's not nearly specific enough, but I still highly doubt I have 20-30.

IVM live birth rates almost half of some IVF clinics
Yes, in IVF they also do a retrieval which is very similar, however, because you've gone through all of the stimulation drugs, the follicles are larger and therefore easier to see and access. Having said that, I would imagine that my personal "success rate" would be quite a bit smaller than the average woman with two ovaries. Maybe not half of what her chances would be, but still enough that it would probably have large impact, seeing as how the chance of success for a "live birth" in a given IVM transfer is only around 21% for women under the age of 35. Who knows how much lower it would be for me - this factor alone would mean that I would need even MORE than 7 cycles of IVM to have the same chance at a live birth, compared to IVF. In truth, this is my opinion having researched things and I don't know for certain my chances will decrease that much.

Ugh. So really we're more than likely back to square one. I mean I still want to ask Dr. Ahlering how our chances will be affected with any treatement, including IVF, because we will need to know going forward how many trys we'll more than likely need to make this happen. The last thing I want to do is buy a single cycle at a time and end up paying WAY more as a result, as Dr. Ahlering's office offers what I like to call a "bulk discount". If you buy 2, it's technically cheaper per cycle - same with buying 3 and with 3 you get a small fraction of your money back if you don't have a live birth at the end.

At this point it's just frustrating. Frustrating that there seems to be some other safer form of treatment that is ultimately most likely unattainable because of my health, the distance from those particular clinics which are far and few between and that this is one situation where it really probably doesn't pay to find something cheaper. If we're going to do this, we should find someone who is really good at baby-making and just go for it because in the end, if we didn't end up being able to have biological children, we'd want to look back and know that we gave it our best effort at the time.

First we're selling. Now we're not... Finding a way to pay for IVF.
This has been a weird past two weeks. First we thought this stupid recession stimulus bill would have a house credit in it and, as a result, we were pretty for sure we were selling our home. Then Congress took that out of the bill and the economy continues to worsen, including the housing market. So our choices were - refi our current home which will drop our monthly bill down quite a bit OR still try and get our house ready and see if it will sell. The main difference between the two was that with a new house we would save just slightly more each month on our bill, we'd have to pretty quickly get our home ready to sell ourselves and then we wouldn't have much room to move on price if we did get an offer. The refi would allow us to skip some of the unknown, the stress and the headache of dealing with a new house. Every person that's close to me pretty much thought refi was the way to go. While I still have mixed feelings (I wondered if we should at least "try" to sell first, but that would cost us each month we wait to refi), but ultimately my husband feels like this is probably the way to go.

The other part of that story is that we might have to wait a bit longer to do IVF - mostly because we may need to build our savings up a bit more so that we have more money to live off of in the situation where we have twins and I can't bring any income in. Ultimately I only want to work part-time (and WAH if possible) so that we don't have to put our baby in childcare, so we need to do what makes the most sense for the long run. Man is it hard to be ok with just waiting another solid year. Waiting while friends and relatives get pregnant, have babies and watch their kids take their first steps. I am starting to feel like I'm in some weird time warp where I'm standing still and everything else is moving right along before my eyes.

Even still, I need to be mindful that so many people are faced with so many things right now that are far worse than what we are dealing with. I need to be humbled and keep things in perspective for sure. God give me the strength!!

A side note - I'm now 27 and the sound of that just freaks me out. Why does that have to seem so much older than 26??!!

Or, how about low cost IVM in Canada?

Looks like this may be on the table for consideration too! I just got through posting the thing about Oxford, and I came across a forum that listed this site: http://www.mcgillivf.com/e/mcgillIVF.asp?s=834183253347DEH&page=193.272

McGill Reproductive Center. They're based in Canada and it would seem they offer IVM and have some really good prices too. At least at first glance. Unfortunately, I'm very tired and am getting yelled at to come to bed :) so it will have to wait. I have plenty of stuff to research this weekend, that's for sure!

We're considering doing IVM at a clinic in Oxford!

Ok people. I'm super excited about this. In fact, I don't think I've been this excited in quite a long time. After getting some financials from the IVM clinic in Chicago (IVF1, w/ Dr. Morris), it revealed that doing IVM really wouldn't be more cost effective compared to doing IVF with SHER. In fact, per single cycle it was a bit more expensive simply because they don't have a true multi-cycle "discounted" package like SHER does. Instead, they said they offer a $2,000 discount for each additional IVM cycle. Even that isn't enough to make it worth my wild.

To also stay relevant, I should say that we recently (like as of this past weekend) decided to not try and sell our home. After many, many, MANY exhausting hours of considering the advantages and disadvantages with selling/buying or refinancing, we've decided that refinancing will probably be the most predictable solution. Given the awful housing market we really don't know what we could expect from selling and would probably get a very low price for our home as a result. We decided that if we want to sell in 5 years (or so), hopefully it will be worth the wait. So, long story short, while it felt good to have an decision made, it made me a little sad. In making our decision, we also came to the conclusion that it also probably made sense to wait a little longer to pursue IVF. The longer we wait, the more we can save each month so that we have more of a reserve to fall back on once we do have our baby.

We were still in the middle of coming up with that time frame when I heard back from the IVM clinic in Oxford, UK, known as the Oxford Fertility Unit, a non-profit clinic (how cool is that!). As a long shot, I e-mailed them almost a week ago to see if they thought I would be a good candidate for IVM, since I only have one ovary that is probably partially blocked due to scar tissue and it being adhered to my uterus. The main reason for e-mailing them was the fact that their website listed the prices for their services - prices that are more than half of what they cost here in the U.S. Even with travel factored in, it would still be about 40% less than an IVM or IVF cycle here in the U.S. I was a bit sceptical as to if the prices were even accurate. So, with those things in mind, I sent my e-mail off.

And today, I received this response -

"Mr Child's reply to your email is: If both ovaries are accessible vaginally and of polycystic appearance then IVM should be possible. We do treat patients from abroad and the costs are correct."

I don't want to get too excited. I still need to confirm that my only having one ovary wouldn't disqualify me. However, I wanted to outline the costs a little more precisely to make sure I wasn't looking at something incorrect. The price difference just seems too good to be true. For approx. $10,000 we could undergo a single IVM cycle - that includes pretreatment testing, retrieval, ICSI, transfer, drugs and travel costs (flight, hotel, food and an misc expense allowance)!! That is compared to $16,000-$18,000 per IVM/IVF cycle here in the U.S.

Months ago when my husband mentioned the idea of doing a "vacation infertility treatment" my reaction was "no way! absolutely not". I couldn't imagine doing something so major outside of the U.S. - it just doesn't seem safe. My mind is slowly changing for three reasons:

1) This is Oxford, England, not a third-world country. I would feel safe while traveling and would trust that the hospital would be held to high standards.

2) This is the clinic that pretty much pioneered IVM and is a part of the renowned Oxford's John Radcliffe Hospital. I would actually feel safer in the hands of Dr. Child's, vs. Dr. Morris in Chicago, only because Dr. Child's had an extensive amount of experience in this arena, in comparison.

3) The fact that we would be able to get away from it all and focus on this experience and nothing else - a little "infertility vacation" if you will - seems like icing on the cake. I do think we should be mindful of the possible effect flying and the time change could have on the success of the treatment and would need to discuss this more in depth with the doctor before making our decision.

Speaking of... once we hear back about my ovary situation, and provided we're still a candidate, I'm guessing that would be our next step - to make a phone consultation with Dr. Child's to talk about the big picture and what exactly this might mean for us.

EEEeeeek! Again, I really shouldn't be getting all worked up about this but the possibility of saving money, avoiding potentially risky injectable meds, possibly moving treatment time frame up and traveling to England is way too cool!!

In the end, I still need to be mindful of how good God is, regardless of how this IVM Oxford thing turns out. I mean when I break it down - yes, we are dealing with some pretty big things. Yes, we are making sacrifices in order to secure a better future for our family. Yes, we may have to undergo some uncomfortable procedures. Yes, our heart breaks from time to time with a feeling of emptiness. BUT, we are so lucky to have a warm and comforting roof over our heads. To have two fur babies that make me smile the minute I walk in the door. To have good paying jobs. To have supportive parents and a few close supportive friends. To have each other. God is the only one we have to thank for that - he is looking out for us well before we know we'll be confronted with an issue. I'm trusting that even as we deal with this, he is looking out for our future and this is just part of our journey. We will be stronger for it!

Ok so now on to the details of doing IVM in Oxford with Dr. Tim Child. Here are some resources you might find helpful. If you have any additional info to add, please let me know!

Cost Analysis - A spreadsheet I created to take a closer look at the overall costs.
http://spreadsheets.google.com/ccc?key=pRJsuX3UYPXuOMcguqjqDMw

A link to the Clinic's Prices - Costs listed on site are in British Pounds. Above doc converts them to U.S.)
http://www.fert.org.uk/index.php?option=com_content&task=view&id=13&Itemid=41

Oxford Fertility Clinic
http://www.fert.org.uk/

IVM Procedure in Detail - These sites explain the overall steps and timeline for an IVM cycle

http://www.babyworld.co.uk/information/trying/infertility_treatments/in_vitro_maturation.asp

http://www.articlesbase.com/men%27s-health-articles/ivm-in-vitro-maturation-in-thailand-442035.html

IVM Cycle Compared to IVF - A short news article on IVM as a whole
http://www.dailymail.co.uk/health/article-1084447/The-new-fertility-treatment-double-womans-chances-getting-pregnant.html

IVM babies - News story about a couple who underwent IVM with Dr. Tim Child
http://www.fertilityauthority.com/news/2009/jan/17/ivm-british-mother-births-twins-after-new-treatment

For the record....
Here is the link to the Chicago clinic that does IVM: http://www.ivf1.com/in-vitro-egg-maturation/
And here is another clinic in the U.S. that claims to also do IVM (It doesn't seem like many clinics are doing IVM yet, so I've had trouble locating another one besides the one in Chicago). I will most likely e-mail them as well just to see what they charge, but haven't done so yet. http://www.startfertility.com/

To IVM or To IVF?

That is the question as of now. We still need to sit down and go over all the options. I recently called the IVM clinic in Chicago, IVF 1 - Dr. Randy Morris, to get a little more info. They started by putting me in touch with a nurse who asked if things like was I PCOS, did I have a healthy BMI, did I know what my antral follicle count was. I also asked if by having only one ovary that automatically made me a bad choice for IVM - she said no, that alone wouldn't disqualify me.

She recommended I make a consultation with Dr. Morris to ask questions and so that he can get a better idea of what diagnostic tests we'd still need to do to see if we are, in fact, good candidates. All signs so far point to yes, I'm assuming. That initial consultation is $236, so we're trying to make sure we really want to be serious about considering this option before going any further.

I called the clinic again - this time to see if they could first share costs with us so that we'd know if it would even be a viable option for us. They were more than willing to share and e-mailed me some information today. As of now, it looks like they only offer a single cycle option that is slightly higher than SHER - St. Louis. Plus, our current clinic offers multi-cycle price breaks which would yield us more than one try at more "cost-effective" (it's so totally not cost-effective, but for the purpose of this convo it is :P) rate. I can't help but think I might need more than one try vs. the average woman simply because I only have one ovary (and therefore would assume I would be at risk for producing less embryos). Anyhoo, I we still need to e-mail some additional questions and sort everything out. It's just nice to be able to consider something else that might be a little easier on my body. The idea of so many shots sort of makes me nauseous.

Will update when we know more!

In Vitro Maturation - Less riskly & expensive than IVF?

It's called In Vitro Maturation (IVM), but I had certainly never heard of it until just the other day. The CBS Early Show ran a story on this very topic; thanks to my Mom for bringing it to my attention. Apparently about 400 babies have been born thus far worldwide thanks to this treatment, but only one baby has resulted from In Vitro Maturation in the U.S. just last year.

What makes IVM so different from IVF
For one, they do not give you tons of injectable fertility meds to stimulate your ovaries in order to produce eggs. Instead, they only give you an HCG shot around days 3-5, retrieve the eggs and then they fully mature them in a dish filled with special media. From there the cycle mimics a traditional IVF cycle in that you take hormones to prepare your uterine lining and then the transfer is done.

Women Under 30-35 and with PCOS Good Candidates
In short, the article states IVM is safter for womem with polycistic-like ovaries (PCOS) and people who are sensitive to fertility drugs, and therefore at higher risk for ovarian hyper-stimulation syndrome. According to Dr. Tim Child, a fertility specialist at John Radcliffe Hospital, "Women who are 35 or less who have a good number of resting follicles in their ovaries, and there's about a 40-45 percent chance of pregnancy per IVM cycle." As a note, that makes it about half as effective as IVF (more like what you'd expect from an IUI cycle).

Cheaper & Less Risky?
In Vitro Maturation is touted as being "cheaper, easier on a woman's body and quicker". The RE that is currently treating the women who's pregnant here in the U.S. is Dr. Randy Morris with IVF 1 in the Chicago, IL area. His website says "The best candidates for IVM (in vitro maturation) are young women with large numbers of egg containing follicles or women who have attempted stimulated in-vitro fertilization and had production of a large number of eggs. Ideally, women under the age of 30 or 35 would be expected to have the greatest likelihood for having many eggs." He also mentions that overweight women would not be good candidates, because you can't see the small ovaries on an ultrasound, making it harder and more fisky to remove eggs.

For more information on how the procedure is done, visit Dr. Morris' website. Also, here is a recent article on the first women in the U.S. to have this procedure done by Dr. Morris.



What does this mean for us?
Well, given that we fit the profile to the T (at least at this point we seem to) and that Chicago isn't that far from home, we'd be silly not to call them and check into it. I can say that I feel really comfortable with Dr. Alhering currently and like the fact that IVF success rates are generally double that (80%) of IVM. However, if IVM is safer and considerably cheaper (like if it was the cost of an IUI), we might be able to afford to do several treatments for what it would cost us to do just one IVF. I have to admit I'm still a little weirded out that they are maturing your eggs for you... a extremely important part of the process, but then again, in ART there are a lot of things done outside the body and it still results in a perfectly healthy child.

I suppose we'll be calling them in the next few weeks and I'll make sure to update and let everyone know our findings!