Posted: 2/3/2006
DVIF&G; Achieves Pregnancy Rates Higher Than the National Average
Those couples facing fertility challenges deserve exceptional treatment. At Delaware Valley Institute of Fertility & Genetics (DVIF&G;), our experienced team of physicians, embryologists, nurses, and support staff take pride in providing the best of care to our patients. We guide the patients through the diagnostic workup and a successful treatment every step of the way. In state-of-the-art facilities and a comfortable environment, we provide the best technological advances, such as Pre-implantation Genetic Diagnosis (PGD), In Vitro Maturation (IVM) and oocyte cryopreservation.

The cornerstone of the DVIF&G; philosophy is that the patient deserves individual evaluation and the best personalized service and care available. The success rates of the different treatment programs available to patients underscore our commitment to every couple’s desire to create a family.

Although there are couples that have a known pre-existing condition affecting their fertility, most of the couples have been trying for some time to achieve pregnancy on their own or with assistance by their physicians. In many cases a considerable amount of time and effort in achieving a family has been invested prior to seeking expert help for fertility. Therefore, the time span to success, a pregnancy, is of the essence. In many cases, it is not the couple’s eagerness to achieve their goal but their current age or other factors that will dictate prompt success.

It is important to minimize the time invested from the first visit to initiation of treatment. This requires a highly trained staff and patient participation. The evaluation should be thorough, complete, and include both partners. Educating the couple on the importance of the tests required and interpreting their results to their satisfaction is necessary to guarantee their active participation. No treatment is delivered until all possible medical conditions affecting the couples’ reproductive potential have been addressed and resolved. This may require some time and effort, but this is time and effort well-invested.

When all the diagnostic tests have been completed and all the underlying medical issues have been resolved, an individual plan of treatment is devised. There are many treatment options available, but not all of them are suitable to every couple and those that are available to them should be used judiciously.

Scientific knowledge and clinical experience is required to direct the couple in this complicated maze of choices. The effectiveness of any particular treatment should be discussed and steps should be taken for alternative treatment approaches. For instance, intrauterine inseminations (IUI) have a success rate over 20 percent per cycle at DVIF&G;, exceeding the national average by more than 5 percent. Statistical analysis of clinical data at DVIF&G; has shown that exceeding three treatment cycles with IUI does not confirm any advantage to the patient’s goal. By the same token, any suboptimal response to the treatment, such as ovulation induction or any side effects to the medication, such as Clomid, triggers an alternative treatment approach, such as gonadotropins, IVF-ET, or IVM.

The ultimate goal is to replicate or exceed the naturally occurring pregnancy rate without compromising the patient’s safety. Ovarian hyperstimulation syndrome (OHSS), a serious side effect of gonadotropin treatment requiring patient hospitalization, has not occurred at DVIF&G; for over a decade.

The average couple that does not seek expert help for fertility and achieves pregnancy without any medical assistance does so within six to eight months. This compares favorably to DVIF&G;’s average pregnancy frequency achieved within nine months after the first visit, especially if two to three months are subtracted to allow for the initial evaluation and correction of medical problems. At any given time one-third of the patients at DVIF&G; are pregnant, exceeding by far the incidence of pregnancy of couples in the general population that are attempting pregnancy.

Dr. Chung H. Wu’s program for women with polycystic ovaries, insulin resistance, and metabolic syndrome, has successfully treated over 2,000 women with this common problem with over 5 percent of them achieving pregnancy without any additional treatment for infertility. Less than 10 percent of the couples at DVIF&G; undergo an advanced and complex treatment since most achieve their goal in a short period of time with conventional infertility treatment.

Nonetheless, the ones that have to undergo IVF-ET have done so with resounding success. In 2004, the START program at DVIF&G; achieved an overall pregnancy rate per transfer of 56.5 percent. In the same year the overall live birth per transfer was 45.2 percent, well above the national live birth rate of 34.8 percent in 2002 and 34.7 percent in 2003. (The 2004 national average is not yet available) and places the START program at DVIF&G; with the best infertility centers in the country. A team approach, individual effort from the DVIF&G; staff, and active patient participation is credited for this outstanding pregnancy rate.

In 2005, the START program at DVIF&G; introduced several new programs after a lengthy preparation that on several occasions required its staff to travel overseas in order to acquire new technologies. PGD, IVM, and oocyte cryopreservation are now available for patients at the START program. DVIF&G; was one of the first facilities in New Jersey to be certified and to offer first trimester screening for Down’s syndrome, the 13 and 18 trisomies with nuchal translucency, and the UltraScreen test through GeneCare. PGD raises the bar of diagnostic testing even higher. With PGD, genetic abnormalities such as Down’s syndrome, and also point mutations such as cystic fibrosis, thalassemia, and Tay Sachs disease, can be diagnosed prior to transferring an affected embryo through an IVF-ET procedure. This approach successfully avoids adverse outcomes of the pregnancy when the patients are known to either suffer from or be carriers of a disease that can be inherited by their offspring. Medical intervention and surgical treatment is thus avoided, and a healthy child is born. The emotional relief that is provided to the couple is invaluable. START is one among a handful of programs in the country to offer in vitro maturation of oocytes (eggs). During this procedure a minimal amount of injectable medication is given to stimulate the egg production by the patient’s ovary, and oocytes are retrieved when they are still immature. The retrieved oocytes are then matured overnight in the laboratory using a special culture solution. The matured oocyte may be fertilized with intracytoplasmic injection of the partner’s sperm (ICSI procedure), and the process continues as if the patient had a conventional IVF-ET procedure. The end result is a safe process for those patients that are at high risk to develop ovarian hyperstimulation syndrome (OHSS). Current conception rates are comparable with traditional IVF-ET cycles.

Those patients that have been diagnosed with cancer and need to undergo chemotherapy or radiation therapy are faced with several emotional and physical challenges. One of them, especially among young women, is preservation of their reproductive potentials. This is one of the first questions they address to their caring physicians. It is a rather pressing problem since no significant time is left for patients to exercise any available options. It becomes even more difficult if the young patient is not in a relationship to undergo a conventional IVF and have the resulting embryos cryopreserved for an embryo transfer (ET) after the cancer therapy is completed.

Cryopreservation of sperm has been available for several decades, but not until recently was oocyte cryopreservation possible. The START program at DVIF&G; has introduced oocyte cryopreservation for those patients that are undergoing cancer therapy as an option to preserve their reproductive potentials. During the last decade, the DVIF&G; staff has worked incessantly to improve the environment for its patients, increase its success rates, and introduce new therapeutic techniques in Southern New Jersey. This effort has placed DVIF&G; and its START program as a premier fertility center in the country and has made it the referral center of choice for doctor and patient alike. John, Please place this information on the last page of the article in a colored box with a photo of Jess.

For more information about any of the programs offered at DVIF&G; and the START program, please contact Jessica A. Macdonald, Supervisor of Reproductive Laboratories at 856-988-0072.