Last year, Shady Grove Fertility celebrated its 20th year of caring for patients with infertility. Our practice has helped families have nearly 30,000 babies and counting. When we started in 1991, approximately one baby was born every 20 days. Today, one Shady Grove Fertility baby is born approximately every 3 hours.
This year, In Vitro Fertilization (IVF) has reached a milestone of its own. Experts now estimate that nearly 5 million babies have been born as a result of it. The first was Louise Brown, a baby born in England in 1978. At the time, she was referred to as the first “test tube” baby.
More than 30 years later, IVF has become mainstream in the medical community and in popular culture. We no longer use terms like “test tube baby,” and attitudes about fertility treatment are only one of the many things that have changed. Major advancements have been made in treatment technology and patient care since Louise Brown was born, resulting in pregnancy rates that are the highest they have ever been.
Dr. Simon Kipersztok of Shady Grove Fertility’s Waldorf, MD office has been treating couples with infertility for over 20 years. He’s seen firsthand how science, technology, medicine and patient care have advanced together so that more and more people with infertility are able to have the families they’ve dreamed about.
ICSI – a Revolution in Fertility Treatment
A watershed in the treatment of male factor infertility happened with the development ofICSI, or Intracytoplasmic Sperm Injection. Before the 1990’s, treatment for couples withmale factor infertility was not very successful. “All we could do is expose the eggs to the sperm we had and hope that fertilization would occur,” says Dr. Kipersztok. “The development of ICSI changed that.”
ICSI is a process done during IVF in which an embryologist injects a single, healthy sperm into the cytoplasm, or center, of each egg. This means that instead of needing to expose the egg to thousands of healthy sperm to achieve fertilization, the embryologist only needs one healthy sperm per egg.
“ICSI revolutionized treatment for male factor infertility because it allows fertilization to take place even in cases of severe male factor infertility,” says Dr. Kipersztok.
Shady Grove Fertility has been using and improving ICSI since the method was perfected in the early 90’s. Dr. Michael Tucker, Shady Grove Fertility’s Director of IVF and Embryology Laboratories, has received world-wide recognition for his pioneering work in advancing the ICSI technique. In fact, in 1992, before joining Shady Grove Fertility, Dr. Tucker was responsible for the first “ICSI baby” born in the US.
“Our embryologists are experts at this technique, and it has improved our success rates tremendously,” says Dr. Kipersztok. “With this treatment, we can help almost every patient with male factor infertility.”
A Safer and More Effective Egg Retrieval
Parallel to this advancement in male infertility, physicians were also improving the most invasive part of the IVF cycle for women, the egg retrieval.
An egg retrieval is the surgical procedure done during IVF to remove mature eggs from the egg follicles in the ovaries so that they can be fertilized in the laboratory. The goal of the procedure is to retrieve as many eggs as possible without causing damage to the eggs or the female reproductive system.
“Egg retrievals have completely changed since I was a medical student,” says Dr. Kipersztok. “They improved dramatically when we switched from doing them with laparoscopy to doing them transvaginally with ultrasound.”
Laparoscopy is a surgery that uses a thin, lighted tube put through an incision in the belly. Not only did laparoscopy require cutting the abdomen, but the physician was limited in his ability to see the egg follicles.
Today, egg retrieval is performed by placing a special needle through the vaginal wall and into the ovarian follicle in order to remove the fluid that contains the egg. The needle is guided by a vaginal ultrasound probe. To avoid any discomfort, short-acting intravenous sedation is provided.
“The procedure is so much safer and easier today that there is almost no recovery time needed – and we retrieve a lot more eggs,” says Dr. Kipersztok. “With the ultrasound guiding us, we can clearly see the ovaries, so we have a lot more precision in finding the egg follicles.”
At Shady Grove Fertility, we do over 3,000 egg retrievals a year, so we have a high level of expertise with the procedure. All egg retrievals are done at the outpatient surgery centers at our Rockville, MD, Greater Baltimore Medical Center location in Towson, and our newest facility in Chesterbrook, PA outside of Philadelphia. The egg retrieval itself takes only about 20 minutes and recovery takes about 30 minutes. Patients are able to walk out on their own and almost everyone goes back to work the next day.
Dr. Kipersztok adds, “The procedure has become so safe that the risk of complications is about the same as having blood drawn from your arm.”
A New and Better Embryo Freezing Technique
A more recent advancement that is still changing IVF today is a new method for cryopreserving, or freezing, embryos calledvitrification. Embryo cryopreservation is used when a patient undergoing IVF produces more high quality embryos than she wants to or is able to transfer during a cycle. Those “extra” embryos are then frozen and stored in the lab for future use.
If pregnancy isn’t achieved during the cycle, the frozen embryos can be used for another chance at pregnancy without the expense and trouble of a new cycle of IVF. If pregnancy is achieved, the embryos can be saved until the patient is ready to try for additional children. When a patient uses her frozen embryos, the treatment cycle is called a Frozen Embryo Transfer or FET. FETs are much simpler and less costly than a new round of IVF.
The problem with FETs in the past was that older methods of cryopreservation sometimes resulted in damage to the embryo during the freezing or thawing process. The pregnancy rates that resulted from these embryos were lower than those achieved with a fresh cycle of IVF, so FET was considered a second-tier treatment option.
The new process for freezing, called vitrification, consists of rapidly cooling the embryos using liquid nitrogen. Little to no damage is done to embryos during this process so that when these embryos are thawed, they are virtually identical to their original state.
In 2009, Shady Grove Fertility became one of the first fertility centers in the country to adopt vitrification as a standard for all embryo cryopreservation. As a result, success rates with Frozen Embryo Transfers (FET) increased to the point of being equal with fresh cycles of IVF.
“This means patients can have multiple chances for pregnancy with the embryos from a single IVF cycle,” says Dr. Kipersztok. “It also makes it easier for us to avoid high risk multiple pregnancies – twins and triplets – by using eSET.”
eSET stands for elective Single Embryo Transfer. When patients know that they can freeze and store their high quality embryos for future use, they are more likely to choose to transfer just one embryo at a time. Because the success rates for FET match those of fresh IVF cycles, patients can reduce their risk of a high-risk pregnancy and still have the same chances of getting pregnant.
Access to Treatment has Increased
“One of the best things that has happened in the last 20 years or so is that infertility has been increasingly recognized as a disease,” says Dr. Kipersztok. “This has led to increased insurance coverage and increased access to care.”
“When we started, there was no insurance coverage for IVF,” adds Dr. Kipersztok. “Then, several states decided to call infertility a disease and a disability so that the need for medical coverage would be recognized.” Today, 15 states have laws requiring insurance coverage for fertility treatment.
While some people still don’t have insurance coverage for treatment, the number of policies that include coverage for treatment has expanded. We find that 90% percent of patients at Shady Grove Fertility have coverage for their initial consultation and diagnostic testing while 70% of patients with insurance coverage have some form of coverage for treatment.
For those without coverage, there has been increasing access to financial programs that help patients afford treatment. “I’m proud to say that Shady Grove Fertility has been in the vanguard when it comes to financial programs,” says Dr. Kipersztok. “It started with the Shared Risk Program and expanded from there.”
In 2011 alone, over 2,300 patients used a Shady Grove Fertility financial program. The most popular program is still our Shared Risk 100% Refund program. This program costs about as much as two IVF cycles but provides up to 6 IVF cycles and all the related Frozen Embryo Transfer cycles for one flat fee. If patients do not take a baby home from the hospital, 100% of their money is refunded.
“I previously worked at a center that did not have a Shared Risk program and I always felt disheartened when a couple paid out of pocket for IVF and didn’t conceive. I felt like they paid for a new car but didn’t get it,” says Dr. Kipersztok. “That’s why I’m so glad we have Shared Risk at Shady Grove.”
Other programs at Shady Grove Fertility include Shared Help, which provides discounted treatment based on a couple’s income level, Multi-Cycle Discount, which provides discounted fees for pre-payment of multiple cycles and Fertility Finance, which can help patients find loans for treatment. In October 2012, Shady Grove Fertility announced their newest financial program for patients. TheMilitary Discount offers a 25% discount on the majority of Shady Grove Fertility services to all active duty and military reservists.
Access to care has also increased in other ways. “I personally feel gratified that we have progressed to the point of not only helping people with infertility but also single parents and same sex couples too,” says Dr. Kipersztok. “It’s a wonderful feeling that we can offer options to everyone who wants to grow a family.”
We’ve Come a Long Way
Shady Grove Fertility opened in 1991 with two reproductive endocrinologists and one office. Today, the practice has 27 physicians and 16 full service offices in Maryland, Washington, DC, Virginia, and Pennsylvania. We also frequently have patients from all over the world come to us for their fertility care.
As fertility treatment has advanced, we have not only kept pace but led the way in developing technologies and protocols for patient care. “Most importantly, we treat the whole person,” says Dr. Kipersztok. “Because of our size, Shady Grove Fertility has tremendous resources we can use to help couples, but we always strive to deliver quality individual care to each patient.”
With the advancements in treatment that have been achieved since Louise Brown was born, there is almost no obstacle to parenthood that we can’t help you overcome.