Article

When Do I Try Something New?

Medical Contributions made by Frank E. Chang, MD

Whether you are trying to get pregnant on your own or working with a doctor, every negative pregnancy test can leave you worrying that it will never happen. Many patients wonder, when does this become a lost cause? Do I have any other options? The good news is that there are many, many options for people with all kinds of fertility challenges – the key is knowing which ones are right for you and when the right time is to use them.

At Shady Grove Fertility, we believe in a stepped care approach to treatment, which means we start with the simplest, most affordable treatment options first and move up to more advanced treatments only if needed. More than half of all the treatments we do are considered “low tech,” and they were successful for nearly a thousand patients alone in 2012.

“It might take more than one cycle, but we now have treatment options to help almost everyone.” says Dr. Frank Chang of Shady Grove Fertility’s Rockville, MD office. “Studies have shown that perseverance with treatment pays off, so if patients are open to using all of their options, we can help almost all of them become parents.”

Here, Dr. Chang shares some of the most common transitions patients go through and what guides his recommendations for when to try something new.

The First Move is Seeking Help

The first question most couples ask if they are having trouble conceiving is: “when do we stop trying on their own and see a fertility specialist?” The easiest way to answer this question is to look at the accepted guidelines based on the age of the female.

If you’re a female under 35 years old, you should seek help after a year of unprotected intercourse without a pregnancy. Females over 35 should seek help after only 6 months. If you’re 40 years old or older and you’re just beginning to try, it’s best to talk to a physician right away.

“One of the most difficult conversations I

have with patients is about the effects of age on their fertility,” says Dr. Chang. “Many women believe that because they are healthy and living a healthy lifestyle, they should be easily able to get pregnant late in their thirties and early in their 40s. Unfortunately, fertility diminishes for all women as they age regardless of their overall health or lifestyle, so it’s really important not to wait too long to seek help.”

Some couples will start by talking with their ob/gyn, but it’s also perfectly fine to go straight to a fertility specialist. “The doctors at Shady Grove Fertility don’t require you to have a referral from your ob/gyn or primary care doctor. You can just make a consultation appointment directly with us,” says Dr. Chang. “Your insurance might require some kind of referral or authorization, but you can still go ahead and call us and we will help you find out.”

Wherever you start, the first step should be diagnostic testing on both partners. “Once your diagnostic testing is done, the question about whi

ch treatments are right for you will become clearer,” says Dr. Chang, “but it’s best not to start any type of treatment until both partners have been tested.” That’s because many couples have multiple factors affecting their fertility, and they can occur on both the male and female side.

Have questions or want to schedule an appointment?
Call our New Patient Center at 888-761-1967

First Line Treatments

Most couples have the option of starting with “low tech” forms of treatment. These treatments don’t have the higher success rates of In Vitro Fertilization (IVF) but they are simpler and much more affordable. Since it makes a lot of sense to start with these, it’s often not so much a question of what to do, as when to move on to more advanced therapies.

“That’s where our experience and knowledge can really help,” says Dr. Frank Chang. “We have a lot of data to guide us and a lot of experience helping couples move through the process.”

For example, many couples begin their treatment path with the female patient taking Clomid, an oral medication th

at helps women ovulate and in many cases produce more than one egg. The medication is taken on specific cycle days and an Intrauterine Insemination (IUI) is timed to coincide with ovulation. During the IUI insemination, a concentrated amount of sperm is inserted directly into a woman’s uterus that gets the sperm closer to the egg to increase the chance of fertilization and ultimately pregnancy. The procedure is fast and painless, and the treatment is about a third of the cost of IVF.

Since this treatment is simple and can be done with a patient’s ob/gyn, many women would prefer to keep doing it month after month rather than transition to the care of fertility specialist. Dr. Chang says this can lead to patients “spinning their wheels,” so to speak.

“If we look at the data, we see that after 4 cycles of Clomid, the success rates drop off dramatically, even if the woman is ovulating. If she is over 35 or the couple’s infertility is unexplained, the data show that they should move on even sooner,” says Dr. Chang. “In fact, it’s actually been shown that it is more cost-effective

to switch to more aggressive treatments like IVF rather than continuing with Clomid.”

So, the first transition for many couples is moving from doing Clomid with their ob/gyn to seeing a fertility specialist – but that doesn’t mean they will jump right into IVF. Depending on the couples’ diagnoses and age, there are still several steps a fertility specialist might recommend before IVF. For example, you might continue Clomid and IUI but add injectable medications. One thing that will change when you work with a fertility specialist is that you will be monitored with ultrasound and bloodwork during the stimulation phase of whatever treatment you do. That way, you and your doctor will know if the medications are having the desired effect.

After each treatment cycle, physicians meet with the couple to review their specific case during this time both the patients and their doctor are able to review how the cycle went and how to proceed. “Ultimately patients will make the decision on what to do moving forward with their treatment. I always provide the couple information on their cycle, the success rates, and data that we have which helps them to make the most informed decision” says Dr Chang.

“Many patients may succeed with these treatments,” says Dr. Chang. “However, if pregnancy is not achieved within a few cycles, we would review their cycles and decide when to move on to IVF.”

Financial Options for IUI Treatment: Insurance, Shared Help, Military Discount

When to Move to IVF

Dr. Chang uses a detailed graph to help his patients understand his recommendations about when to switch treatments. “I have a graph that shows the patient’s age and other key factors for her fertility charted with the success rates for IUI and IVF,” he says. “It really helps my patients to be able to see the data clearly and get a big picture perspective.”

For most patients, success rates for IUI drop off after 3 unsuccessful cycles. “Again, I use age as a guide. If the couple is young and they want to try a 4th cycle of IUI, I would support that decision,” says Dr. Frank Chang. “But with older couples, I’ll try to show them how the decline in success rates correlates to age and advise them to be more aggressive about moving to IVF.”

IVF is the most successful treatment a couple can do using their own eggs and sperm. IVF is also one of the few treatment modalities where success rates have gone up over time due to technological advances. Women under the age of 35 have a 55% chance of getting pregnant on their first cycle. However, if you don’t get pregnant on the first cycle, you still have a very good chance on subsequent cycles.

IVF Program Success Rates (Fresh Program)

January 1, 2011 to December 31, 2011

“If the first cycle fails, we will go over it in detail: what worked well? What didn’t go as well? Are there changes we could make to the next cycle to increase the chances of success?” says Dr. Chang. “For most couples, the data shows that it is worth trying again up through 3 cycles.”

“We find patients successful with IVF are generally pregnant within the first 3 cycles,” says Dr. Chang, “for those patients that are not pregnant after the 3rd IVF cycle, we would talk their options which might include continuing with IVF, moving to donor egg treatment, or even considering adoption.”

Financial Options for IVF Treatment: Insurance, Shared Help, Multi-Cycle, Military Discount, Shared Risk 100% Refund Program

Moving on to Donor Egg

Some patients, especially those who are over 40 or have other medical conditions that reduce the quality of their eggs, go straight to donor eggs when they start treatment. For most patients, however, the move is a result of not having success with IVF. “For these patients, it can be a hard transition, especially if they are younger,” says Dr. Chang, “but the upside is that their chances of success jump back up to a very high level when they move to donor eggs.”

For women unable to conceive using their own eggs, donor eggs allow for a woman to carry a child that is genetically linked to the male partner. Donor egg treatment also offers the highest pregnancy and delivery rates of any fertility treatment because the donated eggs come from women between the ages of 21 and 32 which coincides with these women’s peak fertility. Patients using donor eggs at Shady Grove Fertility have a 53% live birth rate with each transfer.

Donor Egg Program Success Rates
January 1, 2007 to March 31, 2011

Shady Grove Fertility’s donors are healthy women between the ages of 21 and 32. Extensive personal and medical histories are provided on every donor. Once a donor is chosen, the cycle is quite simple for the donor egg recipient. You will take medications that prepare your uterine lining for pregnancy. The male partner will provide a semen sample that will be used to fertilize the donor eggs. Once the embryos are ready, an embryo transfer will take place.

Donor Egg treatment is our most successful treatment options but affording the treatment can be a barrier for some patients. “The best thing about donor egg at Shady Grove Fertility is the Shared Donor and Shared Risk 100% Refund Program,” says Dr. Frank Chang. “Our Shared Donor program allows patients to share the eggs and cost of one donor with 1 or 2 other couples making the treatment more affordable. Many patients will also take advantage of the Shared Risk program that allows couples to try up to six IVF with donor egg cycles and if they don’t bring a baby home from the hospital, they will receive a 100% refund.”

Again, Dr. Chang says that the most important thing is for couples to know all of the options that exist. “Even if my patients don’t think donor egg is something they are interested in when they start treatment, I still talk to them about it along with their other family building options like adoption,” he says. “I want them to know that there’s still hope even if they aren’t successful with IVF.”

Financial Options for Donor Egg Treatment: Insurance, Shared Donor, Shared Help, Military Discount, Shared Risk 100% Refund Program

Keeping the Big Picture in Mind

When thinking about moving to another form of treatment it is important to consider how many cycles you have attempted, your age, and the guidance from your medical team based on their data driven decisions. “My advice is to consider the statistics but to do what you feel is right for you and your family,” says Dr. Chang.
He adds, “It’s unlikely that you will need all the options available to you, but if you have a sense of the big picture from the very beginning, it will be easier for you to stay positive and keep moving toward your goal.”

For more information or to schedule an appointment with one of our physicians, please speak with one of our friendly New Patient Liaisons by calling 888-761-1967.