In vitro treatment success rate soars at Columbia clinic
In vitro fertilization, once a long shot for couples unable to conceive naturally, is becoming a much better option thanks to new technology, but high costs still prevent some couples from pursuing the treatment.
During a recent interview, Gil Wilshire, endocrinologist at Mid Missouri Reproductive Medicine and Surgery Inc., practically jumped out of his seat when discussing the rate of IVF pregnancies, embryos that were successfully implanted.
"I can’t even believe I’m giving this to you," he said, sliding a piece of paper with his office’s statistics across the desk. "Last month I did five transfers, and four got pregnant. ... That’s incredible."
Last year, Wilshire said, his office broke all internal records. It saw a 44 percent success rate for patients between the ages of 38 and 40 years old and a 67 percent success rate for patients ages 35 to 37. Patients older than 40 were successful 17 percent of the time. Those numbers are significantly higher than the most recent national rates, which are also on the rise. Mid Missouri Reproductive performed 56 total IVF cycles in 2007.
The Missouri Center for Reproductive Medicine and Fertility at Columbia Regional Hospital, the other large fertility clinic in town, had a slow year, with only two pregnancies out of nine IVF cycles. But the center has just completed a move into a $1.4 million renovated fertility clinic at Columbia Regional Hospital, and doctors say they’re expecting a big 2008 and 2009.
"We’ve been a two-site program for the last five or six years," said Danny Schust, one of two endocrinologists at the program. Schust said the laboratory was previously housed at University Hospital and the clinic was at Columbia Regional. "It was disjointed. It really makes no sense," he said. "So we’re excited to have it all together."
There are other reasons for optimism. In vitro fertilization has switched from a simple numbers game, where doctors tried to overwhelm long odds with large numbers of sperm and eggs, to a more precise science.
"Back in the early ’90s, when I did my fellowship in reproductive medicine and endocrinology, a good success rate was 14 percent," Wilshire said. "We were groping in the dark as a profession. We’d put a bunch of embryos up there and pray to God, hopefully the embryos would stick and you’d get a pregnancy in there."
If a couple decides to undergo the costly IVF treatment, doctors first prescribe a drug - gonadotropin - that stimulates ovulation to cause the woman’s body to release multiple eggs. They remove eggs from the woman and place them in a petri dish protected in an incubator. The doctor then has two choices: pour sperm over the egg in hopes that one will make its way in or, in cases of men with low sperm counts, use a "micro manipulator machine" to inject a single healthy sperm into the egg.
Then it’s time for the fertilized egg to grow. One of the most exciting advances of recent years is the "medium" used to replicate the fluid of the womb. This medium - made up of amino acids, sugars and nutrients - has been perfected by scientists to replicate conditions in the womb.
Whereas 10 years ago doctors would have to implant the embryo in the womb after one or two days in the petri dish, they now can wait five days, until the embryo has divided into eight cells and is well on its way to becoming a fetus. "The real advances are in the IVF lab. I wish I could say the doctors are getting better, but I think it’s the embryologists who are getting better," Schust said.
But the doctor’s skill comes next. After five days, he or she must remove one or two of the fertilized eggs and implant them near the top of the womb. Wilshire said when he began practicing, he would put in four or five embryos just to be sure one would take. Today, he says, he rarely puts in more than two.
Wilshire proudly wielded the "coaxial catheter," a thin, rotating pipette used to do the implantation.
"I liken it to fly fishing," he said. "When you’ve got crystal-clear water and you’ve got a big trout in the pool, if you even look in there or drop a stone, it scurries away - it’s very scared and skittish. However, if you’re a good fly fisherman, you’re way away and you cast just right, then the fly goes out and it goes ... down real lightly like a natural fly, and the trout comes up and gets hooked."
None of this is cheap, however. IVF cycles typically cost about $7,000 without medication. Once the medications are included, that figure can rise to $10,000 or more. In Missouri, group health insurance policies are not required to cover IVF, but a bill sponsored by Rep. Steve Hodges, D-East Prairie, would mandate that all policies covering more than 25 employees cover the treatment.
Hodges said he got the idea for legislation after hearing the story of a New Madrid couple who needed help from family members to pay for IVF.
"For people who want a child that badly - and the procedure is fairly taxing, not counting the expense and emotion involved - I just thought, ‘We spend lots of money trying to save lives, why not spend some money trying to create one?’ " Hodges said. "I have a saying: ‘A good thing is always a good thing,’ and I think this is a good thing."