Dr. Sameh K. Toma, Medical Director of the North Carolina Center for Reproductive Medicine, warns patients to beware of treatment options that could drain what little medical or prescription coverage you may have.  For example, if a patient has a lifetime benefit of $5000, she should carefully consider how to move forward by choosing the path that would result in the best chance at conceiving a child.

At NCCRM, most patients get pregnant without having to go through in vitro fertilization (IVF), by means of timed intercourse, ovulation induction and intrauterine insemination (IUI).  
Here is an example of a basic treatment plan and its associated costs compared to other fertility clinics in our region:

Pregnancy rates for both of these treatment plans are usually within 5% of each other, resulting in a 10% – 15% chance of conceiving per cycle.  Yet, the cost is dramatically different.  “Examine your benefits and look at the best chance of getting pregnant,” says Dr. Toma.  “Just because a treatment costs more doesn’t mean it has higher success rates.”  

Many patients also may need a laparoscopy to evaluate the fallopian tubes, presence of endometriosis, polyps, fibroids and other issues.  Another procedure often recommended by OBGYNs and fertility specialists is a hysterosalpingogram (HSG).  It’s a special kind of x-ray that involves placing an iodine-based dye through the cervix and taking x-rays to help evaluate the shape of the uterus and whether or not the fallopian tubes are open or blocked.  “It’s important to note that an HSG only confirms whether the fallopian tubes are open but says nothing about the freedom of the tube to pick up eggs from the ovary,” explains Dr. Toma.  Instead, a saline ultra sound followed by air infusion into the fallopian tubes can assess the patency of the tubes as well as the HSG, but would be covered as a gynecologic procedure rather than a fertility procedure with a woman’s insurance company, thus saving any fertility coverage she may have for other procedures.  The saline ultrasound also is used to detect polyps and fibroids.

In summary, it’s critical that patients understand all aspects of their medical and pharmacy benefits.  Here is a list of specific questions every patient should ask their health insurance company and pharmacy benefit provider before moving forward with any treatment protocol:

Do I have benefits to cover testing for infertility??
Do I have benefits for reproductive technology procedures such as IUI and/or IVF?  If yes, what is the lifetime dollar maximum or the maximum number of attempts??
Do I have benefits for infertility drugs??
Is the fertility clinic an in-network provider with your insurance company?

Fortunately, NCCRM has a very experienced and knowledgeable team that can help patients navigate their way through the complex world of health insurance.  For more information, visit www.NCCRM.com.

Couples who require donor eggs before moving forward with in-vitro fertilization (IVF) already know the procedure comes with a hefty price tag. But here’s some good news…

The Scoop

Want to save some money on your donor eggs for your IVF treatment? The North Carolina Center for Reprodcutive Medicine is now offering a “shared egg” donor program that allows two women to use eggs provided by the same donor at the same time. Sharing eggs can save women 30 to 50 percent on the expense of conceiving a child with a donated egg, cutting treatment costs by thousands of dollars.

Though rates vary widely across the US, a typical cycle of Donor Egg IVF at NCCRM costs $13,500 plus medication, with most of the fees not covered by patients’ health insurance.  In the past, donors would supply eggs to only one woman, and often many embryos were never used. But by sharing donated eggs, the price drops.  NCCRM is offering a remarkably affordable price of $10,800 for a shared or split donor cycle.

By sharing the cost of acquiring donor eggs, recipients can save on expenses for intensive screening to identify appropriate donors and compensation for a donor’s time, which runs several thousand dollars. In addition, a donor receives fertility medicine in order to produce multiple eggs, which are then extracted through outpatient surgery. Shared costs also cover this procedure.  Even more encouraging is the pregnancy success rates using donor eggs from healthy, young women reach 70%.

Your Fertility

Will you need donor eggs? There are a variety of reasons why some women will require donor eggs in order to become pregnant. Age is the most common. While some women in their 40s have no trouble getting pregnant, eggs in other “older” women trying to conceive may no longer be viable for pregnancy. Premature menopause, detected problems with chromosomes in a woman’s eggs, and risk for inherited gene defects may also factor into the decision to use donor eggs.

If you are currently considering Donor Egg IVF, contact NCCRM at 800-933-7202 to see if a Shared/Split Egg Donor cycle is for you.

Kolsen Brantley Metz was born on May 2, 2011 at 7:45 AM in Greensboro, NC, weighing 8 lbs. 2 oz. and 21 inches long.  Parents Amy and Stacy are overjoyed. “It is amazing how much you can love somebody in an instant.  We both can’t quit staring at him and telling each other how beautiful we think he is.” Celebrating her first Mother’s Day with Kolsen has been a dream come true for Amy. “We are so thankful for the foundation because it is what got us to this special time in our lives.  We couldn’t say thank you enough,” says the new Mom.

The Metz family received a grant from the Pay It Forward Fertility Foundation in December of 2009 to help pay for fertility treatment in order to build their family. Years of trying to conceive led the Metz’s to the North Carolina Center for Reproductive Medicine (NCCRM) in Greensboro where they underwent In Vitro Fertilization (IVF). After a negative result and thousands of dollars spent, Amy and Stacy needed to fund another attempt at IVF to conceive. That’s when they decided to apply for a grant from the Pay It Forward Fertility Foundation.

The Pay It Forward Fertility Foundation is a non-profit 501 (c)3 organization that was created to help people afford expensive fertility treatments that are not covered by health insurance. The Foundation awards grants throughout the year to couples who live in North Carolina needing assistance in paying for assisted reproductive techniques such as in vitro fertilization (IVF), in vitro fertilization using donated eggs and embryo adoption. The Metz’s baby is the first child to be born from a couple who has received a grant since the Pay It Forward Fertility Foundation began awarding them in 2009. To date, six couples have been given financial assistance to build their families.

Founder and Chair of the Pay It Forward Fertility Foundation, Lori Moscato, says the birth of Kolsen is a dream come true. “The foundation cannot be happier to welcome Kolsen to the world and the PIFFF family. We’re so glad Amy was able to celebrate this Mother’s Day as a Mom. Rob and I personally could not be more ecstatic. This is exactly what we wanted to help someone do – have the miracle of life,” says Moscato.

The Pay It Forward Fertility Foundation was started in December 2008 with a generous donation from Lori and Rob Moscato of Raleigh. The Moscatos conceived their daughter through in vitro fertilization (IVF). After giving birth to Sophia in 2007 they conceived their son Ryan on their own. “Rob and I feel so blessed and so fortunate to have two little miracles, each in their own way,” explains Lori Moscato. “We were fortunate to have health insurance coverage for our IVF treatments but we know most people don’t. We want to help those couples because we can’t imagine life without our beautiful children and we want to pay it forward.”

Infertility is a disease of the reproductive system and affects about one is six couples in the United States. The Pay It Forward Fertility Foundation currently has the full support and involvement from five NC based fertility clinics. The North Carolina Center for Reproductive Medicine, Carolina Conceptions, Duke Fertility Center, UNC Fertility and the Center for Reproductive Medicine at Wake Forest University are all represented on the Board of Directors and the Advisory Board. Their collaborative expertise and guidance play a critical role in the success of the Foundation and its mission.

Couples interested in applying for grants should visit www.payitforwardfertility.org.

About the Pay It Forward Fertility Foundation:
The Pay It Forward Fertility Foundation on is a non-profit 501 (c)3 organization, IRS identification number 26-3906064. The Foundation assists couples in North Carolina in pay for fertility treatments not covered by health insurance. www.payitforwardfertility.org

Legislation will remove financial barriers for infertility treatments

NCCRM applauds Senator Kirsten Gillibrand (NY) for introducing a bill in the U.S. Senate that would provide eligible taxpayers a tax credit for the out-of-pocket expenses incurred with infertility medical treatment.

Appropriately named the “Family Act of 2011,” the bill, S 965, would apply to expenses related to in vitro fertilization and treatments to preserve fertility for cancer patients.

The Bill was introduced just days after RESOLVE’s successful Advocacy Day in Washington, D.C.  Advocates from across the country met with their Members of Congress to advocate for the tax credit.   Enthusiasm was very strong for the tax credit among the Advocates, who see the need for immediate financial relief for infertility patients.

What YOU can do

Now that it is introduced, S 965 needs co-sponsors in the U.S. Senate.  We need EVERYONE who is facing infertility (and their friends and family) to contact their two U.S. Senators.

1. Contact your two Senators right now.  It takes 3 minutes through RESOLVE’s Action Alert System. PLEASE review the online letter and personalize it with your story.  Personal content is far more impactful than a form letter.

2. Ask your friends and family to send letters  too!  Forward this link so they can take action today. http://www.resolve.org/taxcredit

3. Share the information about the tax credit on your Blog or Facebook page!

To read the letter sent by Senator Gillibrand to other members of the U.S. Senate, click here.

Key provisions of the bill:

• The Family Act covers the out-of-pocket costs associated with in vitro fertilization (IVF) including diagnostic tests, laboratory charges, professional charges, and medications for IVF.
• The Family Act covers the out-of-pocket costs of fertility preservation procedures if the man or woman is diagnosed with cancer and the cancer treatment or disease itself may result in infertility.
• The Family Act has a cost sharing provision allowing 50% of all applicable medical expenses to be  covered up to a lifetime maximum of $13,360. You would need to have out-of-pocket costs totaling $26,720 to claim the entire credit in your lifetime.
• If you do not owe taxes in a particular year, do not owe enough taxes to use the whole credit, or do not reach the max amount in one tax year, it carries over to the next year for a max of five years after the first year you use the credit.
• The Family Act is available to couples filing jointly with adjusted gross incomes of less than $222,520, but the credit is smaller for those earning between $182,500 and $222,520.

Follow Family Act of 2011, S 965 on Facebook to keep up to date.

The Board of Directors of the Pay It Forward Fertility Foundation has selected Tiffany and Jamie Nelson and Stephanie and Justin Crooks to receive grants to assist them in getting medical treatment for infertility.  They can seek care at any fertility clinic in North Carolina certified by SART, the Society for Assisted Reproductive Technology, which includes the North Carolina Center for Reproductive Medicine, Carolina Conceptions, Duke Fertility and UNC Fertility locally.

The couples went through a rigorous application process in which their medical history, fertility journey and financial status all were evaluated thoroughly by the Pay It Forward Fertility Foundation Board of Directors, which is made up of several local doctors, former patients, an attorney, an accountant and others with experience in the field of fertility.

Also, the Board of Directors is inviting all members of the public interested in learning more about building their family through assisted reproductive techniques and/or traditional adoption to the 2nd Pay It Forward Fertility Education Forum.  The conference will take place on Saturday, April 30th at the Raleigh Marriott Crabtree Valley.  This comprehensive symposium will feature nationally known speakers, local fertility clinics, specialty pharmacies, holistic providers, adoption agencies and other vendors related to having children.  According to the Centers for Disease Control, approximately one in six couples experiences infertility and the problem continues to grow, making this Education Forum even more important.  More information about the Forum will be available at www.payitforwardfertility.org.

The Pay It Forward Fertility Foundation is a non-profit 501 (c)3 organization that was created to help people of various circumstances afford expensive fertility treatments that are not covered by health insurance. The Foundation awards grants several times a year to couples who live in North Carolina needing assistance in paying for assisted reproductive techniques such as in vitro fertilization (IVF), in vitro fertilization using donated eggs and embryo adoption.  The Pay It Forward Fertility Foundation raises most of its funds through an annual gala that takes place in in Raleigh every fall.  This past year, more than $50,000 was raised in order to help couples in North Carolina build their families.

The Pay It Forward Fertility Foundation was started in December 2008 with a generous donation from Lori and Rob Moscato of Raleigh.  The Moscatos conceived their daughter through in vitro fertilization (IVF).  After giving birth to Sophia in 2007 they conceived their son Ryan on their own. “Rob and I feel so blessed and so fortunate to have two little miracles, each in their own way,” explains Lori Moscato. “We were fortunate to have health insurance coverage for our IVF treatments but we know most people don’t.  We want to help those couples because we can’t imagine life without our beautiful children and we want to pay it forward.”  Couples interested in applying for grants should visit www.payitforwardfertility.org to learn about the requirements and to download an application.

Ryleigh Shepherd was conceived in 1998, the same year as her 11-year-old twin sisters, but she wasn’t born until 2010. 

The three girls from Walsall, in Great Britain, who were born more than a decade apart in two different centuries, are actually fraternal triplets born through in vitro fertilization (IVF).

Ryleigh came from the same batch of embryos that had allowed her parents — Lisa and Adrian Shepherd — to give birth to twins Megan and Bethany.

British experts say they know of no other case in their country in which three siblings from the same round of fertility treatment have been born with such an age gap.

The longest interval between freezing and conception was in the case of a woman from New York City whose embryo had been stored for 20 years, according to a report in the journal Fertility and Sterility.

“It seemed strange to think that we were using embryos that we had stored all those years ago, that were conceived at the same time as the girls,” Lisa Shepherd, 37, told Britain’s Daily Mail newspaper.

“We knew that if we had another baby it would in effect be the girls’ triplet as they were all conceived at the same time,” she said. The girls look exactly alike, according to their mother. “It was uncanny.”

How long embryos can be frozen and still viable is still not known, but American fertility experts say they have great confidence in the success of new reproductive techniques.

“It’s incredibly common for people to go back and second and third time,” said Barbara Collura, executive director of RESOLVE, the National Infertility Association. “There have been recorded cases of kids born far longer apart. This doesn’t tip the scales.”

Fertility experts estimate that about 400,000 embryos are currently in frozen storage in the U.S., and a more comprehensive survey will be underway in the spring.

Couples undergoing IVF must make a decision about saving the eggs at a cost of about $200 to $300 a month for future use. Many couples choose to donate their frozen embryos to other infertile couples, according to Collura.

“When they are done with their family building and years pass, they can donate to another couple,” she said.

Cryogenic techniques have improved significantly since the 1990s, when the Shepherd twins were conceived. Experts speculate that frozen embryos can last “15 to 20 years or more,” said Collura.

Women in their early 30s who are undergoing IVF can be hopeful that their frozen embryos might be used later on.

Such was the case with the Shepherds, who were married in 1994 and wanted to start a family. But Lisa Shepherd had been diagnosed with endometriosis and polycystic ovaries, and doctors told them her chances of getting pregnant were not promising.

“I was given drug treatments to help me conceive, but nothing worked,” she said. “It was devastating.”

In September 1998, the couple underwent fertility treatment; 24 eggs were collected and 14 were successfully fertilized with Adrian Shepherd’s sperm.
Two embryos were implanted and the remaining 12 were placed in frozen storage. The couple said they didn’t “get their hopes up.”

Soon the couple was expecting twin girls, who were born by Caesarian section.

When the twins were 9, the family began to think about having another baby.

“We had been so busy raising the twins that it wasn’t until then that we stopped to think about having another one,” said Lisa Shepherd, whose husband, 45, is an engineer.

“‘So we asked the girls what they thought about having another addition to the family and they really wanted it.”

In December 2009, the couple returned to Midland Fertility Clinic for another cycle of IVF, using the 10-year-old embryos. Ryleigh arrived in November.

“The girls are thrilled to have a sister — and they know that she was conceived at the same time that they were, but has been in the freezer,” said Lisa Shepherd.

Doctors say there are few safety concerns about using long-frozen embryos.

“Once an embryo is frozen, it’s essentially frozen in time,” said Dr. Jani Jenson, a reproductive endocrinologist at the Mayo Clinic. “As a group, children born with IVF are one of the most scrutinized cohorts. ”

Because these technologies are only 40 years old, no one knows how these babies will age, but all other studies have indicated IVF is safe.

“The data we know from fresh and frozen transfers are that it doesn’t put them at any unique or known risks like learning disabilities or birth defects,” said Jensen.

The Shepherd case is, “interesting, and yet mundane,” said Dr. Ellen Clayton, director of the Center for Biomedical Ethics and Society at Vanderbilt University. “They are just siblings and this is clearly a family where everyone resembles everyone else. The twins look like two peas out of a pod and this is the third pea.”

Ethical concerns have been raised about risks involving IVF, according to Clayton, but the “relevant metric” is how parents make other choices about having children.

“The current thinking is that parents are free to make pretty broad choices,” she said. “They are free to continue a pregnancy with Down syndrome. People make all kinds of choices that are potentially risky.”

As for the Shepherds, said Clayton, “God bless them. This looks like a happy family that is now even happier.”

In a study published in the journal Fertility and Sterility, in which 477 women were asked to take fertility drugs, scientists say that a higher dose of ovulation-stimulating drugs ensure obese women to have a lower body mass index (BMI) similar to those of their slimmer peers.

The results are said to show 25 percent of normal, 37 percent of overweight, and 36 percent of obese women who sought out treatments conceived with them.

“With the higher drug dose, you bring the chances of conceiving close to that of a normal woman, and you’ve got a good chance of a live birth,” Dr. Irene Souter, lead author on the study, said. “I wouldn’t say that obese women do better, I would say that they have a comparable outcome.”

Read more: http://thenewschronicle.com/drugs-obese-women-pregnant-easier/0108010812/#ixzz1An8ixyr1
Under Creative Commons License: Attribution Non-Commercial No Derivatives

Before even thinking about IVF, however, potential parents might try a simple new program or iPhone app developed by some British researchers which may predict with new levels of accuracy their chances of success.

Parents who use the app could also be helping the cause of science. IVFpredict.com asks nine questions and then calculates the odds of IVF leading to a baby. The questions range from the low tech, like the mother’s age and how many pregnancies or rounds of IVF she’s had before and whether her eggs or someone else’s are being used, to the technical, like what type of medicine will be used and whether the egg will be fertilized using intracytoplasmic sperm injection or ICSI (a single sperm injected directly into an egg.)

The folks who devised the test, Scott Nelson from the University of Glasgow in Scotland and Debbie Lawlor from the University of Bristol in England, created the model after analyzing data on 144,018 IVF cycles from the Human Fertilisation and Embryology Authority in Britain. (More on TIME.com: BPA Exposure May Reduce Chances of IVF)

Their findings were published in this week’s issue of PLoS Medicine. The chances of a baby arriving, they suggest, are decreased by the mom’s more advanced age, the length of the infertility and the use of the woman’s own eggs, but increased by a previous successful IVF-generated birth and use of ICSI.

“Pending external validation, our results show that couple- and treatment-specific factors can be used to provide infertile couples with an accurate assessment of whether they have low or high risk of a successful outcome following IVF,” say the authors. However, those results need to be tested. Hence the app, which is already online and becomes available for iPhones soon.

Another, slightly more elaborate way of predicting IVF success—by filming the embryo as soon as it is formed—was announced in October by Stanford University professor Dr. Renee Reijo Pera. (More on TIME.com: Putting to Rest Fears that IVF May Be Linked to Cancer)

The British method might be more of a first step. It gave this 40-something mother of two a 4% chance of IVF ending in a live birth. Don’t think I’ll need to be filming any embryos soon.
Read more: http://healthland.time.com/2011/01/04/predicting-ivf-success-theres-an-app-for-that/print/#ixzz1An6NKnaA

According to a University of Iowa (UI) study published in the October issue of the journal Human Reproduction, IVF babies scored better than age- and gender-matched peers on the Iowa Test of Basic Skills – a widely used test that evaluates students’ abilities — and the Iowa Test for Educational Development (ITBS/ED), which is generally considered an objective measure of educational outcomes. Researchers found that children conceived by IVF score at least as well as their peers on academic tests at all ages from grade 3 to 12.

The study should soothe parents who are concerned about adverse effects of fertility treatments on babies’ cognitive skills. Although IVF is considered safe, there isn’t much in the way of long-term data on health outcomes. The Iowa study tracked children to an older age than previous research. (More on Time.com: A New Way to Predict Which IVF Embryos Will Lead to Pregnancy)

“Our findings are reassuring for clinicians and patients as they suggest that being conceived through IVF does not have any detrimental effects on a child’s intelligence or cognitive development,” says lead study author Bradley Van Voorhis, a professor of obstetrics and gynecology and director of the Center for Advanced Reproductive Care at UI Hospitals and Clinics.

Van Voorhis and his fellow researchers measured the academic performance of 423 Iowa children, ages 8 to 17, who were conceived by IVF against the performance of 372 age- and gender-matched children from the same schools. The researchers also took into account whether different characteristics of the children, parents or IVF methods had an effect on children’s test scores.

The study found that IVF children scored above average on standardized tests compared to their peers. The research also linked other factors to higher test scores, namely older age of the mother, higher education levels of both parents and lower levels of divorce.

“The likelihood is this has to do with nature and not nurture,” says Robert Stillman, medical director at Shady Grove Fertility Center in Rockville, Md., which has the country’s largest fertility program. “Those fortunate enough to be able to afford IVF in an arena where there’s little insurance coverage may very well have the means to provide a high level of education for their children.” (More on Time.com: IVF Pioneer Robert Edwards Wins Nobel Prize)

Would-be parents relying on assisted reproduction techniques are sometimes concerned that using frozen rather than fresh embryos is less than ideal. After all, aren’t fresh veggies better than frozen ones? Yet the Iowa study debunked that, showing that children’s test scores didn’t fluctuate as a result of various methods of insemination or reliance on fresh vs. frozen embryos.

Deliberating between transferring one or more embryos? You might be interested to learn that the researchers found that single babies performed better than twins, who performed better than triplets — if only every so slightly. But even the triplets performed better than the average score of children conceived the old-fashioned way.

Still, that’s no reason to rush into IVF if you don’t have to. Says Stillman: “This is an argument not for doing IVF to have brighter kids but for having insurance coverage so everyone can have a child if they’re having trouble getting pregnant.”

Courtesy: Time Magazine

Read more: http://healthland.time.com/2010/10/01/building-a-brighter-kid-consider-ivf/#ixzz17YU1vdfN