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Four Simple Clicks Will Help You Have a Baby

This article was written by one of my patients, Debbie Denenberg, a Choice Mom of 4 year old twins. Excerpts will appear in Choice Mom Guide to Fertility by Mikki Morrissette, available for purchase in November 2007 on www.ChoiceMoms.org. My patient is right on about using the SART statistics to help chose a doctor and she shows you how. Here it is:

I was a lucky one. Because I found Dr. Frederick Licciardi at NYU Fertility Center, I gave birth at age 42 to boy/girl twins. My experience taught me one of the most important first steps in seeking infertility treatment: all doctors are NOT created equal, and with a few easy clicks you can find the best doctor in your area.

Infertility is one of the ONLY fields of medicine where the lay person can actually compare medical results, because success rates of infertility clinics nationwide are reported and accessible. This fact is exquisitely, crucially helpful to the woman seeking to become pregnant.

Here’s how easy it is. Go to www.sart.org and click on the big yellow button: IVF Success Rate Reports. Then click on a state or type in your zip code. Now you see a list of clinics to compare. Click on one to see Clinic Contact Information. The last line is a link: ART Data Report click here. When you open that link, you can review the results by age. The best comparison is “percentage of retrievals resulting in live births”. And if a doctor doesn’t report results for any reason, run! All the excellent clinics report results.

A quick example. The NYU Fertility Center performed 356 IVF cycles on women under 35, and the “percentage of retrievals resulting in live births” was 52%. Another clinic in walking distance to NYU (we’ll call it Clinic X) reports 131 IVF cycles performed, with 22% resulting in live births. Think of what that means:
52% vs. 22%! Based on these track records, if 100 women do IVF at each clinic, 52 will have a baby at NYU Fertility Center, and only 22 will have a baby at Clinic X.
That means 30 (a huge number) failed as a result of choosing the wrong doctor. And failure is not to be taken lightly. Some of the failures may be a woman’s last chance; some women may go into debt just to try.

Still not convinced? Another clinic in Manhattan performed only 25 ivf cycles in a year’s time, and reported only ONE live birth. Would you walk into that clinic? Perhaps these doctors have a lovely office or great bedside manner. Perhaps they went to school or play golf with a GYN who, not having checked their numbers, refers to them. (YOU have much more at stake than your referring physician. It is up to YOU to protect yourself). It took me only four clicks to uncover these dreadful results.

Be careful of clinics that tell you about a high pregnancy rate, but publish a low rate. Many programs with low numbers use the excuse that they do the harder cases. The opposite is usually true. After women have failed one or more cycles, they usually seek out the programs with the best reputations.

Size may matter. There can be small practices with good results, but these tend to be exceptions, so check them out carefully.

Dr. Licciardi points out, “Your infertility doctor does not work alone. He depends on embryologists, laboratories, nurses and many others. If any link in this chain is weak, your chances for success are compromised. So my recommendation always is to go to a program with published, excellent results. Your homework here could be well rewarded.”

And it only takes four clicks!

Luteal Phase Defect 3

So we thought we had it all figured out. There were many studies establishing what “the ideal” biopsy should look like for each day. But then science started changing for the better and some important issues were raised.

First, the original studies of luteal phase defect were done using the day of temperature rise as the day of ovulation (LH kits and fancy automated blood test machines were not yet invented). It is true that in many women the temp rise signifies ovulation and there are plenty of web sites dedicated to the temperature rise. However, the temperature rise is not completely accurate and could be off by a day or 2. So if luteal phase defect is all about timing (the day in the cycle after ovulation) the original studies were flawed because they used a less reliable method for timing the day of ovulation.

Second, even highly trained reproductive endocrinologists differ on their opinion on what the biopsies for each day should look like (even using the book) . If you give the same biopsy slide to 2 different qualified doctors, they could differ form one another by a day or 2. Well that’s just not good enough. Even when you give the same biopsy slide to the same doctor on 2 separate occasions, the opinion may be different. Not good if we are saying everyone with more than a 2 day discrepancy ahs a luteal phase defect.
Third, no one has ever shown that untreated women with abnormal biopsies are less fertile than the general population.

In general, most reproductive endocrinologists do not believe in the luteal phase defect and do not test for it. In the old days, doctors would use progesterone clomid or FSH to treat the supposed defect, and today women are getting on those meds more quickly than before. And it takes time; months and months can go by while you’re waiting to see if the progesterone is working. In most cases you don’t have the time to waste.

I realize there are some of you who were diagnosed with luteal phase defect and were given progesterone with great success. I am very happy for you, but your success is the exception, not the rule.

What about the obvious case: a woman who knows she gets her period day 11 after ovulation (normal is 12-14). Here I think most doctors would agree that this indeed may be a luteal phase defect and there is no harm in treating accordingly.

What about progesterone levels, what are the right numbers? We have no idea. There is no good study showing some levels are better than others. And if you were pregnant, had low progesterone and had a miscarriage, it’s usually a bad pregnancy casing a low progesterone level, not a low progesterone causing a miscarriage.

So if you are in a doctor’s waiting room and the other women with you are trading stories about how you all have luteal phase defect, that’s too many. Your doctor is probably over diagnosing LPD. If you are the only one or one of the few with LPD, then the physician is probably more reasonable and is close to getting it right, and treatment may be the right thing for you.
Don’t forget to read the dislaimer 5/17/06.
Dr. Licciardi

References:

  • van der Linden M, Buckingham K, Farquhar C, Kremer JA, Metwally M. Luteal phase support in assisted reproduction cycles. Cochrane Database Syst Rev. 2011 Oct 5 ;(10):CD009154.
  • Licciardi FL, Kwiatkowski A, Noyes NL, Berkeley AS, Krey LL, Grifo JA. Oral versus intramuscular progesterone for in vitro fertilization: a prospective randomized study. Fertil Steril. 1999 Apr; 71(4):614-8.
  • Feinberg EC, Beltsos AN, Nicolaou E, Marut EL, Uhler ML. Endometrin as luteal phase support in assisted reproduction. Fertil Steril. 2012 Nov 5. pii: S0015-0282(12)02238-8. doi: 10.1016/j.fertnstert.2012.09.019. [Epub ahead of print]
  • Engmann L, DiLuigi A, Schmidt D, Benadiva C, Maier D, Nulsen J. The effect of luteal phase vaginal estradiol supplementation on the success of in vitro fertilization treatment: a prospective randomized study. Fertil Steril. 2008 Mar; 89(3):554-61.