Treatment Options
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Patient Education |
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The Advantages of Cryopreservation of
Embryos for an IVF/ICSI Patient |
For a woman
undergoing IVF/ICSI, it costs approximately
Rs 6000-7000 to produce an embryo. (that is
Rs 65000 to Rs 75000 per fresh IVF cycle
resulting in 10 embryos)
The chances of such an embryo to result in a
baby varies from 10-20% depending upon the
quality and other parameters.
Invariably, a woman of about 30 years age,
produces 9-12 embryos on an average, of
which 3-4 are normally transferred back into
her uterus in any transfer cycle.
If such fresh IVF/ICSI treatment cycle
fails, she has to undergo the routine
rigmarole of pain and the expenses of
producing the embryos all over again.
But no more such agonising problem after the
availability of Cryopreservation Facility in
an IVF center.
If a woman
produces, let us say, 10 embryos in her IVF/ICSI
cycle, she would have wisely cryopreserved 7
of her embryos which is enough for 2 more
cycles of embryo transfer and the chances of
her getting pregnant with such frozen-thawed
embryos is as good as with fresh embryos.
It makes enormous economic sense to
cryopreserve all the surplus embryos for
subsequent embryo transfer cycles.
Mind you, cryopreservation does not cost
much. It costs about Rs
5000 only in Baheti Hospital.
The science
and art of cryopreservation has been
developed and refined since the time of
introduction and the success rate has
greatly improved after the use of 1,2
Propanediol: sucrose as cryoprotectants.
With the
availability of such technique, there is so
much of embryos lieing in storage abroad
that they were in a dilemma as to how to
dispose of the surplus embryos from
childless couples after storage life of 5-10
years!!! We have embryos lieing
with us for the past one year.
Let us see the
benefits of cryopreservation for any
100 patients. For every 100 couples
undergoing IVF/ICSI, 30 could be expected to
get pregnant in their fresh IVF treatment
cycle. Of the remaining 70 who failed
in their first attempt, 42 will have enough
cryopreserved embryos from their last cycle.
With a survival rate of 70-80% after thawing
and a pregnancy rate of 25%, another 11
patients can be expected to get pregnant
with frozen thawed embryo transfer cycle.
Again some of the failed patients (15) may
have still enough embryos for one more cycle
of embryo transfer. From which 4
more patients can be expected to get
pregnant. Hence, with
cryopreservation the chances of achieving a
pregnancy has incresed by 50%.
The main advantage of cryopreservation is
that frozen thawed embryo transfer cycle
treatment is not as expensive as any
stimulation cycle for IVF.
Because this time the treatment aims at
preparing a good bedding for the embryo to
implant in the uterus of the patient with
simple hormone tablets or pessaries or daily
injections without any need either for
intensive follicular monitoring or serum
hormone monitoring.
After reading this article, one would see
immediately the benefits of undergoing IVF/ICSI
treatment in any IVF unit with
cryopreservation facility.
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Cost Comparison
of Fresh Versus Frozen thawed ET |
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Procedures |
in USA(1995) |
in Baheti
Hospital |
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Fresh
IVF |
US
$ 14316 |
Rs
35000 |
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Hormones |
US
$ 1826 |
Rs
30000 |
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Freezing |
US
$ 500 |
Rs 5000 |
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Frozen
ET cycle |
US
$ 1582 |
Rs
15000 |
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Cost
per IVF Delivery |
US
$ 44200 |
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Cost
per IVF Child |
US
$ 30900 |
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Cost
per Cryo Delivery |
US
$ 8215 |
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Cost
per Cryo Child |
US
$ 12857 |
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BABIES COMING FROM THE COLD |
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Food
storage is OK. Can embryos be stored? |
People
have got quite used to the concept
of short-term cold storage of food materials at around –20’ C
for 6 months to one year. But
the concept of long-term cold storage
of embryos (stage from conception
to first 5 days of human baby development)
for upto 5 to 10 years at –196’ C
is quite novel and has been in vogue
in this decade only.
We, in BAHETI
HOSPITAL, are pleased to offer this
service to all our IVF/ICSI patients
on a regular basis and are proud
to have achieved successful pregnancies
also. Our hospital is one of the
very few hospitals in the country
with this kind of service. The advantage
and value of freezing the surplus embryos
produced is not fully appreciated by
all IVF patients.
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Why
excess embryos and the need
to store them? |
Any
patient who seeks IVF treatment is
desperate to conceive and deliver
a single child – mostly the couple’s
life-time ambition. There are
two fundamental reasons behind her
problem. One is lack of
good quality embryo and another is
the lack of good quality bedding (endometrium)
to support the embryo. Hence
the solution lies in attacking these
twin areas. Hormone
preparations come in handy (only problem
is their high cost) for cajoling the
ovaries to produce more eggs (averare
10-15). IVF laboratoty
will make embryos (60-70% of the eggs)
from the eggs by IVF/ICSI. After
collecting the eggs from the patient,
the next target is to make her endometrium
good enough for the embryos to grow
further. Though more embryos
mean, higher the success rate, but
not more than 4 are transferred back
at any cost. |
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Now
what to do with surplus embryos? |
But
for cryopreservation, the remaining
embryos would have to be discarded. This
was the real paradox before the availability
of freezing. Not anymore. It
costs very little to freeze the embryos.
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What
next after Freezing the Embryos? |
If
a patient fails to get pregnant in
the first cycle and if she has frozen
embryos, she can come back for Frozen
thawed Embryo transfer treatment. This
costs only 25% to 30% of the cost
of any fresh IVF cycle treatment. Not
only that this Frozen thawed Embryo
transfer step is an Out-Patient Procedure
with no involvement of Operation
theatre or anaesthetic procedures
and no pain of daily hormone injections. Hence
to that extent, this treatment is
free from the attendant risks associated
with the above mentioned theatre
procedures. |
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One
IVF & many ET’s! |
That
is from one harvest of eggs/embryos
in a cycle of treatment, the patient
can undergo multiple cycles of Embryo
transfer attempts, because she has
a bank of frozen embryos in our safe
custody. Even if a patient
delivers a child from a cycle of IVF
treatment, she can always preserve
her surplus embryos for her second
pregnancy whenever convenient to her
at her free will. This can be after
5 years or more also. What a
convenience of planned pregnancy!!!. This
is what is called money well spent! |
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Frozen
for how long? |
The
beauty of Embryo cryopreservation
is that embryos once frozen at –196’ C,
don’t demand any extra nutrients
other than continual maintenance of
liquid nitrogen level in the tanks,
because the life of embryos is kept
under total suspended animation. Neither
do they get spoiled during the passage
of time. Normally, a limit of
3 or 5 years is defined as the safe
period of storage. This
arbitrary 3/5 years figure is meant
to be more for convenience and does
not imply any degradation of embryos
exactly after 5 years.
Overall, the success rate with Frozen
thawed Embryo transfer is comparable
to that of Fresh Embryos. Hence,
the cost benefit ratio of cryopreservation
is indeed higher with Freezing of Embryos. |
We, in BAHETI HOSPITAL, feel that
the value of Embryo Cryopreservation
facility should be fully appreciated and
utilized by the patients.
Fresh IVF or IVF
by ICSI costs around Rs 35000+ 30000
per cycle of treatment. The
chances of success in this cycle is 30-40%. If
the patient fails to get pregnant, she
has to spend again the same amount of money. If
she has frozen any surplus embryos produced,
she will have to hardly spend about Rs
20000 that is just 30% of the cost of fresh
IVF cycle. Remember, in this
attempt there is no daily pain of undergoing
injections. There will be some
patients for whom there may still multiple
chances of some more cycles of frozen
embryos. Even for a patient,
who delivered the first child with Fresh
Embryos, she can come back for her second
child, whenever convenient without having
to undergo the costly IVF treatment. This
can be after 5 years or more also. What
a convenience of planned pregnancy. This
is what is called money well spent!
Overall,
the success rate with Frozen thawed Embryo
transfer is comparable to that of Fresh
Embryos.
Hence, the cost benefit ratio of cryopreservation
is indeed higher with Freezing of Embryos.
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