Stanford University researchers have developed a test to determine whether a patient is likely to conceive a child through in vitro fertilization – a breakthrough that could save women tens of thousands of dollars in fruitless procedures, as well as the heartbreak of failed treatment.
Doctors perform nearly 150,000 in vitro fertilization treatments in the United States each year, but fewer than 1 in 3 results in a live birth. The treatments cost $10,000 to $20,000, with health insurance only rarely covering the expense.
The new test will use data from a woman’s first, failed in vitro fertilization treatment to predict her likelihood of success with a second treatment. The test could be available to patients by the end of this year.
“Deciding whether to have another IVF treatment after the first one has failed is a very, very challenging decision,” said Dr. Mylene Yao, an assistant professor of obstetrics and gynecology at Stanford’s School of Medicine who led the team of researchers that developed the test. “The treatments are expensive and physically and emotionally consuming. I wanted to help support patients by giving them the best information available to make their decision.”
Currently, when a woman wants to know her likelihood of getting pregnant with in vitro fertilization, doctors base their predictions on the woman’s age. Sometimes they factor in height and weight.
Yao’s team created a personalized prediction test based on 50 factors, including a woman’s hormone levels, the number and quality of her embryos and the characteristics of the embryos used in her first in vitro fertilization treatment. While the test only works for women who have had at least one round of treatment, it produces results that are 1,000 times more accurate than the age-based guidelines, according to Yao’s research.
Yao has taken a leave from her Stanford job to form Univfy, a company that will bring the test to market. She hopes to get FDA approval on the test and start putting the software in doctors’ hands by the end of the year.
Linda Gosling, a 37-year-old Redwood City woman, tried two cycles of in vitro fertilization before becoming pregnant and giving birth to twins, now 6. She called the experience “distressing – physically, emotionally and financially.”
Her treatments totaled $30,000 and were not covered by insurance.
“It was difficult to decide to try again after the first cycle failed,” Gosling said. “I couldn’t have kept going and going from a cost perspective – I could only afford two or three treatments max. But, had I not been successful on the second try, it would have been really hard to stop.”
Nationwide, less than 2 percent of the 7.2 million couples with clinical infertility seek in vitro fertilization treatment. According to Yao, this is due in part to the treatment’s high cost, emotional burden and limited medical insurance coverage.
Thirty-five states, including California, do not require health insurance companies to cover infertility treatment, so most women who seek treatments in California pay for IVF cycles out of pocket.
Gosling’s experience led her to start a local support group in partnership with Resolve, a national infertility organization.
“I just got off the phone with a group member who had her third failed try at IVF,” Gosling said. “She’s devastated and trying to decide what she’s going to do next. All the women in the group who’ve had failed treatments are worried about giving up too soon, but they also don’t want to be pouring massive amounts of money into something that will never work.”
Dr. Lynn Westphal is the director of women’s health at Stanford’s Reproductive Endocrinology and Infertility Center. She administers in vitro fertilization treatments for about 300 women a year and provided the clinical data Yao used to develop the test.
Tests based on data
Westphal said she thinks this personalized prediction will “help patients know where they fit in the spectrum. If the test says they have a good chance of getting pregnant, it may give them more hope to try again. If not, it might be the information they need to move on to another option, like using a surrogate carrier or adopting.”
Yao’s test is an algorithm. By using a computer program and answering a series of questions such as a woman’s specific hormone levels or egg counts, the doctors can calculate the woman’s personal odds of having a child with IVF treatment.
The computer program bases its calculations on data from almost 1,700 in vitro fertilization cycles performed at Stanford from 2003 to 2006. Yao and her team tested their model with data from 600 more women who received the treatment in 2007-08.
For more than half the patients, the results from Yao’s test were significantly different than the age-based predictions. The test indicated that about 30 percent of patients had better odds of having babies than the age-based statistics indicated.
Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/08/23/BAGP1EVA8P.DTL#ixzz0z6b9ag4T