IVF: Should Treatment Cycles be Uninterrupted or be Conducted in Pre-scheduled Batches?

Dr. Geoffrey Sher - February 9, 2017
IVF: Should Treatment Cycles be Uninterrupted or be Conducted in Pre-scheduled Batches?

The conventional way of conducting IVF treatment is to provide patients with opportunity to undergo treatment any time they are ready to do so. But such delivery of services in fact often falls short of affording access to the most efficient and best quality of treatment because it fails to allow much needed opportunities for clinical and laboratory staff to take much needed breaks in order to implement optimal quality control and to recover from the pressure resulting from uninterrupted delivery of services. So it was that about 25 years ago, I introduced a  “batching system” , addressing these deficiencies while simultaneously improving patient access to services.

 

 

Batching IVF programs that deliver such services usually provide several  two- week “batches” per year. This means that a number of patients arrive together at a predetermined dates for treatment. At Sher IVF Solutions (SFS) these batches are prescheduled to start on set dates that are calendared and posted on our website, www.sherivf.com , or in advance. This enables my patients to make travel and accommodation arrangements well in advance. In order for the system to be effective, patients who are to be treated in a particular batch need to start their cycles (onset of menstruation) on or around the same date. To synchronize their cycles with the scheduled cycle batches, we place women on a birth control pill (BCP) to lead into the cycle of stimulation. By shortening or lengthening the time on the BCP, we can ensure that menstrual bleeding starts at the required time to coincide with the start of a given cycle batch. Contrary to the erroneous belief that the BCP suppresses response to gonadotropin therapy, provided that in the last few days of using the BCP, it is overlapped with a GnRH agonist (e.g. Lupron, Superfact, Buserelin Gonapeptyl), this approach actually improves response to ovarian stimulation. Following the launching an ovarian stimulation cycle on a BCP and the subsequent addition of a GnRH-agonist the woman will have a bleed. At this point she will be required to have a baseline ultrasound assessment and have blood drawn for measurement of estradiol (E2). If she is from out of town, this is done by her primary OB/GYN. Provided that the ultrasound does not detect an ovarian cyst and her estradiol level is <70pg/ml or <200pmol/l), she will be eligible to start taking gonadotropins for ovarian stimulation under our oversight. We will by this time have schooled her and partner in administering the shots…so this should not present a problem. Thereupon she will need to arrange to arrive at LA-IVF located in Century City, West Los Angeles, CA (where I currently conduct hands-on IVF in "batches, once every 3 months)...for me to begin monitoring her response, 7-8 days after commencing ovarian stimulation. It is unusual (and even inadvisable) for a woman undergoing controlled ovarian stimulation (COS) for IVF to be ready for triggering with hCG prior to the 8th day of stimulation so her arrival should be timely and not be too late. In my experience, most patients fully embrace and most even prefer this “batching” approach for the following reasons:Batching allows for much better quality control because between batches the clinic is able are able to re-calibrate at every level (lab, administrative and clinical). This is in my opinion, the most important advantage because it reduces the likelihood of errors glitches that can and often do occur at all levels. It enables allows patients to plan their lives and travel arrangements in advance, around prescheduled treatments. This is especially helpful to patients such as my own,  >70% of whom travel from abou 40 different countries or out from out-of-state,  for treatment. From a clinical standpoint, launching cycles off a birth control pill not only allows batching to be scheduled reliably, but (provided the BCP is used appropriately (see above), it has clinical advantages with virtually no disadvantages. The “batches” cited on my website (sherfertilitysolutions.com ) represent fresh cycle batches. In addition there are collateral separately batched for frozen embryo transfers (FET) during the week following conclusion of fresh IVF treatment batches. The process of batching patients who journey to Sher-IVF in Las Vegas from afar, might at first glance seem somewhat complex, but it really is not. In fact it is very easy, efficient convenient, safe, seamless, uncomplicated and highly effective. Most importantly, the vast majority of the seventy percent (70%) of my IVF patients who journey from out of state and from abroad for treatment in Las Vegas would attest to this.


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