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Old 11-23-04, 11:15 PM
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My clinic does it with women who have Hx of implantation failure, or with women 37 or older.
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Old 11-24-04, 06:21 PM
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My clinic does AH on women 38 and over. Anybody under 37 can choose to do it, but I think they still check the thickness of the zona before suggesting it. But again, I would do it regardless of age or zona thickness.

Glinda, by marketing I mean Vitrolife marketing it to clinics (not the patients). I'm sure they have drug reps that come in touting that embryo glue is the answer to all prayers. I am not sure if my clinic has ever tried it (I didn't ask), but Dr. L basically said that she gets around in the medical world (you know all those conventions and seminars the docs go to!) and I assume has read studies and/or talked to other docs, embryologists, lab people, etc. that can't recommend it. Her biggest point being is that if it's so great and works so well, why would a clinic charge *MORE* for it than a regular medium? Not saying you shouldn't pay for it, but why the extra charge? I would think if it worked so well they would use it on every patient...regardless of the price. Their stats sure would increase!
 


It's kinda like the PGD debate. I have had several RE's in my clinc say that PGD was supposed to be the *miracle* in the IVF world. Sure, it has it's good points, but PGD is not all what it's cracked up to be. Not sure of the specifics, but I guess they thought they would be able to do more with it and it just hasn't come to fruition. I'm sure that the diagnosing certain hereditary diseases worked out, but I guess in the beginning scientists were hopeful for more.
 
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Old 11-24-04, 07:05 PM
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When I asked about using embryo glue, my doctor said that although the clinic does use it, she would strongly recommend against it. She didn't go into specifics, but did mention that all studies, trials etc. that had been done were conducted by the manufacturer and she wasn't aware of a single independent study. My clinic charges an extra $100 to use it.

Good luck with your decision JB, please let us know what you & dh decide.
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Old 11-24-04, 08:39 PM
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Quote:
Her biggest point being is that if it's so great and works so well, why would a clinic charge *MORE* for it than a regular medium?
Q - Why culture embryos to the blastocyst stage?

A - The longer the period of time that elapses between egg retrieval and embryo transfer, the easier it is to see differences between good and poor quality embryos. By day five after egg retrieval, embryos that have reached the blastocyst stage have distinguished themselves as the best quality embryos. Embryos that are not blastocysts by day five or six are poor quality and are destined to arrest in their development. Culturing embryos to the blastocyst stage allows us to transfer fewer embryos (usually two) while maintaining high rates of success. Thus the rate of multiple gestations can be reduced.

(5) fees for blastocyst culture ($300) or assisted hatching ($300) when applicable

Why does your clinic charge extra for a blastocyst culture?
 
And you tell Dr. L that Glinda said she fell off her chair when she saw that she charged $745 for the operating room. That's one extra charge that I don't understand.


I'm also going to disagree with you on PGD. I'm not sure that it was ever supposed to be the "miracle" of the IVF world but it has been a miracle for many women. You know my history as a poor responder. If I wasn't, PGD would have saved me heartache. Had I responded well to meds, the embryo with trisomy 21 would have been removed from the pack instead of implanting in my uterus. JB has done PGD and had abnormal embryos discarded. If you are a carrier for cystic fibrosis, PGD is your miracle. And ICSI has been a miracle for couples with male factor.

Haylie, I don't rely on studies done by the manufacturer. Would any manufacturer really release poor results while marketing a product? Any results can be skewed. A friend I made while going to my clinic is now pg. She's young and was doing IVF due to male factor. She produced over 20 eggs in every cycle. Prior to now, she got pg on a FET but had a chemical. She also donated her eggs in shared cycles. In both cycles, both recipients got pg. Clearly, her eggs were fine but they just didn't stick. This last cycle she used embryo glue. There is another site I go to where women have had multiple m/c. I also noticed that alot of them are dealing with immune issues. I think the results are something like 7 out of 10 of them are now pg after using embryo glue. I only lurk on this board because I noticed these women go to my clinic. So that's why I'm going to pay extra for embryo glue. Because of actual results that I can see, not results from some study performed by the manufacturer with nameless women.

JB, I feel with every cycle, we must optimize our chances. You've probably put alot of pressure on yourself acknowledging this is your last cycle. You have to go with your gut on this one. Anything we do has the potential to put stress on the embryo. I think assisted hatching is less stressful than PGD. With PGD, you're removing a cell. With assisted hatching, they are making a little hole. By the way, they make the hole right before transfer. The embryo is not sitting around in a petri dish for days with a hole in it.

Here are Glinda's non-invasive rules/procedures/superstitions for maximizing a cycle: 1 baby aspirin a day, acupuncture once or twice a week until transfer (if you can do it right after transfer, do it once), red meat, wheatgrass juice every other day (it's just so gross to take daily), colustrum, 1 glass of wine the evening of transfer, pineapple during 2 week wait, pasta during 2 week wait
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Old 11-24-04, 10:43 PM
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Glinda, I like your non-intrusive superstitions!! I do most of them, but now I will be focusing on that glass of wine and some pasta with this cycle!!
 


Ok, no no no...I think you are misunderstanding what I said about PGD. The way my RE explained it to me is that PGD is useful for detecting certain things (CF, Down's, Tay Sachs, Turners, etc.). I think what the 2 RE's in my clinc are trying to say is that PGD still can not detect many things. Even when you put back "normal" embryo's (as assessed by PGD) they don't always create a pregnancy (or even a healthy pregnancy for that matter). They thought PGD was truly going to be the answer for why most women did not achieve or hold a pregnancy (or achieve or hold a "normal" pregnancy). PGD is amazing for what it can detect. Unfortunately, there are many other things it can't.
 


Quote:
If they have to purchase it, there is no reason why I shouldn't have to pay too.
Like I said in my previous post, I agree with this. The $300 that my clinic charges is that exact fee. It's not an *EXTRA* fee...it's just the fee for the culture medium. But if they were using embryo glue, they wouldn't charge me $300 + another $300 (or whatever) for the use of embryo glue. Maybe I misunderstood and your clinic only charges a total of $300 total - which in that case it doesn't sound like an *EXTRA* charge. In my opinion, culture medium is culture medium. If it keeps those little buggers alive that is what we are shooting for.
 
I just remember asking Dr. L about the use of embryo glue and she said "I truly believe ours is better".
 
I'm not gonna question her. I'd rather google over her cuteness.
 


Every clinic has junk fees because they have to make their profit somehow. Doesn't your clinic have out of town monitoring fees?
 
$745 for operating room fees are for things like breathing circuits, Versed, Fentanyl, Lidocaine, Progesterone, and misc. things like (you will love this!) gowns, sheets, blankets, needles, needle guides, foley catheter (what??? They better not be using this on me during an ER!), aspiration needle, overshoes, masks, etc. The clinic purchases this stuff, and I agree some of it should be absorbed in the cost of doing business, but for whatever reason they have determined that for them to "make ends meet" or "make a profit" these charges have to be passed along to the patient. I think a lot of these junk fees came about when clinics started contracting with HMO's because the HMO would negotiate a much lower rate that wouldn't cover the procedure. Then they had to create these "fees" to cover the difference between their negotiated rate and their actual cost. Bottom line is that insurance reimburses them for these fees, so why wouldn't they charge that? I have to pay the $745, but it comes back to me in the form of a check from UHC (thank God!).
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