As part of the National Infertility Awareness Week, Atlantic Reproductive Medicine Specialists wants you to “Listen Up!” when it comes to issues around infertility. Building awareness can help empowered you as you move along the family building journey.
The cost of fertility treatment can be a barrier between patients and their plans for a family. The INVOcell, a recently FDA approved gas permeable vaginal culture device, allows women to incubate eggs and sperm themselves, decreasing the cost of and increasing access to fertility treatment. Atlantic Reproductive is happy to be the first practice in the Raleigh area to offer intravaginal culture with INVOcell in the hope that this treatment will allow more patients to afford fertility care.
What makes traditional IVF expensive?
To care for eggs, sperm and embryos outside of the body, the IVF laboratory is an intensive care unit for embryos, requiring air filtration systems, incubators with continuous monitoring and alarm systems, and highly trained embryologists that care for the embryos for the five to six days of embryo culture. Intravaginal culture has the potential to decrease treatment cost by reducing the need for the laboratory and embryologist intervention. Because IVF is expensive, the ovarian stimulation for IVF involves taking medications to recruit multiple eggs so that patients have their best return upon their investment. Robust ovarian stimulation requires many ultrasound and blood tests to monitor the ovarian response. The goal of INVOcell is to decrease cost of fertility care, therefore we use a more modest ovarian stimulation that requires less medication and less monitoring which provides another cost savings.
How does INVOcell work?
The INVOcell is a small device, made of plastic permeable to gases. Eggs are retrieved from the female patient, mixed with sperm in the laboratory for a few minutes, and loaded into culture media in the INVOcell device. The device is them placed into the vagina. Because the plastic is permeable to gases and the gas mixture and temperature at the top of the vagina is like the gas mixture and temperature inside the fallopian tube, the conditions in which the eggs, sperm and embryos are developing are like the conditions in the IVF laboratory. After five days, the device is removed from the vagina and the embryos are removed from the device. The best quality embryo or embryos are transferred into the patient’s uterus and any additional high quality embryos are frozen for future use.
Is INVOcell a replacement for traditional IVF?
INVOcell is a useful fertility tool, however it should not be considered as a replacement for traditional IVF. When used in a group of patients predicted to have high chances of success with IVF (37 or younger, body mass index less than 36, normal ovarian reserve, and good sperm parameters), INVOcell generated fewer top quality blastocysts than traditional IVF. Because only one or two embryos were needed for transfer, the birth rates were similar (55% for INVOcell, compared to 60% for traditional IVF), however the INVOcell patients had fewer embryos to freeze.
INVOcell also requires sperm that are functional enough to fertilize eggs without assistance in the device. Patients with certain abnormal sperm parameters should undergo traditional IVF with intracytoplasmic sperm injection (ICSI) rather than INVOcell culture
Is INVO a replacement for intrauterine insemination (IUI)?
For some patients, the higher pregnancy rate of INVOcell may make it an attractive replacement for IUI. One in four couples with infertility conceive with up to three cycles of intrauterine insemination. In the study of INVOcell, just over half of patients conceived in one cycle, and some had embryos to freeze for future use. The cost of INVOcell is slightly greater than the cost of three cycles of IUI and approximately half of the cost of traditional IVF, so some couples may elect to skip IUI and go directly to INVOcell.
Summary: The promising published success rates for INVOcell were from a group of patients with infertility predicted to have good chances of success with IVF (age less than 38, normal ovarian reserve, good sperm parameters, body mass index less than 36). While other groups are currently under study, the decision of whether INVOcell will be a useful tool for patients with infertility requires discussion with a reproductive endocrinologist trained in use of the device.