The Doctor Is In!

Q & A with Dr. John Frederick Payne, MD
Reproductive Endocrinologist & PREG Partner
Discusses Simply IVF

What is Simply IVF?

Simply IVF is PREG’s term for IVF using the INVOcell device. It is a revolutionary assisted reproductive treatment that allows our fertility specialists to provide in-vitro fertilization (IVF) at approximately half the cost and similar to slightly lower pregnancy rates.

It involves a milder ovarian stimulation protocol, lower doses of meds, and performing the Simply IVF method using the INVOcell device. A patient can bypass many of the office visits, labs, and procedures we use in traditional IVF, saving time and money, making it more affordable for many of our patients.

Describe the INVOcell Device and how it works?

Simply IVF uses lower ovarian stimulation and will usually have a lesser ovarian response. Therefore, a lower number of eggs (3-10) is retrieved than the number of eggs (10-25+) using full IVF. All of our egg retrievals at PREG are under IV sedation, with a transvaginal ultrasound-guided aspiration of the follicular fluid. The embryologist identifies the best eggs for standard insemination. A particular concentration of sperm is added to the media containing all the eggs. The eggs and sperm are then placed into the INVOCELL device. Fertilization occurs there almost as it would naturally in the fallopian tubes. The INVOcell device in an airtight capsule and is inserted into the vagina allowing the proper condition to achieve fertilization and progression of the eggs to embryos.

The device has a retention device similar to a diaphragm that allows it to remain in place. The insemination and placement of the device vaginally all happen within 30 minutes after the egg retrieval. The patient becomes the incubator as the eggs and sperm are in the INVOCELL for five days where fertilization occurs, and the embryos cell numbers increase over time. On the fifth day after the egg retrieval, the patient returns, and the device is retrieved from the vagina digitally. An embryologist takes the inner chamber of the INVOCELL and examines the eggs for fertilization and to determine which embryos have reached the blastocyst stage and have a high grade. The best quality embryos are then transferred into the uterine cavity vaginally, passing a small catheter through the cervix with a fresh transfer. 10-12 days later, we can check for pregnancy. One advantage is the best sperm can more naturally fertilize the egg instead of the embryologist selecting the single sperm to inject into an egg when performing ICSI with full IVF.

What about harvesting any remaining embryos for the future?

After the fresh embryo transfer, we can freeze any additional embryos that have reached the blastocyst stage of development (5-6 days after fertilization), which can be used for frozen transfers in the future. These transfers may be necessary if they are not initially pregnant. A second transfer could occur approximately six weeks later. These frozen transfers require synchronizing the uterine endometrium to 5 days after ovulation when the blastocysts were cryopreserved. The synchronization occurs either with natural ovulation or with hormonal stimulation with estrogen for 17 days, then adding progesterone for six days. If pregnancy occurs, then the estrogen and progesterone support will continue until the 9th week of pregnancy.

How does it differ from traditional IVF methods and practices?

When using standard insemination, there is a risk that 20-25% of patients achieve no fertilization or embryo progression to a blastocyst by day five and therefore have no embryo transfer. Intracytoplasmic sperm injection (ICSI) used in regular IVF minimized the risk of fertilization failure. Pregnancy rates and Live Birth rates for any treatment depend on the woman’s age undergoing the therapy and can differ with the IVF clinic. With traditional IVF/ICSI, the live birth rate is approximately 50-60% under age 35 and 12-15% at age 42. Simply IVF success rates are expected to be similar but could be much lower depending on other factors. Full IVF typically involves using higher doses of fertility injections and more monitoring visits with labs and ultrasound and is more expensive.

What are the advantages, and for whom is it ideal?

Simply IVF is ideal for women with tubal factor infertility, especially prior tubal ligations without other fertility issues. Single women or women in same-sex relationships requiring donor sperm might benefit from Simply IVF. The cost savings and only requiring one vial of donor sperm instead of having to order and ship many vials if multiple different treatment cycles are necessary with each donor. The IUI cycle has a 10-15% success rate depending on the woman’s age. Advantages include lower cost, less fertility injection medicines, and fewer appointments. Some feel that the fertilization method with INVOCELL is closer to natural fertilization, but it is happening outside of the body and at a considerably lower cost. Women also like the idea of using their bodies to help incubate the embryos while the INVOCELL is in the vagina, and it gives the couple a sense of greater involvement in the process because she is the incubator instead of keeping the embryos in the lab.

Some patients are not the best candidates for IVF due to older age or lower ovarian reserve, but they are not ready to move to donor egg, and Simply IVF can give them a reasonable chance of success and allows them to try IVF with their eggs at a lower cost. Patients with unexplained infertility and significant male factor are NOT good candidates for Simply IVF. Traditional IVF with ICSI would serve them better. Also, patients with very high ovarian reserves, such as PCOS, are not good candidates due to OHSS risks. Additionally, if a patient desires to have embryos biopsied for pre-implantation genetic testing (PGT-A), they would need traditional IVF.

Are there any risks involved in comparison with traditional IVF methods?

The risks are all pretty much the same. Ovarian stimulation is required, and there is always the risk of ovarian hyperstimulation and a risk of bleeding or infection from egg retrieval. Patients also run the risk of not having any fertilization or any embryos to transfer and, therefore, a zero chance for pregnancy. We prefer to perform single embryo transfers on almost all of our patients with the desire to achieve a singleton pregnancy leading to one birth at a time and hopefully at full term. Transferring more than one embryo increases the risk of multiple gestation pregnancies with its associated risks to both mother and baby.

Another Option in the arsenal?

Yes, Simply IVF requires fewer steps, is lower cost, and a little more natural with a slightly lower success rate. It’s a draw for some people who want to try something other than traditional IVF and gives us a different tool in the toolbox of helping our patients. With every patient, we try to find the easiest, fastest, and least expensive way of achieving PREG’s goal of “growing families one baby at a time”.

PREG has 3 IVF Centers (Greenville, Columbia & Lowcountry) with offices in Asheville & Spartanburg.

Images: INVOcell & CDC