In Vitro Fertilization (IVF) - a Quest for Fertility

As we sat together in the sterile white room with the curtain pulled, my wife and I shot each other nervous smiles. She was about to undergo the final step in the In-Vitro Fertilization process, and we were both on edge.

Then, the curtain was pulled aside, and Dr. Robert Filer stood smiling at us warmly.

"How are you guys doing?" he asked. "Are you ready?"

That was the moment I was sure we had chosen wisely when we had decided to go with The Fertility Center.

"Helping couples through this emotional journey is a big part of what we do," Dr. Filer said. "We are here to make sure this process is as easy as possible on them both."

The path to IVF is not an easy one. There are many emotional bumps along the way, and every time there seems to be a beacon of hope rising from the woods, it burns out quickly, like a mirage, as soon as you get close.

For nine years, my wife, Elizabeth, and I had tried to have a child on our own. For nine long years, we watched as other couples married and had children, just the way it was supposed to happen. Like them, we had tried to let nature take its course. We tried various positions and methods. We tried holistic methods Beth found on the Internet. When none of those things worked, we decided to place our faith in science and tried artificial insemination through her gynecologist.

With each and every negative pregnancy test, the pain became more and more intense, and we decided to try IVF, a process in which a doctor places a fertilized egg into a woman's uterus using a long tube. To our chagrin, we discovered there are actually very few reputable fertility doctors in the United States. As luck would have it, one of them was relatively close: Dr. Filer and his team at The Fertility Center in York County.

Nevertheless, we didn't want to go to Dr. Filer simply because he was close. We wanted to make sure we were receiving the very best care for our money. IVF is not cheap, and it is therefore important that such a large investment is carefully spent.

We spoke with several doctors, including Dr. Filer. We immediately hit it off with him. We liked his bedside manner. We liked his office staff. We very much liked the center's proximity. The closest other fertility doctor who met our expectations was a state away.

There were many days of discussion before we determined to proceed with The Fertility Center. The chief topic was Dr. Filer's proximity. We wanted to be sure we weren't just picking him because he was so close.

What wound up cinching it for us, believe it or not, was the fact that Dr. Filer wasn't standing on his head to get our business. He urged us to do the research. He wasn't fudging the statistics to sway us to his practice.

"I try to be as honest as possible with all my patients," Dr. Filer said. "The fact is that for couples who've experienced a prolonged infertility, the chances of a pregnancy are slimmer with each passing year, no matter what method we use. IVF is a big part of what we do, but it isn't always successful."

This information wasn't new to us. Like I said, my wife had been researching IVF for well over a year. What we liked most about him, and the entire practice, was they didn't hide from the statistics, but remained upbeat and positive all the way. ***

Not every couple that walks into The Fertility Center for the first time is recommended for IVF, Dr. Filer said.

"The majority of the procedures we do are (artificial inseminations), with fertility medications, not IVFs," he said. "Most patients are self pay, so if there are clear-cut indicators that another method has a good chance of working, we're going to try to be as cost-effective as possible."

Most insurance carriers don't cover fertility treatments or a procedure, so helping his patients save money is of paramount importance, Dr. Filer said.

"In some cases, IVF is the most cost-effective procedure, so we'll go in that direction," he said.

For the average couple who hasn't gotten pregnant, the first step in the process is to conduct a thorough analysis of his semen and her hormones.

"Forty percent of infertility is male factor," Dr. Filer said. "It is correctable less than 10 percent of the time."

That doesn't mean, however, that the man's sperm is unusable, Dr. Filer said. It simply is one possible explanation for the couple's infertility.

The first step - if the man's semen is OK and the woman's hormones are within normal ranges - is treatment with fertility drugs like clomid along with natural conception techniques.

"In large population studies, there is 13 to 18 percent pregnancy rate per month for couples just coming off birth control the first year they try," Dr. Filer said. "After a year of trying, the monthly pregnancy rate is less than 1 percent a month."

With artificial insemination, along with the fertility drugs, that rate jumps to 18 to 20 percent per month for four menstrual cycles.

"After that, the figures drop off," Dr. Filer said. "We don't recommend doing it for longer than four cycles because the treatment loses its effectiveness after that."

When the artificial inseminations are conducted along with fertility injections, the pregnancy rate jumps to 28 to 30 percent per month, he said. This rate drops after three cycles, in this case, so further treatments are not recommended.

"The next step is IVF," Dr. Filer said.

***

As my wife and I got up to head into the next room, where Dr. Filer was going to do the IVF, I was overcome with emotion. We were finally here, after all these years. When my wife was seated and sedated, she heard Dr. Filer give her one final word of reassurance.

"We're going to take good care of you," he said.

Next month: PART 2 of our IVF journey and its outcome.