Wall Street Journal Examines Less Invasive IVF Method, Debate Surrounding Approach

Main Category: Fertility
Article Date: 27 Mar 2006 - 9:00 PDT

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The Wall Street Journal on Thursday examined a new and "milder" method of performing in vitro fertilization. Some physicians say the method reduces pain and the risk of complications, but others say it allows "no margin for error" and might force women to return for another "expensive and emotionally draining treatment," the Journal reports. The new method -- developed by the Kato Ladies Clinic in Japan and performed by New York City-based fertility doctor John Zhang -- uses what he calls "oral therapy IVF," through which patients receive a pill form of an egg-producing stimulant called clomid. Clomid was popular when IVF treatment first was introduced but was replaced when newer hormones became available, according to the Journal. Zhang, who performs about 700 IVF treatments annually, supplements clomid with up to three injections of "more-powerful" egg-producing hormones, rather than the standard 25 injections, the Journal reports. Zhang said the method still requires him to extract the eggs with a needle -- a procedure similar to conventional methods -- but a local anesthetic can be used because ovaries are less swollen as a result of the oral treatment. Zhang typically removes three to five eggs during the treatment, compared with an average of 10 to 20 eggs in conventional IVF. He said that taking more fertility drugs than necessary results in many "useless eggs." Clomid is available in generic form, which lowers the overall cost the treatment and allows Zhang to charge $4,800 per cycle compared with an average cost of $9,000 in New York for traditional IVF. He said preliminary statistics have shown his method has about a 38% pregnancy rate in women under age 37 and a 19% pregnancy rate in women ages 38 and above. Both success rates equal those of the national average for conventional IVF treatments reported in 2003, according to Zhang. Austrian researchers -- who published results in 2002 that supported the milder approach -- conducted a randomized clinical trial that compared a clomid-based treatment with conventional IVF. The trial of 294 women found pregnancy rates of 35% in the mild hormone group and 29% in the conventional IVF group. The authors wrote in the journal Fertility and Sterility that the less-invasive methods required fewer shots, cost less and led to fewer complications in patients. They recommended the treatment as a first approach for women undergoing IVF.

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The "biggest deterrent to adopting" Zhang's oral IVF treatment could be that most doctors feel conventional therapy is "working fairly well right now," the Journal reports. Bart Fauser, chair of reproductive medicine at the University Medical Center in Utrecht, Netherlands, said, "It's time for a paradigm shift," adding, "It's going to be hard for the scientific community to deny this." But William Gibbons, president of the Society for Assisted Reproductive Technology, disputed the notion that women are being "blast[ed]" with treatments to extract a maximum number of eggs in conventional IVF, noting that many physicians have reduced treatment dosages for sensitive patients (Pagan Westphal, Wall Street Journal, 3/23).

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