EXPERT > Doctor In The House

Helping Couples Get Pregnant

By Dr. Philip McNamee
Interviewed by Melissa Moniz
Wednesday - April 16, 2008
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Dr. Philip McNamee
Practice Director of Pacific In Vitro Institute at Kapiolani Medical Center

What is in vitro fertilization (IVF)?

In vitro fertilization is a process by which we help a couple who is unable to build a family. It can either be a male factor or female factor. In either case, we are able to stimulate the female’s ovaries to make eggs. We then, at the proper time when these eggs are mature, harvest the eggs in a non-surgical procedure from her ovary with a little needle. The needle is about the size of the needle used to draw blood when you have a blood test.

This is all monitored by ultrasound. We do ultrasound monitoring to make sure that the eggs are ready. Once the eggs are taken to the embryo laboratory, they are then treated specially and are fertilized either by approximately 50,000 specially treated sperm on top of each egg. Or if it’s a male factor, the eggs can be fertilized by injecting just one sperm into each egg - that’s called intracytoplasmic sperm injection (ICSI).

Either one of these processes fertilizes about 70 percent of the eggs that we obtain from the patient. Then those fertilized eggs become embryos, and we grow them for about three to five days in a special fluid with a number of nutrients in it. After the three to five days, it is then returned back into the uterus where it grows to become a baby.

Can you discuss the history of IVF and perhaps how it has changed and improved through the years?

The first IVF procedure was performed in 1978. Dr. Patrick Steptoe and Dr. Robert Edwards had done this process for approximately five years before they had a successful IVF baby. At that time, there was no stimulation of the ovaries and they used natural cycles, which is one egg per month. It took them about 50 tries before they got a pregnancy, but that was an ectopic pregnancy that occurred in the fallopian tubes and it wasn’t successful, so it had to be removed. The 300th try resulted in a successful baby, and this was Louise Brown, born in 1978. That was the first baby ever. In the United States, the first baby ever was in 1981 in Virginia. In Hawaii, the first baby ever was in 1984 from our Pacific In Vitro Fertilization Institute.

Have you seen an increase in patients over the years?

Yes. We see approximately 350 patients per year here now. I think the reason more people are coming is because they have realized that the process has improved over the years. When we first started, the pregnancy rate was about 16 percent. Now the younger patients have about a 50 percent chance.

Can you discuss the increased chance of multiples - twins, triplets or more?

With every in vitro fertilization program in the world, the increased risk of multiples is there. For example, twin gestation occurs maybe one in every 100 pregnancies with natural fertilization. With IVF 25 to 30 percent of the babies born are twin gestation. There is an organization called SART, Society for Assisted Reproductive Technology. It’s a very important organization because SART has established standards for how many embryos to put back. The goal is to have a single good, healthy baby. Despite that goal, with the expense involved and the difficulty for a couple to go through this more than one time, we do put back more than one embryo and the number we do put back is age-related. But we have decreased the number of multiples. Now, you need to sort the difference between IVF, where triplets is usually the highest number, versus when you see sextuplets. That is not IVF, that is a result of over-stimulation of the ovaries and intro uterine insemination, which is artificial insemination.That is not part of the IVF process. We are responsible for increased twins, but not for high-order multiples.

What’s the highest number of embryos that would be put back into the uterus?

Five embryos is the most, and that would be in a patient who is about 44 or 45. These guidelines are established by SART because it shows that the older the patient is, the less-quality eggs they make. For example, at age 43 about 90 percent of the eggs have abnormal chromosomes, so they have a very decreased chance. So that’s why you would put in more for a woman who is 43. In younger women, we are sometimes doing just single embryo transfers.

Do you know the exact number of babies you have helped to conceive?

The exact number we don’t know, but we (Pacific In Vitro Fertilization Institute) just passed 2,300 babies born.

Are most of the procedures done with the couples’ eggs and sperm, or do you have a lot who use donors?

I’d say about 90 percent of what we do is the actual couples’ eggs and sperm.

Is IVF sometimes covered by medical insurance?

Yes, in this state all insurance carriers are required to cover IVF on a one-time basis. The rules are that you have to be married and you have to use the sperm and egg of the married couple. They don’t cover a donor. Actually HMSA does cover a portion of the donor, but it’s the only insurance company that does right now. We are very fortunate, because there are only 13 states in the country that have mandated that insurance companies cover IVF on a first-time basis.

Where can couples go to learn more about IVF?

Two Saturdays a month one of the doctors here gives a lecture in a seminar on IVF. That’s carried out here at Kapiolani Medical Center’s conference room on the second floor, from noon to 1 p.m. or longer because we stick around for people’s individual questions. It’s a power point presentation and, of course, it’s free.