Reproductive Endocrinologists Answer Your Questions

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[text on screen]: Journey to the Crib. Fertility Talk with Pam and Dr. Dave Pamela Madsen: Hi. I'm Pamela Madsen, and welcome to another segment of Journey to the Crib. And I'm here with Dr. Dave Kreiner, who is the founder of East Coast Fertility. Thanks for joining us! [text on screen]: Episode 7: Financing Treatment Pamela Madsen: With the recession and the cutback in credit for people, a lot of the traditional ways that couples who were trying to have babies financed their treatment was through, you know, second mortgages on their home, credit, Mom and Dad, retirement funds. A lot of these things are shrinking now and they're not available. So, what are programs like East Coast Fertility doing to help patients finance their fertility treatments? Dr. Dave Kreiner: Fortunately, we were selected by the New York State Department of Health to provide the grants for IVF. We also provide our own, internal East Coast Fertility grants. And we have IVF studies as well. The New York State department of health grant is especially rich. Unfortunately, there is limited funding so we can't offer it to everybody. But basically they're income-based. Our internal grants, we can offer IVF for couples that have an income of $100,000 or less. The basic IVF at $6,900, and, again, it's adjusted by income up to $200,000. The cost share for patients for basic IVF is $9,900. We also have some financing for those patients who don't have the cash up front. Fortunately, they've been able to utilize our financing program, which seems to be quite fair. We also have, as we mentioned, the IVF studies. So, patients who do the ECF grant, as we call it, are able to get their medications covered and even more grant money when they do the IVF study in addition to receiving the ECF grant. Pamela Madsen: You know, I was once debating somebody on health care on television and he said to me, "You know, if a patient can't afford $60,000, you know, to have their children, then they shouldn't be parents." And I looked at this guy and I said, "Did your mother have $60,000 in a savings account when she conceived you?" And the guy turned about five shades of red and he said, "No, she didn't." So, I think that's, you know, I think that's a really good lesson. [text on screen] To Learn More Visit: www.thefertilitydoc.com www.thefertilityadvocate.com For a Free Fertility Consultation Visit: www.eastcoastfertility.com

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[text on screen]: Journey to the Crib. Fertility Talk with Pam and Dr. Dave Pamela Madsen: Hi. I'm Pamela Madsen, and welcome to another segment of Journey to the Crib. And I'm here with Dr. Dave Kreiner, who is the founder of East Coast Fertility. Thanks for joining us! [text on screen]: Episode 5: Micro IVF (Part 2) Pamela Madsen: OK, so. There's less drugs in my body. Less injections. The cost is about the same. It has a higher success rate. So why isn't everyone in the United States doing micro IVF right now? Dr. Dave Kreiner: Well, let me just add one other thing. Pamela Madsen: One other thing: OK! Dr. Dave Kreiner: It's also less risky. Pamela Madsen: And it's less risky. OK. Dr. Dave Kreiner: Because your risk of hyperstimulation syndrome from gananotropins IUIs is four times as high as it is with the micro IVF. Your risk of multiple pregnancies is far greater with gonadotropin IUI. It's at least 30 percent chance of having a multiple pregnancy with a 5 percent chance of having triplets or more. Let alone the famous cases of the octomoms. Pamela Madsen: OK, so, I've got to go back to this again. So, as far as I know, there's, like, three doctors in the U.S. doing this. Why? Why isn't everybody offering this to their patients? Do you have an answer? Dr. Dave Kreiner: Well, I think one of the main reasons why this isn't so popular in a lot of programs is it's not the highest pregnancy rate procedure that they can offer. The micro IVF is part of the statistics that is publicized on the Internet. So when a prospective patient is reviewing the success rates of a program, they look at IVF success rates. And micro IVF is included in a program's statistics if the program's success rate is 30 percent from micro IVF. Well, as great as that is compared to insemination, it's less than it is for a full, stimulated traditional IVF. Pamela Madsen: You know, isn't it interesting how the CDC report, the SART report, which is, you know, was created to keep patients safer, sometimes works against us. Because patients are so; you know, doctors are concerned about attracting patients to their program, so they don't do things that would perhaps make them look artificially lower in success rates when that's not true. So it's actually kind of; it's really doing the right thing by patients and perhaps in a roundabout way, not really being shown for that because of the reports. Dr. Dave Kreiner: Well, it fosters a competitiveness because the programs want to look the best in front of their prospective patients. So, what a program might do is choose only to do those patients that have the highest success rates and only do a full, stimulated IVF, which would give those patients the higher success rate. Pamela Madsen: Right. So, if you're an IUI patient, if you're seeing your gynecologist and you've been recommended to do IUI, then you need to find a doctor who can talk to you about micro IVF. Well, thank you, that was really… Dr. Dave Kreiner: It's a much more successful alternative to IUI. Pamela Madsen: Well, thank you. That was really enlightening, and I wish it was around when I was going through this. [text on screen] To Learn More Visit: www.thefertilitydoc.com www.thefertilityadvocate.com For a Free Fertility Consultation Visit: www.eastcoastfertility.com

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[text on screen]: Journey to the Crib. Fertility Talk with Pam and Dr. Dave Pamela Madsen: Hi. I'm Pamela Madsen, and welcome to another segment of Journey to the Crib. And I'm here with Dr. Dave Kreiner, who is the founder of East Coast Fertility. Thanks for joining us! [text on screen]: Episode 3: Single Embryo Transfer. So, what I've noticed by traveling around and listening to all the conferences and having all of our thought leaders in the field pontificating from the podium about the importance of single embryo transfer… And what I've noticed in that conversation is, while they're talking about the importance of single embryo transfer, nobody's really addressing the patient. Because the patient is dealing with the cost of their IVF cycle. If they're going to do a single embryo then they're going to have to create, on purpose, multiple other cycles. Right? Freezing those embryos. Storing those embryos. Then they have the fear of it not working; how are they going to be able to afford those next cycles. And I think what you have created with your single embryo transfer program is unique and it's finally addressing how patients can opt in to doing the right thing by themselves. Can you talk about single embryo transfer program? Dr. Dave Kreiner: The single embryo transfer program is a way for us to take the financial incentive out of the need to put all our eggs in one basket. So, basically, you can go through a single retrieval and transfer, just pay the one IVF cycle fee, and then the freezing of excess embryos is free, storage of the embryos is free. And patients can come back an unlimited number of times for their frozen embryo transfers and it's all covered. Pamela Madsen: So, until they achieve a live birth? Dr. Dave Kreiner: Until they achieve a live birth, yes. Pamela Madsen: Wow. That's really amazing. It's really great. You know, I think we have to be careful. When we're going through infertility we're dealing with a certain kind of pain and we want to fix that pain. We don’t understand the other kinds of pain that could be out there. Such as, you know, children who don't do well because of high multiple birth pregnancy. Losing children because of that. And the financial and emotional stress of raising high-order multiples. And you've talked about the stresses on the marriages. So you really take seriously the; what's the oath? Help me, here. Dr. Dave Kreiner: The Hippocratic Oath. Don't do harm. Pamela Madsen: Don't do harm. And I think that's really and truly amazing. [text on screen] To Learn More Visit: www.thefertilitydoc.com www.thefertilityadvocate.com For a Free Fertility Consultation Visit: www.eastcoastfertility.com

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[text on screen]: Journey to the Crib. Fertility Talk with Pam and Dr. Dave Pamela Madsen: Hi. I'm Pamela Madsen, and welcome to another segment of Journey to the Crib. And I'm here with Dr. Dave Kreiner, who is the founder of East Coast Fertility. Thanks for joining us! [text on screen]: Episode 1: Introducing Dr. Kreiner Pamela Madsen: You and I have been around this field for such a long time. Probably longer than we want to admit to on television. So, tell me a little bit about where you came from. Dr. Dave Kreiner: In 1985, I had the great fortune to do my fellowship in reproductive endocrinology and infertility at the world-famous Jones Institute in Norfolk, Virginia. The Jones Institute had been successfully performing IVF for five years or more, and people knew about the Jones Institute and came from all over the world because we had a world-leading 15 percent pregnancy rate. Pamela Madsen: My sister went there! It was the only place in the country to go. I think you actually may have treated her. Dr. Dave Kreiner: Yes, I did. Pamela Madsen: So, it didn't matter. It wasn't like you went across the street for an IVF center, like today. Dr. Dave Kreiner: People came from all over the world. Pamela Madsen: Right. So, that's where you started. During that time. Dr. Dave Kreiner: Things were quite different then, Pamela. Back then, IVF was very inefficient and we had to transfer many embryos. Pamela Madsen: What's also changed in the field? Dr. Dave Kreiner: Over the years, we have improved many of the technologies. We started doing laparoscopic retrievals. We now do them under ultrasound guidance, just by needle aspiration through the vagina. We do a much more sophisticated IVF in the lab. We have media that are; the environment in which the embryo grows is much healthier, and is able to encourage much healthier development of the embryos, hence developing embryos of much higher pregnancy potential. Pamela Madsen: What I love about you, Dave, is that you are really not ego-driven. I mean, many people wouldn't realize that many of the quote-unquote "famous" celebrity reproductive endocrinologists around the country were trained by you. And you have continued to be very quietly a thought leader and have taken a lot of these ideas that you've talked about just now into practice to really change the way fertility care is delivered in this country in a very patient-directed way. And that's really extraordinary. [text on screen] To Learn More Visit: www.thefertilitydoc.com www.thefertilityadvocate.com For a Free Fertility Consultation Visit: www.eastcoastfertility.com