A New Potentially Cost Saving Option for Fertility Patients
The cost of fertility treatment can be a barrier between patients and their plans for a family. The INVOcell, a recently FDA approved gas permeable vaginal culture device, allows women to incubate eggs and sperm themselves, decreasing the cost of and increasing access to fertility treatment. Atlantic Reproductive is happy to be the first practice in the Raleigh area to offer intravaginal culture with INVOcell in the hope that this treatment will allow more patients to afford fertility care.
Traditional IVF vs. INVOcell
The IVF laboratory is an intensive care unit for embryos. It requires air filtration systems, incubators with continuous monitoring and alarm systems, as well as highly trained embryologists to care for eggs, sperm and embryos outside of the body for five to six days of embryo culture. Intravaginal culture has the potential to decrease treatment cost by reducing the need for the laboratory and embryologist intervention.
The ovarian stimulation for IVF involves taking medications to recruit multiple eggs so that patients have their best return upon their investment. Robust ovarian stimulation requires many ultrasound and blood tests to monitor the ovarian response. These factors add to the expense of IVF. With INVOcell, we use a more modest ovarian stimulation that requires less medication and less monitoring, which provides another cost savings over traditional IVF.
How INVOcell Works
The INVOcell is a small device made of plastic that is permeable to gases, allowing eggs, sperm and embryos to develop inside the vagina. Eggs are first retrieved from the female patient then mixed with sperm in the laboratory for a few minutes. Next, eggs are loaded into the culture media in the INVOcell device, which is then placed into the vagina. Because the plastic is permeable to gases and because the gas mixture and temperature at the top of the vagina are similar to the gas mixture and temperature inside the fallopian tube, a woman can use her own body, rather than the IVF lab, to simulate the necessary conditions for the eggs, sperm and embryos to develop.
After five days, the device is removed from the vagina and the embryos are removed from the device. The best quality embryo or embryos are transferred into the patient’s uterus and any additional high quality embryos are frozen for future use.
While INVOcell is a useful fertility tool, it should not be considered as a replacement for traditional IVF. When used in a group of patients predicted to have high chances of success with IVF (37 or younger, body mass index less than 36, normal ovarian reserve, and good sperm parameters), INVOcell generated fewer top quality blastocysts than traditional IVF. Because only one or two embryos were needed for transfer, the birth rates were similar (55% for INVOcell compared to 60% for traditional IVF). However, the INVOcell patients had fewer embryos to freeze.
INVOcell also requires sperm that are functional enough to fertilize eggs without assistance in the device. Patients with certain abnormal sperm parameters should undergo traditional IVF with intracytoplasmic sperm injection (ICSI) rather than INVOcell culture.
INVOcell vs. Intrauterine Insemination (IUI)
For some patients, the higher pregnancy rate of INVOcell may make it an attractive replacement for IUI. One in four couples with infertility conceive with up to three cycles of intrauterine insemination. In the study of INVOcell, just over half of patients conceived in one cycle, and some had embryos to freeze for future use. The cost of INVOcell is slightly greater than the cost of three cycles of IUI and approximately half of the cost of traditional IVF, so some couples may elect to skip IUI and go directly to INVOcell.
The promising published success rates for INVOcell were from a group of patients with infertility predicted to have good chances of success with IVF (37 years of age or younger, normal ovarian reserve, good sperm parameters, body mass index less than 36). Other groups are currently under study. The decision of whether INVOcell is the right tool for a patient is best determined with a reproductive endocrinologist trained in use of the device.