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Growing Concern Over Safety of High-Dose IVF Therapy

July 18, 2012 — In most fertility clinics, it is standard procedure to administer high-doses of hormones and drugs during In-Vitro Fertilization (IVF). High doses improve a woman’s chance of conception and reduce the risk that she will need multiple treatments. Unfortunately, the risk of side effects is also higher for women who receive high-dose fertility treatments — approximately 10% of women who get high-dose stimulation develop Ovarian Hyper-Stimulation Syndrome (OHSS), a condition in which the ovaries swell and leak fluid into the chest or abdomen, which can be life-threatening in rare cases.

Fertility treatment typically begins with an injection of Lupron, a drug that suppresses the ovaries, followed by high doses of hormones that stimulate the production of eggs. Compared to low-dose fertility treatments overseas, fertility clinics in the U.S. and U.K. give higher doses of hormones and stimulate the ovaries longer.

Lupron is not approved by the FDA for use in IVF. In fact, Lupron is approved for the treatment of prostate cancer, and its use in IVF is off-label. Despite the fact that Lupron has been used in fertility treatments for decades, there are few scientific studies about its safety for this purpose. Adverse reactions reported to the FDA include memory loss, liver disorders, bone loss, pain in muscles, bones, and joints, and more.

Some fertility clinics are now shifting to low-dose fertility treatments. Although this is probably healthier for women, it could be more expensive because women who need high-dose treatment will need to pay for multiple cycles of treatment — and a standard IVF therapy costs between $15,000 to $30,000 per cycle. This means more exposure to medications, egg retrievals, anesthesia, and more expenses.

However, advocates for low-dose fertility treatments say that it could be significantly cheaper, because less medicine and monitoring are necessary. Costs are reduced even further because fewer women have serious complications with the low-dose treatment.

Fertility clinics in Europe and Japan have already switched to low-dose therapy, but clinics in the U.S. have resisted this change. One possible reason is that many clinics promote themselves based on the percentage of women who conceive after treatment, so there is strong incentive for every fertility treatment to work.

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