More Research About IVF in SIRM

In my “Best” IVF Clinic post last Saturday, I mentioned about wanting to know more about SIRM. So I spent a couple of days exploring the SIRM website. This post contains what I gleaned from all that computer-staring…

This is how they introduce themselves:

LOCATION
Take note that each location is independently-owned. I wonder how much sharing of practice standards goes on really. As for a centralized management system, I wonder why that is necessary if each is independently owned. I noticed that they have set cycle dates per clinic. Could this be in some way related to the centralized management system? Anyhow, here are examples of 2008 Cycle Dates., for example:

SIRM - Dallas : Jan 17, Feb 11, Mar 24, Apr 14, May 5, Jun 9, Jul 17, Sep 2, Oct 13, Nov 10
SIRM - New Jersey: Jan 21, Feb 25, Mar 31, May 5, Jun 9, Jul 21, Sep 8, Oct 13, Nov 13
SIRM-Mosaic:
Las Vegas - Jul 14, Aug 18, Oct 13, Dec 8
New York - Jul 28, Sept 15, Oct 27
SIRM - New York: Jan 21, Feb 18/26, Mar 24/30, May 27, Jul 7, Aug 11/18, Sep 15/22, Oct 27/30, Dec 1
SIRM - Las Vegas: Jul 21, Aug 18, Sept 22, Oct 27, Dec 1

Take note also that SIRM-Mosaic is listed as a separate bullet in their list of nationwide SIRM centers. However, if you look at the addresses , the SIRM-Mosaic center shares the same address as the LV and NY clinics. What is common instead is that Dr Sher goes to both the LV and NY clinics. So perhaps the Mosaic term was added to identify the patients that are being personally seen by Dr Sher? Probably… I’ll find out as I communicate with them more…

Another thing about this multiple locations… If you check SART, only the Las Vegas, New Jersey and Dallas locations are listed in SART. The first 2 locations submit to stats to CDC while the last location submit to SART. The SIRM website has an article criticizing the current reporting system for lacking the verifiability of a clinic’s self-reported IVF statistics and for its inability to compare “complex” vs straightforward IVF cases.

I am not very comfortable with the multiple location thing. Each location may be benefiting from bearing the SIRM name but ultimately, the knowledge, skill, procedures, practices and facilities of each location will vary. So unless the individual location’s stats are published, I would not go to any other clinic. I would go where the motherlode is - in this case, it means the SIRM-Mosaic where Dr Sher is.

I wonder how much SIRM-Mosaic/Dr Sher charges for the IVF procedures compared to the SIRM-NY and SIRM-LV where he shares facilities?

I wonder if Dr Sher is fully booked???

CGH (Comparative Genomic Hybridization)
SIRM shares a lot of information on CGH. (CGH is another method of PGD (Pre-implantation Genetic Diagnosis) which analyzes all the 23 chromosomes, unlike the current standard right now, FISH (Fluorescent In-Situ Hybridization) which tests 5-12 chromosomes only.)

The information they share include their own studies and realistic expectations on this technology. One thing I noticed is an omission of 1 fact in their study that 6 women cancelled because of 0 normal eggs (as tested by CGH). Although it may sound trivial, it does de-emphasize that it is possible to get ZERO normal eggs.

Also ReproCure which does the genetics testing is just next door to SIRM-LV. (I would not be surprised if they are sister companies!) Could cycling in SIRM-LV make it possible to avoid a Staggered IVF???

I am very inspired by Polly’s strategy on Egg PBB1 - I am assuming that is done using CGH since she previously cycled with a SIRM location. (Polly mentioned in her Consult 2 of 3 that CCRM/Dr Schoolcraft said they could do that too (egg PBB1 only) although technically, a PBB2/Blastomere CGH is usually with it.)

I am looking to explore those option as well… still got to talk to DH though!

OBP (Outcome Based Plan)
This is another very interesting thing about SIRM. Here are the relevant quotes from their website:

“The Outcome Based Plan (OBP) entitles qualifying, patient/couples for whom IVF is medically indicated, to a maximum of three (3) completed IVF/ET attempts at an SIRM location . Each complete IVF attempt comprises one (1) egg retrieval procedure and as many embryo transfers (ET’s) using fresh or frozen/thawed embryos as needed to achieve a viable pregnancy or deplete all available embryos, whichever occurs first. ”

“OBP enables women/couples to be reimbursed up to 100% for in-house clinical and laboratory services associated with IVF/ET (excluding medication and anesthesia costs) if the transfer of all embryos does not result in a live birth.”

“Qualifying patients/couples pay the same up front amount regardless of their age or circumstances. The difference lies in the amount that is refunded (refund plan amount) in the event that IVF does not result in the birth of a baby. Patients may apply for outside medical financing of OBP-related IVF services (see below). Since pregnancy rates are profoundly influenced by the age of the woman producing the eggs, the amount refunded in the event that a live birth does not occur is determined by the woman’s age.”

“Over 90% of all IVF candidates would qualify for the OBP, either by using their own eggs or a donor’s. Even severe male infertility, requiring intracytoplasmic sperm injection (ICSI), or testicular sperm extraction (TESE) to obtain sperm in men who have no sperm in the ejaculate, or repeated failure to conceive in another IVF program does not preclude a couple’s eligibility for the OBP. If the woman experiences a first trimester loss, whether through miscarriage or medically indicated therapeutic abortion, the couple is still entitled to a refund.”

I wonder how expensive the OBP is. It does feel better to have a refund if you don’t take home a baby. Will have to get more information though and do the math to see if this is worth what it seems to promise.

Communication and Discussion
SIRM has a Bulletin Board that is open to everyone, not just exclusive to their patients. And the great thing is that the doctors respond to the questions. Well at least that’s who they are logging in as…

Based on my limited sampling of the BB, Dr Sher answers on weekends as well and asks the message poster (presumably his patient) to call him at his cell phone on a Sunday! Yay!

(I just got reminded of the posts I read from other bloggers that the CCRM doctors also makes follow-up calls to their patients.)

……

Alright, that is plenty of information already. I’ve got my thoughts organized on SIRM. Still need to get more specific info from CCRM and SIRM though to make a better decision analysis discussion with DH on Thurday night on this topic!