Once called the “secret disease,” infertility is at center stage as Billings Clinic offers in vitro fertilization for the first time in Montana.
Already, there is a waiting list.
The first round of IVF procedures has been completed, drawing patients from Montana, Wyoming, North Dakota and South Dakota. Babies have been conceived.
“We are very pleased with our pregnancy rates,” said Dr. Christopher Montville, a reproductive endocrinologist and medical director of reproductive medicine at Billings Clinic. “The results of our first cycle far exceeded our expectations.”
The procedure, which costs $11,500, marks a milestone in fertility treatment in the region. Montana was one of only three states without a clinic offering IVF. Wyoming and Alaska remain the holdouts. The fee includes lab work, ultrasounds, lab fees, plus doctor and surgery fees. Most patients are self-pay.
Until recently, the Billings area hasn’t had a population large enough to support an IVF clinic. Couples seeking IVF treatment traveled to Denver or Seattle, where the cost is closer to $20,000 and the treatments can keep them away from home for two to three weeks.
“We’re a hospital that wants to give people choice in terms of their health care,” Montville said. “It may not be for everybody, but it certainly is a way for some couples to achieve their dreams of having a family.”
Infertility affects more than 10 percent of couples worldwide.
Having the option of being treated closer to home is “huge,” said Monica Spini of Laurel. She and her husband, Michael, have two daughters born through IVF. “What a service they will be providing to the Billings community, and to all the outlying areas,” she said.
The couple traveled to Washington for their IVF treatments, spending as much as $40,000 to conceive the two children.
An estimated 45,000 babies are born each year in the United States as a result of IVF, and the American College of OB/GYN has long considered IVF to be part of the standard of care for women’s health.
It has been more than 30 years since Louise Brown in Great Britain became the first baby born through the technique in which eggs are removed from a woman, fertilized outside her body and then implanted into the womb. Brown was born July 25, 1978.
Since then, some 4 million people have been born with IVF — a rate that is up to about 300,000 babies worldwide per year, according to the European Society of Human Reproduction and Embryology.
Numerous advances have been made in infertility treatments during the past three decades, including:
The use of ultrasound to enhance a physician’s ability to retrieve eggs. In the past, people used laparoscopy and very few eggs were collected.
Enhanced laboratory techniques that improve the ability to transfer healthy embryos to the uterus.
Stimulation medications that have enabled physicians to stimulate egg development with fewer side effects.
Improvements in lowering multiple-pregnancy rates. The number of embryos that can be implanted is not regulated by the government, but there are recommendations by professional groups. Generally, if a woman is 35 or younger, one embryo is recommended, while one to two embryos are recommended for implanting if the woman is between 35 and 40. The goal for IVF practitioners, Montville said, is to minimize the adverse events that are associated with IVF, primarily multiple births such as those of Nadia Suleman, dubbed the “Octomom.” Her physician was later accused of giving Suleman too much of a hormone while stimulating in vitro fertilization.
The ‘take-home baby rate’
With in vitro fertilization, eggs are stimulated in the ovaries, removed from the woman and then fertilized with the male partner’s sperm. The eggs are developed into embryos in a laboratory and then transfered back into the woman’s uterus.
Each IFV cycle takes between 14-18 days.
In many cases, extra embryos can be frozen and saved for a later, much less expensive future treatment. The cost for subsequent frozen IVF cycles is a fraction of the cost of the original cycle.
Numerous factors can cause infertility, including damaged fallopian tubes, ovulation problems and sterile male partners. In many cases, it isn’t clear what causes infertility.
At Billings Clinic, the IVF treatment begins with an assessment of past fertility history and prior treatment. A fertility evaluation is then performed to investigate potential problems with ovulation, uterine anatomy and function. A patient’s family history is also reviewed and she is screened for genetic diseases.
Success rates decline as women age, dropping off dramatically after about age 37, according to the Society for Assisted Reproductive Technology. Part of the decline is due to a higher risk of miscarriage with increasing age, especially over age 40. There is, however, no evidence that the risk of birth defects or chromosome abnormalities (such as Down syndrome) is any different with assisted reproduction than with natural conception.
As the science of IVF improves, so does the success rate. In 2002, about 28 percent of IFV cycles in the United States in which women used their own eggs resulted in the live birth of at least one infant, according to SART. That’s double the rate in 1989.
The average success rate for women under age 35 is 42 percent per cycle.
That’s much higher than the successful pregnancy rate among couples with proven fertility, which is about 20 percent per cycle.
A 1st in Billings
In January, Billings Clinic began offering IVF services from a suite and laboratory in its Surgery Center, stocked with $520,000 in equipment.
The clinic anticipated providing 40 to 50 IVF cycles in the first year but now expects to nearly double that.
In the U.S., an estimated 10.2 percent of women between 15 and 44, or about 6.2 million women, have impaired fertility, and the number is increasing. While not every patient who struggles with infertility requires IVF, the procedure boosts the potential of success for couples who have not achieved pregnancy with other fertility treatments.
Today, the probability that an infertile couple will take home a baby after a cycle of IVF is 1 in 5, about the same odds that healthy couples have of conceiving naturally.
The Clinic’s IVF lab director and embryologist is Kathleen Miller, who has helped develop IVF programs around the country. Based in New York City, Miller will travel to Billings four times a year for seven to 10 days.
Miller’s 25 years of experience and a success rate that exceeds national averages gives the Clinic’s program “instant credibility that is rarely seen in other new IVF programs,” Montville said.
In July, Dr. Stacy Shomento, a Bozeman doctor, will return to the clinic after completing fellowship training in reproductive endocrinology and infertility. Shomento has been with the clinic for eight years and will offer IVF services in her Bozeman practice.
With only 410 clinics as members of SART, most are in concentrated population centers so that the volume of patients can support the program. Many are also affiliated with academic institutions and hospitals, said Barbara Collura, a University of Montana graduate and executive director of RESOLVE: The National Infertility Association.
Access to quality care for infertility is an issue for many people in the U.S., given that there are so few Society for Assisted Reproductive Technology clinics, Collura said. “This is really good news for the residents of Montana. They no longer need to leave their state to have access to care.”
Successful IVF programs need a population of about 250,000 people within a 200-mile radius. With Billings, Bozeman, Northern Wyoming and the western Dakotas in the region, Billings Clinic officials are confident that the area can support the service.
“Our physicians have had to work with practitioners in other IVF centers in Denver and Seattle, so we knew patients needed it but we were unable to provide that care,” Montville said.
Even with the new clinic, some couples will continue to travel out of state.
Dr. Douglas Ezell, of Billings OB/GYN Associates, specializes in women’s primary health care, including family planning and diagnosis and treatment of infertility. He has sent the majority of his patients seeking IVF treatment to Washington.
He said Billings Clinic’s entry into IVF is “probably a good thing for the community” and he has nothing but praise for Montville, saying he is well-trained and “knows what he’s doing.” One of the most important components of an IVF lab is that it has an embryologist with a good reputation, he said.
While he expects he’ll send some of his patients to Billings Clinic, Ezell said he’s waiting to see what its success rate is, although he expects it will be be “pretty good.”
“Assuming they had some people who were relatively uncomplicated, I would expect — and hope — that they would have a 50 percent success rate,” Ezell said. “That’s kind of a good rule of thumb.”
In 2008, the success rate for women under age 35 was 41.3 percent, with 39,621 cycles resulting in live births, according to SART. While babies have been conceived in the Billings Clinic program, the success rate cannot be released publicly until a third-party review is complete.