If you’re having trouble getting pregnant, in vitro fertilization gives a beacon of hope.
But if you have a medical condition — such as heart disease — that requires more supportive care, IVF treatments can become more complicated.
Suneeta Senapati, MD, MSCE, a fertility specialist and assistant professor of obstetrics and gynecology at Penn Fertility Care, explains how a new program is helping women with complex medical conditions conceive.
Q: What is in vitro fertilization (IVF) and how does it work?
A: IVF is a fertility treatment where we fertilize a woman’s egg with sperm in a dish in the laboratory. After fertilization the embryo is transferred back into the woman’s uterus. You can learn more about IVF, here.
Q: What is hospital-based in vitro fertilization (IVF)? Is it different from IVF in an outpatient clinic?
A: The care that patients receive including the initial consultation, nursing care, and monitoring before we retrieve the eggs is the same. What differs is where the egg retrieval procedure takes place. Most women have their egg retrieval procedure safely performed in an outpatient surgery center. However, women with medical conditions that require additional anesthesia, special monitoring or supportive care are better cared for in a hospital operating room where a team of specialists is available for immediate consultation and care management.
For example, if a patient has a congenital cardiac disorder, the we can perform her egg retrieval in a hospital operating room staffed by a cardiac anesthesiologist. Then, after the retrieval, we may have a member of her cardiology team visit before discharge from the hospital. The specialists involved in this process depend on the patient’s underlying medical condition.
While the egg retrieval is typically still considered an outpatient procedure — meaning patients are often able to go home the day of the retrieval — there are some cases when they may need to be admitted to the hospital before the procedure. For instance, we’ve had patients with low platelet counts who were admitted the night before the retrieval for extra monitoring. But in general, hospital-based IVF does not involve an inpatient stay.
Most IVF clinics are in ambulatory settings which do not meet the American Society of Anesthesiology criteria to handle these complex cases. We now offer IVF at the Hospital of the University of Pennsylvania.
Q: Who might hospital-based IVF benefit?
A: Hospital-based IVF may be helpful for patients with complex congenital heart conditions or other chronic medical conditions. We have cared for patients who have had Fontan procedures, cardiac arrhythmias with cardiomyopathy, hepatic fibrosis, seizure disorders, and pelvic vascular malformations, to name a few.
Hospital-based IVF is an option for women with medical conditions that make it unsafe for them to carry a pregnancy themselves or who have problems with their uterus. In this case, the fertilized egg will be implanted into a gestational carrier — a different woman who will carry the pregnancy for the patient.
In the past, many of these women were simply told they could not undergo IVF because their cases were too complex. So often, hospital-based IVF is the first time they are told that this is even an option for them.
Q: How is this work innovative?
A: Penn Fertility Care has the only hospital-based IVF program in the state, and is one of only a handful of centers in the U.S. that can provide IVF for patients with these unique needs. Since we have one of the most advanced women’s healthcare programs in the region, women are often referred from outside of Penn Medicine.
Q: What are some common misconceptions about hospital-based IVF?
A: People may not realize that there are many steps involved in assessing whether fertility treatments like IVF are appropriate for a particular patient and to get to the end goal of a healthy pregnancy. A lot goes into coordinating care for each unique situation, and we personalize the care plan for each patient.
If a patient comes to us, we review their history to determine if it is appropriate for them to undergo a hospital-based IVF procedure by reviewing their case with our team as well as the physicians and specialists who are taking care of that patient for their primary medical condition. Any decisions we make in terms of whether hospital-based IVF is appropriate for the patient are made with their medical team’s involvement.
For some patients, this may involve several months of preparation and planning prior to achieving a pregnancy. At Penn Fertility Care, we are dedicated to helping patients navigate through this journey and providing the personalized care needed to meet their goals.
We can also offer a continuum of care beyond fertility treatment. Many patients who come to see us use a gestational carrier for their pregnancy. In those cases, the carrier’s pregnancy typically isn’t considered high-risk and can be monitored by a through routine prenatal care. However, if a patient is able to safely carry the pregnancy themselves, we have an interdisciplinary team at Penn that can transfer their care from fertility care to obstetric care seamlessly.