The Biological Clock is Ticking...For Men Too!

Its long been known that women who are over 40 have significantly more fertility problems than younger women. It's been assumed that a man's age is much less a factor in the fertility equation. This seems to make sense, as a women's eggs are as old as she is, whereas a man's sperm cells are constantly replenished. New research from French scientists shows that this common belief might not be accurate. The study looked at success and miscarriage rates from 21,000 male samples from fertility clinics. It was found that as men reach the age of 40, they have a much higher chance of their partner having a miscarriage, when compared with younger men. Specifically, this research found that men over 40 had a significantly higher chance of causing a miscarriage (35% vs 10-15%) than men younger than 30. Researchers aren't really sure what the reason for this is, but the message is pretty clear to women and now men: its best not to wait too long to start a family.

What To Expect At Your First Appointment

By: Maureen Hanton, BS, RN, MPA

The first time visiting a fertility clinic is an important day for most couples; they arrive at the doors with a mixture of emotions. It may help to know what to expect. First, the appointment is usually longer than a regular doctor's visit. A typical first appointment at a fertility clinic can last two or more hours. Generally you can expect to speak with the physician for about an hour. The physician will listen to you as you relay your fertility journey, will ask you questions about your medical history and discuss diagnostic testing. He (or she) will answer any questions you may have about causes and treatment of infertility, as well as success rates of various types of advanced reproductive technology (ART). Together with your doctor you will discuss diagnostic and treatment options that suit your needs. After you speak with your physician, your nurse will help you implement the doctor's orders and will explain the testing he (or she) recommended.

You may also speak with a genetic counselor and a financial counselor at your visit, depending upon your individual needs. It can be a lot of information in one day! The following are some helpful hints that can help make your appointment go smoothly:

• Consider coming prepared with notes and or questions for the doctor.


• Bring your insurance and prescription cards with you to the visit.


• Bring records of previous treatment or pertinent OB/GYN records such as HSG reports or hormone testing.


• Bring your calendar. If you have vacation plans or work obligations, court dates, house guests or anything that cannot be rescheduled, let the physician or nurse know to help plan diagnostic testing and fertility treatment.


• Feel free to take notes and ask questions. It is very common for couples to get home and realize they forgot to ask something they wanted to ask.


• Please don't be shy about contacting your nurse if questions or concerns arise or if circumstances change. It is always OK (even encouraged) for you to call or e-mail staff with follow-up questions.


• Remember that the pace of therapy will be set by you. Doctors will make recommendations, but no one will require that you proceed with a given treatment or at a given timeline. If you are concerned that a recommended treatment is too aggressive -or not aggressive enough, feel free to voice that to your physician.

Emotionally speaking, the days and months leading up to your first appointment with a fertility specialist (reproductive endocrinologist or RE) can be stressful. Couples often question whether now is the right time to seek help, which clinic to go to, which doctor to request, etc. They research their insurance policies to ascertain what type of coverage they can expect with regard to fertility treatment. They may discuss as a couple how far they want to go down the fertility treatment pathway in terms of time or money spent. While you are discussing the practical matters, take time to discuss your priorities and share your feelings. Talking about all of these things can help to decrease stress along the way. As you proceed, remember:

• It is normal to feel a range of emotions. It is not uncommon to feel excited and hopeful at the prospect of getting pregnant, while at the same time nervous because you don't know what will occur. Many couples say they feel sad or resentful walking in the door of a fertility clinic because they are at a doctor's office when it seems that so many friends and family members are able to get pregnant on their own, with very little effort.


• Your spouse may be experiencing similar emotions to what you are feeling, but not necessarily at the same time or in the same order as you are.


• Fertility treatment can impact vacation plans, work schedules, finances, marriages, families and self-image. It can bring up a lot of emotions. Consider asking your clinic if they can recommend a counselor or support group. You may find this very helpful during your fertility journey.

A positive thought to remember is that most couples who seek help and continue treatment do conceive. Your first appointment is your first step to success.

Sperm Numbers Are Falling!

By: David Karabinus, Ph.D., HCLD

The adult human testis is a busy place: on a given day each one produces approximately 45,000,000 sperm. Not bad for an organ that is about the size and weight of a walnut. Sperm production is neither simple nor speedy: the process, called spermatogenesis, takes place over a period of about 64 days and is a sequence of meiotic and mitotic divisions plus final maturational steps. The result is 256 mature spermatozoa being produced from one spermatogonial stem cell. Spermatogenesis takes place within the seminiferous tubules, the little hollow tubes about the diameter of a hair that compose most of the testicular tissue. Testicular function is regulated by intricate hormonal feedback interactions between the testis, hypothalamus, and pituitary gland to assure normal spermatogenesis occurs.

Declining sperm production in humans has received much media attention recently, accompanied by dire predictions of widespread infertility, jabs at the collective competence of males and snickers about the extinction of men. In reality, such reports are not new: as far back as the mid 1970s there have been such reports in the scientific literature. However the results are not as clear-cut as they may appear. An Italian study reported a decline in sperm concentration between the 1970s and today. A French study also reported a reduction in sperm concentration from 1973 and 1992. There were two US studies that showed that sperm density in the US had decreased 1.0-1.5% per year between the mid- to late 1930s and early to mid 1990s. During the same period, sperm densities were reported to have declined ~3% per year for European/Australian subjects. A US study indicated that sperm counts had actually increased between 1974 and 1994 while another study showed that sperm numbers declined for those born after 1974 compared with those born before 1959. A Japanese study showed sperm concentrations were steady to increased in 1998 compared to the period between 1975 and 1980. A study in India showed that sperm concentration had not declined between 1990 and 2000. A Danish study showed no change in sperm numbers among volunteers whose semen was periodically evaluated between 1996 and 2001.

The results of these studies do not present clear cut evidence that sperm production is declining in humans. The statistical and sampling methods employed by the studies showing sperm reductions have been called into question. There are indications that geographical differences in sperm production may reflect variations in diet, environmental exposure, pollution, etc. Is there anything we need to be concerned about? Maybe. Sperm production can be affected by a multitude of things such as medication, illness, trauma, and stress. Exposure to environmental pollutants, too much heat and too much cold can also impact testicular function. Hormonal supplements can significantly disrupt the feed back mechanism between testes, pituitary and hypothalamus. The chemotherapy or radiation that kills the cancer and saves your life can eliminate the testes’ ability to produce sperm. Alcohol and recreational drug use also have adverse effects.

There is no evidence that males are becoming inherently less capable of producing adequate numbers of sperm. However, since we do know that lifestyle and environmental factors can impair sperm production, avoiding such factors is prudent. In unavoidable situations, such as medical treatment, obtain a physician’s advice about potential reproductive impacts. Healthy habits such as eating a balanced diet, regular exercise, taking a multi-vitamin, and avoiding environmental toxicants are probably the most effective actions that can be taken to maintain the male’s inherent ability to produce sperm.

Guatemala Adoption Crisis

Endemic poverty, high fertility rates, and the stigma of unwed motherhood are the major reasons that children in Guatemala are available for adoption. The program has been attractive to Americans because children may become available for adoption at very young ages and infants available for adoption are often cared for by foster families. Adopting parents often receive extensive information about the birth family, including names and photos and the travel time is usually brief. In 2007, there were 4,728 successful adoptions from Guatemala, from the US alone. This number has dwindled to almost none this year because Guatemala signed on to an international convention that greatly complicates the adoption process.

The "Hague Convention on Protection of Children and Cooperation in Respect of Intercountry Adoption" entered into force with respect to the United States on April 1, 2008. Newly initiated intercountry adoptions between the United States and other Convention countries must comply with the Convention’s standards. Many countries have signed onto the Hague Convention, in the hopes of reducing child trafficking and other criminal actions. Signatories to the convention must meet strict international rules and procedures that smaller and poorer countries (such as Guatemala) have difficulty meeting. Under the new legislation, the adoption process is controlled by a Central Authority, the National Council on Adoption (CNA), which oversees adoption service providers. The Government of Guatemala has had insufficient time to build the capacity to implement the reform legislation. Over two thousand cases have been put on hold this year and one family's story is detailed in this article. The US State Department has issued a warning that advises potential adoptive parents and adoption service providers not to initiate new adoptions from Guatemala because the Department cannot process such adoptions from Guatemala to completion at this time. Until Guatemala can dedicate the resources to comply with the new convention, adoptions will continue to suffer.

Oprah Show on Sperm Donors Misses the Positive View

The February 8, 2008 broadcast of the Oprah Winfrey Show aired a segment on sperm donation. The show included as guests three sperm donors who had agreed to be identified to now grown children who had been conceived using sperm that these men had donated to sperm banks many years ago. The show also included children conceived through sperm donation who wanted to find the identity and to establish relationships with the donors who had provided half of their genetic makeup. The show also included a film of two adult half siblings, brother and sister, who met for the first time and who later joined the show live. The program did not include any representatives from sperm banks or lawyers representing the rights of anonymous donors. Obviously the show did not include any of the many former donors who wished to remain anonymous, or any donor recipients or donor offspring who wanted their donor to remain anonymous.

The show presented a skewed view of the varied interests involved in this issue and therefore conveyed a one sided picture of this topic, failing to present that the rights of donors, recipients, and offspring are all legitimate and must be acknowledged. The implication of the program was that the right of the offspring to know his/her donor supersede the rights of all others involved in the use of donated sperm. The show seemed to indicate that all Donor Insemination (DI) recipients and offspring want to meet their donor, yet there are many who want the donor they used to remain anonymous forever. It is important not to breach donor anonymity just because someone wants to know their donor. To do so would violate representations and contracts made by the sperm bank to its anonymous donors and parents who used an anonymous donor on condition of anonymity of the donors. In response to the desire of some to know the identity of their donors, most major cryobanks have a class of donors who have agreed in advance to have their identities and contact information released when donor-conceived children reach age eighteen. It is interesting that when donors willing to have their identities released are made available, these donors are not selected disproportionately to anonymous donors, indicating that there is not an unusual demand to know donor identities.. Also in countries such as the United Kingdom that now require that all donors be identified, there is now a severe shortage of sperm donors. Breaching anonymity would have a negative impact on those women who wish to use this approach to parenting now or in the future.

The program also left the impression that sperm donation is unregulated and that recipients are blind as to the medical histories of the donors. Most sperm banks, however, provide more information on their anonymous sperm donors than any person could reasonably obtain about their spouse. Medical histories go back three generations. Medical tests include a battery of sexually transmitted diseases (STDs), genetic diseases and physical exams looking specifically for infections, viruses, and genetic diseases that can be passed to a recipient or child. The FDA regulates a huge part of this process, as it does for blood donation and organ donation, and the standards are very high. Most sperm banks make availabledonor childhood pictures, (some even have adult pictures of a donor), detailed interests of the donor, audio interviews, personality tests, and the list goes on and on. The only information missing is the donor’s identifying information and the opportunity to make a physical connection with him. The donor’s medical and family information are available in detail. Parents have the freedom to share or not share this information with their children; from the nature of their child’s conception to the details of their donor’s history. Society assigns to the parents the right to control what information to pass on to their son or daughter.

To expose donor identities is not appropriate nor is it reasonable to encourage children from donor insemination to find a ‘daddy’ as they look for their donor. This was clearly the case in several situations on this show. Donors are only offering donor sperm and most certainly do not want to be active partners in the parenting process. The law does not and society should not treat them as if they were. As one donor said on the show, when he donated sperm he saw no difference between that and donating blood. At the time all these children on the show were conceived, sperm donors were available to offer women the means to have these very much wanted children. Oprah did little to celebrate this reality as every child on that show would not have existed except for the availability of sperm donation. If donors were required to reveal their identities, many women and couples would not be able to experience the joy of a child, since the availability and diverse selection of sperm donors would be significantly curtailed.

The Coming Revolution in the Embryology Lab: Microfluidic Embryo Culture

By: Andrew Dorfmann, M.S. ELD(ABB)

In some ways, the Human Embryology Laboratory has come a long way since the early days of IVF when I began in this field. Culture media and conditions have been improved and we now have tools to micro-manipulate sperm and oocytes to assist with fertilization and biopsy embryos. But the basic culture set-up looks and feels largely the same as it did back in the early 1980’s. Gametes and embryos are placed in static drops of culture medium in Petri dishes (not usually the proverbial “test tube”) and cultured in incubators which control temperature and the gaseous environment.

Fortunately, in recent years, the blending of physics and biology is sparking a revolution in the cell biology laboratory, and the Embryology Lab may be a promising new target. The nascent science of Microfluidics has taken the cell biology world by storm and in the next few years may transform the way tissue culture is performed. It turns out that fluids behave differently in micro environments than they do in the macro environments we are used to handling in the laboratory and these differences in fluid flow can be utilized in beneficial ways. Also, by using micro environments, we may begin to more closely imitate the actual environment that gametes and embryos experience inside the human body.

A group of researchers, led by Dr. Gary Smith at the University of Michigan have been developing microfluidic embryo culture devices. This system has shown very promising data when used on animal embryos. Mouse embryo culture was dramatically improved when they were grown in these devices and now they are in the early phase of clinical trials. The device is a simple gas permeable “chip” in which micro fluidic flow is controlled by computer and can be placed in a conventional incubator. The potential benefits of these kinds of devices are multifactorial. They more closely mimic the natural environment both in the sense of scale and in the fact that the embryos are in a dynamic environment rather than a static one. These devices also have the potential to eliminate or at least reduce some of the very labor intensive work that must now be done in the embryology lab in which embryos must be moved from one solution in one dish to another. Lastly, the spent media from these devices have the potential to be analyzed and used diagnostically to more accurately choose the best embryo for transfer. All together these innovations have the potential to improve pregnancy rates and revolutionize the way in which the modern human embryology lab functions.

The coming years are likely to be filled with great advances in Assisted Reproductive Technologies and microfluidic embryo culture is likely to be one of the biggest stars.

Unintended Consequences

Loss of donor anonymity leads to sperm donor shortage

A textbook story of a government mandate run amok is now playing out in the UK's sperm and egg donor business. The Human Fertilisation and Embryology Authority (HFEA) is the UK's independent regulator overseeing the use of gametes and embryos in fertility treatment and research. New HFEA regulations, which became effective in early 2005, have made it very difficult for childless couples to find an egg or sperm donor. As outlined in this article, the new regulation states that when offspring from any donor reaches the age of eighteen, they can access the identity of their donor. The regulation also stipulates that donors can no longer be compensated for their donations; they can only claim "reasonable expenses" incurred while donating.

The new regulations have had the obvious result of reducing the number of men and women who are willing to donate. The number of women treated with donor sperm fell by over 20% from 2,727 in 2005 to 2,107 in 2006. Shared eggs were used in only 680 fertility procedures in 2006, compared with 1,142 in 2004 (a 40% decline), the last year before the new regulations became effective. Donor anonymity has been typical of the egg and sperm bank business for decades in the United States, and before 2005, this was also true in the UK. While many donors have a desire to help childless couples, it's not hard to predict what would happen if they are given no choice in anonymity and are not compensated for their efforts.

The author of this article describes her quest to import donor sperm after learning of the two year wait in the UK. The author describes the struggle between different people's rights and states "Whose should be the greater? The right of the child to track down its biological parent when it's 18, the right of the donor to stay anonymous, or that of the mother simply to have the child?" At the present time, compromise would seem to be the best solution...many US sperm banks and egg donation programs now offer donors and patients a choice in anonymity. If there's anything positive that can be said about this situation, it's that it should be a clear warning to legislators in the US of the serious implications from following the UK’s regulations on donor anonymity and compensation.

Infertility and Marital Problems

By: Kathleen

A recent blog article titled Fertility Problems Do Not Need to Break Up Your Marriage! does an excellent job of outlining common problems that infertile couples frequently face. Fertility problems can be a huge strain on a marriage, but can also bring couples together, as many struggles in life can. As the article points out, communication is the key to staying a happy couple while facing your fertility problems (and the rest of your life together, for that matter). Couples who talk to one another about their worries, concerns, thoughts and feelings as they go through this difficult process, are much more likely to be the ones that come out having a lasting and sometimes stronger relationship.

Also high on the list of things to avoid is the pointless exercise of blaming one partner or the other. Blame leads to hurt, which leads to anger, which will quickly strain any marriage.

Finally, the article points out the importance of focusing on the positive things in your life. Infertility can be an all consuming weight on your shoulders, and taking the time to realize that other parts of your life are actually pretty good, can help put things into perspective.