A Thanksgiving Sequence

Finally, a team of researches have decided its time to sequence the turkey genome! According to this article the international consortium of scientists will commence with the effort using a new state of the art Roche GS-FLX(tm) sequencer. The goal is to get a complete turkey genome sequence to help scientists understand how to breed better, healthier, more disease resistant
birds. As the chicken genome has already been sequenced, this will allow for comparative studies between the two animals. According to the National Turkey Federation, turkey was the fourth most popular choice of "meat protein" for consumers in the United States in 2007 with an estimated 271 million turkeys will be raised in 2008.

British Fertility Society Calls for Changes to Address Donor Sperm Shortage

The British Fertility Society is calling for changes to address the radical shortage of sperm donors in the UK. They claim many clinics have long waiting lists or have been forced to stop providing services. Three years into the UK's ill fated decision to eliminate donor sperm anonymity, the inevitable shortage is in full swing. Around 4,000 UK patients require donor sperm each year which would require a minimum of 500 new donors each year. According to this article, only 307 men agreed to donate sperm in 2006 under the new guidelines. The resulting shortage of donors has led some fertility experts to ask for an increase in the current limit of 10 pregnancies per donor. Members of the British Fertility Society argue "that this figure is arbitrary and not evidence based, and a more flexible approach is needed." They believe that the limit should be increased to 15 or even 25 offspring per donor.

To view blog from earlier this year see this link.

Do Any Preconception Sex Selection Methods Work?

There is a lot of information on the internet about different ways to improve your chances of having a girl or boy baby. Do any of these preconception sex selection methods actually work?

Here is the short answer: Except for flow cytometric sperm sorting, there is no pre-conception sex selection method that has been shown to improve the chances of conceiving a baby girl or baby boy. Methods such as "sperm spinning", density gradient separation, dietary modifications, tying off a testicle, abstinence, timing of intercourse, intercourse positions, ancient Chinese lunar calendars, and altering the vaginal pH are just plain ineffective. Claims made by promoters of these pseudoscientific methods are not supported by sound data, are not independently repeatable, and cannot withstand scientific peer review. None of these other methods have been reviewed by the FDA.

After conception takes place, PGD may be used to identify male or female embryos for transfer in an IVF or ICSI cycle. PGD is a very effective post-conception method of sex selection. Before conception, however, there is only one way to make a girl baby: make sure a sperm carrying an X chromosome fertilizes the egg. To make a boy baby, a sperm carrying a Y-chromosome must fertilize the egg. To increase your chances of conceiving a girl baby or boy baby, the percentage of X- or Y-bearing sperm available for fertilization must be skewed away from the normal 50:50 so that a meaningfully increased percentage of the sperm are carrying the desired sex chromosome (X or Y). The only way to meaningfully increase the percentage of X- or Y-bearing sperm is by flow cytometric sorting of the sperm using MicroSort®. The other methods mentioned above are fine ways to spend time and money to achieve an outcome that would have occurred anyway: a 50:50 chance of conceiving a girl or a boy.

When is it Time to See a Fertility Specialist?

By: Laurence C. Udoff, MD, FACOG

Though on the surface one would think this is a simple question, the answer is actually a bit complicated. In fact, it is very likely that many physicians who aren't specialists in fertility care are not aware of the most recent recommendations from the American Society for Reproductive Medicine (ASRM). The answer to the question really depends on the patient's individual situation and specific concerns.

In most situations infertility is diagnosed if a couple has been unable to conceive after one year of regular unprotected intercourse. It is important to note that this definition does not imply that the couple is using any special monitoring or testing to time intercourse. This is a frequent point of confusion, since most practitioners start the patient encounter by asking. "How long have you been trying?". Actually, a better question would be. "How long have you been having unprotected intercourse?". If the answer is twelve months or more, it is time at least to discuss your fertility with your primary care doctor/-Ob/Gyn or a fertility specialist.

If you are over age thirty-five, the answer is different. In a Practice Committee Report dated June 2008*, the ASRM stated that "Earlier evaluation and treatment . . . is warranted after six months for women over age thirty-five years." Though in practice many clinicians have been taking this approach, this official recommendation from ASRM should improve the uniformity of care.

The ASRM report also notes that earlier evaluation and treatment may be justified based on medical history and physical exam. For instance, if a couple is known to have a medical problem that will make it unlikely for them to conceive, no waiting is required. Examples would include chronic anovulation (patient rarely, if ever, ovulates), known or suspected tubal disease (e.g. previous history of pelvic inflammatory disease or ectopic/tubal pregnancy), known or suspected sperm problems (e.g. history of testicular surgery), exposure to substances toxic to eggs or sperm (e.g. chemotherapy) and findings on physical exam suggesting a hormonal imbalance or an anatomical abnormality involving the reproductive system.

Lastly, the ASRM report notes that patients who experience two or more pregnancy losses should be seen to determine if a specific evaluation is warranted. A pregnancy is specifically defined as an ultrasound that documents a pregnancy in the uterus, or tissue passed from the uterus that is found to represent a pregnancy.

In general, anyone who has concerns about their fertility should feel free to discuss their concerns with their primary care provider. Most fertility clinics (GIVF included) are happy to discuss a specific situation to help determine if consultation is warranted.

*Definitions of infertility and recurrent pregnancy loss. Practice Committee Report. Fertility and Sterility. Vol 89, No.6, June 2008.