Fertility Bits

What is ICSI?

2010-03-09T13:00:00.001-05:00

By: David S. Karabinus, PhD, HCLD

ICSI, pronounced "Ick-See", is an acronym for Intra-Cytoplasmic Sperm Injection, a microscopic procedure where a single sperm is injected into an egg. Normally for a sperm to fertilize an egg, a sperm has to swim to the egg, penetrate the cells surrounding the egg, penetrate the covering of the egg, and penetrating egg cell membrane. ICSI does all this work for the sperm to make sure the sperm DNA is delivered to the egg. ICSI is performed in circumstances when the number of sperm is insufficient for fertilization to reliably occur, when the sperm's ability to fertilize the egg is impaired, or when the egg is known to resist sperm penetration. ICSI does not require the use of ejaculated sperm; sperm surgically retrieved from the testes or epididymides may be used. Before the development of ICSI, donor sperm, adoption, or childlessness were the only options for men who produced low numbers of sperm or functionally impaired sperm.

Personal Egg Banking (Elective Oocyte Cryopreservation)

2010-03-03T13:15:00.002-05:00

Not quite ready to start a family?
Give yourself time, save your eggs with Personal Egg Banking

When a woman wishes to start a family is a personal choice, but it’s no secret that fertility typically declines with age. Decreased ovarian reserve is a result of the natural aging process as the number of eggs with the potential to produce a successful pregnancy declines.

That’s why the Genetics & IVF Institute is pleased to offer Personal Egg Banking (also known as Elective Oocyte Cryopreservation) as a proactive means for women to preserve their future fertility. This is accomplished by giving women the option of cryopreserving, or freezing, their eggs until they are ready to use them. So, a woman could potentially freeze her eggs at age 32 and choose to use them several years later to achieve pregnancy.

While there are no guarantees that a frozen egg will lead to a pregnancy and live birth after thaw, Personal Egg Banking can increase a woman’s chances of conception later in life with her own eggs. Current management of age-related infertility includes the use of In-Vitro Fertilization (IVF) with a woman’s own eggs, or Donor Egg IVF where eggs are obtained from a younger, more fertile donor. Though success rates are very good with Donor Egg IVF, many patients do not find this option attractive because the child will not have a genetic link to the mother. Freezing one’s own eggs at a younger age for use later in life can provide another option in addressing age-related infertility.

The Science behind Personal Egg Banking:
How does it work?

Until recently, egg freezing was an experimental procedure with limited success in only a few select programs around the world. However, the use of a specific type of freezing called vitrification, has led to a dramatic improvement in oocyte survival, fertilization rates, and pregnancy rates. Most importantly, these successes are being reported by many different centers worldwide.

Based on the reports of approximately 1,000 births worldwide through egg freezing and our own successes at GIVF, we now offer Personal Egg Banking to women as a means of improving their chances of conception if they plan to delay childbearing. The experience so far with frozen eggs predicts that a patient in her 40s would significantly improve her chances of a successful pregnancy if she were able to use eggs that were frozen at a younger age (e.g. 30s).

Who is a candidate for Personal Egg Banking?

Not every woman is a good candidate for egg freezing. Women who are over 40 years of age or already have significantly decreased ovarian reserve (poor egg quality) may not benefit from egg freezing. Additionally, younger women (under age 30) need to carefully consider whether freezing eggs will be of later benefit to them. These women are more likely to conceive without assistance as they have many more years to conceive without assistance.

A major part of offering Personal Egg Banking to women is appropriate counseling. Key points to consider include:

1) Egg freezing requires ovarian stimulation and egg retrieval. Multiple mature eggs must be retrieved to have a realistic chance of conception after freezing and thawing. In a natural menstrual cycle, only one egg is matured each month. Therefore, patients who choose egg freezing are given medications to stimulate the maturation of multiple eggs in a single cycle (same treatment used for IVF patients). To appropriately time the egg retrieval, frequent office visits are required for blood tests and transvaginal ultrasound to monitor the development of the eggs. The eggs are retrieved by placing a needle through the back of the vagina into the ovary. This is an outpatient procedure performed in the office under anesthesia.

2) Freezing eggs is not a guarantee of future pregnancy and is still an emerging technology. Since egg freezing is an emerging technology, it is difficult to accurately assess the chance for pregnancy and delivery. Based on published data, largely from donor egg cycles, it is estimated that a single egg that is warmed from the vitrification method has a 4% chance of resulting in a live birth. These rates may be lower in women over the age of 32 since fertility is known to decline with advancing age and age is not the only determinant of egg quality. More recent reports and our own current experience suggest live birth rates will improve as techniques and protocols are refined, but are expected to remain low due to the inherent limited potential of a single egg producing a successful birth. As with all pregnancies, naturally or assisted, there is no guarantee of a normal outcome.

If you would like to receive information about Personal Egg Banking, click here.

Clinic Offers Single IVF Cycle Pregnancy Guarantee

2010-02-23T13:09:00.006-05:00

The Genetics & IVF Institute (GIVF) in Fairfax, Virginia (in the Washington, DC suburbs) is offering a limited time Single IVF Cycle Pregnancy Guarantee. If you do not become pregnant after one IVF cycle you receive a full refund. The base cycle fee is $10,900 and medications are excluded from the refund. Some medical eligibility apply and patients must be 36 years old or younger when treatment begins. Offer is good through May 31, 2010. Click here to schedule an appointment.

Clinic Offering Free Donor Egg IVF Cycle at Seminar

2010-01-06T13:16:00.008-05:00

The Genetics & IVF Institute (GIVF) in Fairfax, Virginia (in the Washington, DC suburbs) is offering a free educational seminar on donor egg IVF at the McLean Hilton in McLean, Virginia on January 16, 2010 from 10:00AM to 12:30PM. Come listen to Dr. Laurence C. Udoff, a board certified reproductive endocrinologist, and Dr. Harvey Stern, a board certified geneticist, talk about the medical aspects of this treatment option. GIVF's donor egg counselor also will discuss the emotional and personal aspects of donor egg IVF. Meet an actual egg donor.

One seminar attendee will receive a single donor egg IVF cycle at absolutely no cost and all attendees will receive a 15% discount on the base fee on donor egg IVF contracts signed after January 16, 2010. For more information or to register visit this page. GIVF is planning a series of educational seminars in the Washington DC area and elsewhere. Those interested in notices about these seminars should sign up here.

Reproductive Toxicology

2009-12-10T13:00:00.000-05:00

By: Amy Erickson-Hagen, MS Reproductive Physiology

Likely there are things you remember from various stages in your education like being the line leader, square dancing in gym, or senior skip day. However, the lab next to my lab in graduate school studied environmental effects on frogs. Phthalates were the main compounds found in the environment causing effects such as additional limbs, deformed genitalia and much more. One specific Phthalate is Bisphenol A (BPA) which has been getting press about its presence in water bottles and possible effects on miscarriage and sexual function. Phthalates are xenoestrogens which are industrially made compounds that have estrogenic effects and differ chemically from estrogens which are naturally occurring, produced by living organisms. It is believed that Phthalates can last in the environment for over 70 years.

Phthalates are used mainly in plastics to increase their flexibility, transparency, durability and longevity. They are being phased out of many products in the United States and European Union (EU) over various health concerns. However, last time you looked on a product was it made in the US or EU? Probably not! Therefore it is still a concern to people living in the United States.

Phthalates are used in a large variety of products, from coatings of pharmaceutical pills and nutritional supplements to adhesives and glues, building materials, personal care products, medical devices, detergents, packaging, children's toys, waxes, paints, printing inks, pharmaceuticals, food products, and textiles. Phthalates are used in a variety of household applications such as shower curtains, vinyl upholstery, adhesives, floor tiles, food containers and wrappers, and cleaning materials. Personal care items containing phthalates include perfume, eye shadow, moisturizer, nail polish, liquid soap, and hair spray. They are also found in modern electronics and medical applications such as catheters and blood transfusion devices. Just about everywhere you turn.

After graduate school I...

1. Stopped wearing nail polish with Phthalates -spent the extra $2 to get Phthalate free.
2. Never microwave plastics or freeze anything in plastics. Phthalates leach more from plastics when exposed to increased temperatures.
3. Rarely eat anything canned - just buy frozen veggies. The linings of cans commonly contain Phthalates. FYI, You can find frozen mandarin oranges if you really look (that was my canned good weakness).

An Often Overlooked Infertility Cause

2009-12-01T15:00:00.000-05:00

STD's can cause fertility problems, which frequently go under or miss-diagnosed. Chlamydia is the most common STD in America, affecting more than a million people each year. Unreported cases could easily double this figure. As reported in the Wall Street Journal, Chlamydia can lead to pelvic inflammatory disease (PID) which in turn can cause a variety of fertility problems. Women who are considering getting pregnant are encouraged to get tested to rule out any problems. Chlamydia can be detected with a urine test.

Infections can be persistent for years, with minor side effects that can mask its presence. Women are more likely to have an infection than men, but both should get tested. The article points out that Chlamydia can be treated effectively with a quick round of antibiotics, so there's no reason not to take action so you can rule this potential fertility problem out!

Drinking and IVF Don't Mix

2009-11-19T13:00:00.000-05:00

A study presented recently at the American Society for Reproductive Medicine (ASRM) suggested that alcohol consumption decreases IVF success rates. The researchers questioned 2,574 couples undergoing IVF treatment. Couples who consumed over six alcohol units (two pints of beer or two large glasses of wine) per week were significantly less likely to become pregnant. Women were 18% less likely to have a successful IVF cycle, while men reduced their chances of success by 14%. The negative effects were particularly strong for women who consumed white wine and men who consumed beer. Based on these findings experts advise couples to avoid alcohol three months prior to an IVF cycle.

The lead researcher of the study, Dr. Brooke Rossi, stated "there are many factors why IVF fails and most of these patients have no control over. But how much they drink is something that they can change." The results of this study also suggest that alcohol consumption may decrease pregnancy rates in all couples attempting pregnancy, even those without specific fertility issues.

Assisted Hatching Benefits in Question

2009-11-12T13:00:00.000-05:00

Assisted Hatching, a common procedure performed during an IVF cycle in which the zona pellucida (ZP- outer layer of the egg) is thinned or breached, was the subject of a recent scientific study. 121 women were involved in the randomized, double blind study, which was published in the Journal Fertility and Sterility. The women were younger than 38 years and had embryos with a ZP thickness of ≥13μm. Rates of clinical pregnancy, implantation and live births were compared. Surprisingly, the results showed no significant differences between the group that had the hatching procedure and the control group.

Previous studies have had conflicting results. According to the Society for Assisted Reproductive Technology and the American Society for Reproductive Medicine, the procedure is still considered useful in cases with a poor prognosis. Women with previous history of ≥2 IVF failures, poor quality embryos, and women aged ≥38 years should be considered candidates for assisted hatching.

Strict Fertility Laws Cause Flight to Other Countries

2009-10-27T13:00:00.000-04:00

According to a recent study, thousands of British women are traveling abroad to have fertility treatments that are not available in the UK. Over 40 European clinics were surveyed about their patient demographics, including country of origin and reason for traveling to receive the treatments. It is estimated that over 20,000 European patients travel outside their countries for fertility treatment. The largest populations came from Italy, Germany, the Netherlands, France and the UK; and traveled to Belgium, the Czech Republic, Denmark, Slovenia, Spain and Switzerland.

The number one reason provided was to avoid home country legal restrictions around fertility treatments. Many European countries have enacted widespread restrictions and regulations that have had predictable side effects. UK sperm and egg donors are no longer allowed to be completely anonymous or compensated, which quickly lead to a shortage of donors. There are currently long waiting lists for free National Health Service (NHS) treatment and seventy-five percent of IVF procedures are performed privately in the UK. Many UK women traveling for treatment were over forty, at which age women cannot access IVF through the NHS.

The studies authors hoped policy makers will consider these findings when introducing future fertility legislation.

New Test for Endometriosis

2009-10-16T13:00:00.000-04:00

The results of a new test to detect endometriosis were recently published in the journal Human Reproduction. Endrometriosis is a painful condition that affects up to 10% of women. This medical condition is characterized by endometrial like cells which flourish outside the uterine cavity and are influenced by hormonal changes. The main symptom is pelvic pain and it can be associated with infertility. Doctors traditionally rely on an invasive laproscopic procedure to diagnose the condition, requiring anesthesia. The new test can be done in a doctors office with a simple swab being taken and sent out for analysis. The swab is taken from the lining of the uterus (endometrium) and is performed vaginally. The swabs are analyzed for presence of nerve fibers, which has a high correlation with having endometriosis. Although the sample size for this study was small, it does represent the possibility of a much better technique for diagnosing a condition that affects millions of women each year.

Sugary Snacks Lower Testosterone in Men

2009-10-09T13:00:00.000-04:00

A recent study noted the dramatic effect that a dose of glucose has on testosterone in men. The findings show that there is a need for dietary guidelines when measuring blood levels of testosterone.

The incidence of hypogonadism (low testosterone levels) has been increasing and may be related to the well documented rise in obesity. Obtaining an accurate testosterone level is critical to diagnosing hypogonadism, so understanding the effects of diet on testosterone level should be well understood by medical professionals and patients.

In the study, 74 men were given a glucose tolerance test in which each drank a pre-measured dose of a glucose (sugar) solution. In addition to the surprise that 9 (12%) of the volunteers had undiagnosed type 2 diabetes, the researchers also noted that when testosterone levels were checked several hours later, 73 of the 74 men showed significantly lower testosterone levels than before consuming the sugar solution. This observation indicated that eating before having a testosterone level tested may result in an artificially low test result.

The researchers stressed men who have been found to have low testosterone levels should have their levels rechecked after they fast overnight. Doing so may avoid the the lowering effect that eating may have on testosterone levels.

An Evolutionary Reason For Male Infertility

2009-10-06T13:00:00.000-04:00

In the past several years, numerous articles that have reported how men's sperm producing ability is decreasing, thus leading to reduced fertility. Now there is a report that suggests that men are producing sperm that are too good and this may also be contributing to infertility. According to Evolutionary Biologist Dr. Oren Hasson, some men are producing 'super-sperm' that are too aggressive to produce a pregnancy. These sperm move too fast to be stopped by the myriad of defenses set up in the women's reproductive system. The result is more than one of these sperm reach the egg and fertilize it, which causes an unviable polyspermy egg. Eggs fertilized by more than one sperm usually do not go on to produce a baby.

Although it only takes one sperm to fertilize an egg, in order for fertilization to reliably occur, many more sperm are required. Usually this means that hundreds or perhaps thousands of sperm need to be in the vicinity of the egg, ready and able to fertilize. However, there is significant attrition in sperm numbers as they overcome the barriers in the female reproductive tract during their quest for the egg. For those hundreds or thousands of sperm to reach the egg, millions of sperm need to be delivered by the male so that sufficient number of sperm survive the trip. Dr. Hasson theorizes the situation results from an 'evolutionary arms race' in which subtle changes over time occur to improve fertility. Women have evolved extra defenses which in turn compel sperm to evolve countermeasures. Men who produce 'normal' or 'non super' sperm must overcome the female defenses that were honed to ward off their kryptonian cousins.
Dr. Hassan based his theory on fertility statistics and mathematical models. Because he believes that stressful lifestyles, infection and pollution alone cannot account for all human infertility, his 'super sperm' hypothesis may provide an additional explanation for infertility.

PGD In The News

2009-10-02T10:52:00.004-04:00

Preimplantation genetic diagnosis (PGD) is a reproductive technology used with an in-vitro fertilization (IVF) cycle. PGD can be used for diagnosis of a genetic disease in early embryos prior to implantation and pregnancy. PGD was recently featured on a segment of the Early Show on CBS.

Navigating the Land of IF- A Melissa Ford Interview

2009-09-29T13:00:00.000-04:00

By: Trina Leonard

Written as a "travel guide" to the Land of IF (the online abbreviation for infertility), Melissa Ford's new book, Navigating the Land of IF: Understanding Infertility and Exploring Your Options, offers a refreshingly candid perspective on the emotional and social aspects of infertility, as well as practical information about testing, treatment, handling invitations to child-centered events, talking with friends and family and more. Ms. Ford is well known for her widely-read blog on infertility, http://www.stirrup-queens.com/ , and as a contributing editor for BlogHer. In a recent conversation with GIVF, Ms. Ford discussed her blog, her experiences as an infertility patient and her tips for current travelers in the "Land of IF."

When she began her own journey by trying to get pregnant naturally, Ms. Ford says she was shocked when conception failed to occur. "Before that, I had trekked through life pretty successfully, in school and in work," she says. "For the first time, when I began trying to get pregnant, I put in the 'work' and wasn't seeing results." Thanks to IVF, she eventually became the mother of twins, but her infertility experience changed her, including her attitudes about treatment. At first," she says, "I had lots of 'won'ts' and 'can'ts' in my vocabulary. Now, I would eliminate those and leave myself open to the possibilities."

She says that patients should do their best to maximize their visits to the doctor so that "you don't leave with questions unanswered because you forgot to ask them." To use both the patient's and the doctor's time well, she says: 1) Always be honest and upfront. Better to over-report than miss telling your medical team something important. 2) Write questions down before the appointment. Know what you need to ask. 3) Use a journal to record your questions, the answers and other information about medications or the process. "I kept a spiral notebook in my purse and wrote everything in one book," she says.

Traveling in the Land of IF is an emotional as well as a physical journey. Ms. Ford says, "It is very important not to ignore your emotional needs. Having the emotional side addressed makes getting through the physical side easier." She launched her "Stirrup Queen" blog in 2002 after participating in an online patient organization, but not finding the kind of information and support that she really wanted online. Now, more than 2,000 people visit her blog each day, reading her thoughts and sharing their own experiences - both physical and emotional. Online support is a valuable adjunct to "face to face" support for infertility patients. Ms. Ford says,"In online support, you constantly have new people you can connect with. There is always someone who will listen to you and who may have had a similar experience."

Although most blogs and books about infertility focus on women, Ms. Ford zeroes in on men's needs, too. "Men's emotional needs are sometimes overlooked, because they process their emotions differently. My husband is very male and can compartmentalize. When he was at work and I'd call or email him about some aspect of our treatment, sometimes I didn't think he cared as much as I did, but eventually I learned that just because he wasn't talking about it didn't mean he wasn't affected."
Melissa Ford offers the following tips for offsetting the emotional aspects of infertility:

-Engage in a physical activity that isn't related to fertility.

-Go out, perhaps with friends or a partner.

-Join a support group.

-Find a therapist who specializes in infertility.

"Although I didn't choose infertility, I would never wish that I hadn't had it," she says. "I've learned a lot. I've also become a more patient, more sensitive listener. Before I started to blog, I didn't know that there were so many people with so many different stories about infertility. I learned to set aside what I thought I knew and listen to what people were really telling me. Everybody has a story."

Use An FSA To Fund Your Fertility Treatment

2009-09-24T13:00:00.000-04:00

A Flexible Spending Account (FSA) is an account set up through your employer for medical expenses not covered by insurance such as office visit or prescription medication copays, dental or vision expenses, over-the-counter medications, or medical procedures such as infertility treatment. All expenses must be intended to treat or prevent a specific medical condition. Money is taken out of each paycheck, then you submit a request for reimbursement whenever you have a qualifying expense. All expenses must occur during the calender year- January 1st-December 31st.

The benefit to FSA's is that the money deducted from your paycheck for a FSA is not subject to payroll taxes. FSA's are also "prefunded" by your employer meaning the entire amount of money you select to put in your FSA is available on January 1st. If you are terminated or leave your company before the end of the calender year you do not have to reimburse your company if you already used the entire amount. One of the drawbacks to FSA's is the "use it or lose it" policy- if you do not use all the money in your FSA before the end of the calender year you lose it.

Typically toward the end of the year (October-December) companies allow you to select your benefits for the following year including health insurance and FSA's. So now is a great time to start thinking about setting up a FSA for 2010 or using up the rest of the money in your FSA for 2009!

Doctor, Tell Me About Clomid

2009-09-22T13:15:00.000-04:00

By: Stephen R. Lincoln, MD, FACOG Reproductive Endocrinologist

Clomiphene Citrate

How does it work?
Clomiphene Citrate is an oral medication that stimulates the release of FSH (Follicle Stimulating Hormone) from the pituitary gland. In turn, FSH stimulates the production and release of follicles from the ovaries. Clomiphene may be given to patients who do not ovulate regularly, who have an ovulation dysfunction, patients with unexplained infertility, or patients undergoing intrauterine insemination.

How is Clomiphene Taken?
Clomiphene is administered orally with starting doses of 50-100 mg/day for five days (cycle days 3-7, 4-8 or 5-9). The dose of Clomiphene may be increased by 50 mg increments in order to achieve desired clinical results. Ovulation is expected to occur 4-8 days after the last tablet of Clomiphene is taken. The time and dose may be different depending on your medical history.

How do we determine that Clomiphene is working?
If you have not been ovulating regularly, the presence of menstrual flow at the end of the treatment cycle is the most obvious sign of appropriate response to Clomiphene. Other methods of monitoring ovulation include basal body temperature charts, serial ultrasounds, urinary ovulation predictor kits and blood measurements of progesterone. Pregnancy is the ultimate confirmation that Clomiphene is working.

What side effects can be expected?
Temporary hot flashes are the most common side effects of Clomiphene citrate. Temporary ovarian enlargement may cause abdominal discomfort. Less frequent symptoms include breast tenderness, headache, nervousness, moodiness, dizziness, nausea and vomiting, fatigue and visual disturbances. About 10% of women experience side effects, usually mild, from Clomiphene citrate. Approximately 90% of pregnancies resulting from Clomid are singleton births. Twins occur in approximately 9-10% of pregnancies and <1% result in triplet pregnancies. The incidence of congenital malformations (birth defects) in children conceived while using Clomiphene is the same as in the general population. Additional information on Clomiphene is available on the pharmaceutical manufacturer's package insert, or directly from the manufacturer.

Does Clomiphene Citrate cause cancer?
Clomiphene Citrate has been on the market for over 30 years. Some studies have suggested a small increase in the lifetime risk of ovarian cancer for patients who have taken the medicine for over 12 cycles. There is no evidence of any increased risks for patients who take Clomiphene for less than 12 cycles. We generally recommend a 3 - 6 month course of treatment and then moving on if no pregnancy has occurred.

Swine Flu And Infertility Treatment/Pregnancy

2009-09-15T15:00:00.001-04:00

The swine flu (H1N1 virus) is a new strain of influenza virus first identified in April 2009. The virus is spread by coughs or sneezes or by touching contaminated surfaces and then touching your nose or mouth. The symptoms of swine flu are similiar to other seasonal flus: fever, coughing, sore throat, and fatigue or weakness. The CDC notes that most cases worldwide have been mild. Most hospitalizations and deaths are in people who have underlying health problems such as asthma, diabetes, obesity, heart disease, or a weakened immune system.

Here are the current CDC guidelines as related to pregnancy (or those trying to conceive):

Swine flu may be more severe in pregnant than non pregnant women

Pregnant women (and those attempting pregnancy) should recieve the vaccine when available

If pregnant and suspected of having swine flu you should stat treatment immediately (do not wait for confirmation from lab tests) with Tamiflu or Relenza.

The H1N1 vaccine is currently in clinical trial and may not be available until October.

New Egg Screening Technique

2009-09-04T13:00:00.000-04:00

The first baby was born in Britain using a new screening technique which examines eggs for chromosome abnormalities allowing physicians to select the best eggs to use in fertility treatment. Baby Oliver was born to parents who had thirteen previous failed IVF attempts. The test is called Comparative Genomic Hybridisation (CGH) and uses a sample of a "spare" set of chromosomes that are expelled by the egg during fertilization. These chomosomes are compared to a normal set of chromosomes identified by the Human Genome Project.

The researchers believe that this technique could double IVF successs rates. Professor Simon Fishel, lead researcher for study states, “Up to half of the eggs in younger women and up to 75 per cent in women over 39 are chromosomally abnormal. Array CGH is used to screen eggs or embryos in an IVF cycle, evaluate all the chromosomes and select the most chromosomally normal embryos." Experts caution that this new technique needs further research in a well designed clinical trial.

Delaying Parenthood- Wake Up Call Needed in UK

2009-08-27T13:00:00.000-04:00

Many women in the UK are delaying conception...the average age that married women have their first child is now above thirty. And while infertility treatments can be very successful they are not a miracle cure, especially in cases of advanced maternal age. Experts are calling for educational efforts through schools on fertility in conjunction with sex education. Mark Hamilton, MD, former chair of the British Fertility Society, believes that the public is uninformed about fertility, even those who are well-educated. Adding to the issue is the demographic profile in the UK. Much of the population consists of older people who are retired or near retirement and there is a shortage of young people. While keeping older people in the workforce longer would be helpful, educating young people about the risks of waiting to start of family would also be beneficial.

Susan Seenan of Infertility UK agrees that more education is needed for the general public. She states the only emphasis currently for younger women is contraception. "We spend our twenties trying not to get pregnant and our thirties trying very hard to get pregnant," she said. If women choose to put off having a family it should be with a full understanding of the risks, she added.

Male Infertility: The Other Half Of The Equation

2009-08-21T13:00:00.000-04:00

By: Sunita Kulshrestha MD, FACOG Reproductive Endocrinologist

When a couple has trouble getting pregnant, there is about a 50% chance that there is a male factor causing or contributing to their infertility. In order to achieve pregnancy, a man must deliver into the vagina healthy sperm that are able to reach, penetrate and fertilize the egg.

The first test to assess male fertility potential typically is a semen analysis. Semen is the fluid that contains both the sperm and the secretions from glands that nourish and protect the sperm. A normal ejaculate contains more than 40 million sperm! A semen analysis measures several factors, including: the amount of semen produced (volume); the total number of sperm in each milliliter of semen (concentration); the percentage of sperm moving (motility), and the percentage of sperm that are normally shaped (morphology). Abnormalities seen in the analysis may include too few sperm (oligospermia), sperm that are not motile and do not move the way they should (asthenospermia), abnormally shaped sperm (teratozospermia) or a combination of all of the above. The number of sperm and the percentage of those sperm that are motile influence how many sperm are able to reach the vicinity of the egg. Sperm motility and morphology determine the ability of the sperm to penetrate the egg.

Historical risk factors for infertility and abnormal semen analysis include a history of sexual/erectile dysfunction, history of sexually transmitted diseases, exposure to environmental toxins including tobacco, drug use, and alcohol, prolonged exposure of the testes to high heat, history of undescended testes, history of mumps, chronic medical conditions such as diabetes, a family history of cystic fibrosis, urological procedures including inguinal hernia repair, history of cancer treatment, use of anabolic steroids, and the use of certain types of medications.

If a semen analysis is abnormal, another test should be performed at least three weeks later to confirm the findings. For any given man, semen quality can be quite variable and simple environmental effects (such as a fever, excess alcohol use, medications) can temporarily decrease the quality of the semen. If an abnormality persists, a urological evaluation can be informative. A physical exam can evaluate the size and location of the testes and the presence of a varicocele. A varicocele is a dilated testicular vein that can compromise fertility. The physical exam can also determine the presence of a patent vas deferens, the duct through which sperm flow from the testes to the penis.

Additional testing for the male may include a blood hormonal profile. Total testosterone and FSH (follicle stimulating hormone) are both indicators of testicular function. A prolactin excess or thyroid abnormality can also be evaluated with blood tests and can affect fertility. If the sperm concentration is less than 5 million/ml, genetic blood testing such as a chromosomal analysis (karyotype) and testing for missing segments of the Y chromosome (Y deletion) is recommended. A karyotypic abnormality can not only cause infertility, it can increase the risk of miscarriage and an abnormal pregnancy.

The treatment for male infertility is based on the suggested cause. Some causes of infertility can be accurately defined and effectively treated. Lifestyle changes such as avoiding smoking, excess alcohol, and heat to the scrotum can improve semen quality. Medication can help men with erectile or sexual dysfunction. Varicoceles can be treated through outpatient procedures. Hormone treatment can be instituted if there is a hormonal insufficiency of the thyroid gland or the signals from the brain that control sperm production (FSH, LH). Antibiotics can be given for prostatitis or other infection.

Most causes of male infertility, however, do not have an identifiable cause. For mild to moderate abnormalities in sperm numbers, sperm motility or morphology, an intrauterine insemination (IUI) can improve fertility. An IUI delivers a higher concentration of sperm closer to the egg and improves the efficiency of the process.

For moderate to severe abnormalities, in vitro fertilization with ICSI (intracytoplasmic sperm injection) can be performed with great success. IVF involves the female partner taking hormones to stimulate the ovaries, collecting eggs through an office procedure called an egg retrieval, and then injecting a single sperm directly into each egg (ICSI) to create embryos. These embryos then grow in the lab and are transferred back into the female's uterus. IVF with ICSI has revolutionized the treatment of male infertility because the vast majority of problems that lead to male infertility can be completely bypassed, as long as just a small amount of normal sperm is present (rather than the normal millions).

Sperm can be obtained for IVF/ICSI from an ejaculate or directly from the testes/epididymides using the techniques of testicular biopsy, epididymal sperm aspiration and non-surgical sperm aspiration (NSA). An NSA can be performed in a simple medicated procedure in the office at the time of the egg retrieval. This procedure can also be used to obtain sperm from men who have had vasectomies.

For men who are azoospermic (no sperm produced at all), the use of donor sperm offers an option for achieving pregnancy. Donor sperm can be obtained from either a known donor or an anonymous donor (or both) and can be used with both IUI and IVF.

Book Review- Navigating the Land of IF

2009-08-18T13:00:00.002-04:00

By: Kathleen

Navigating the Land of IF by Melissa Ford has a refreshing take on the experience of dealing with infertility. The “IF” in the title is named after the online abbreviation for infertility, but also plays on the many “ifs” involved in infertility. The Land of IF is a place no one really wants to visit but many women find themselves isolated there. Melissa Ford writes “There are the what ifs and if onlys and if this, then that…being here is all about living in uncertainty and doubt and wonder and hope”. The author goes one step further than most books on this subject, intimately sharing with the reader what it actually feels like to go through infertility, rather than a more clinical overview of the process. Through her witty and honest writing the reader feels like they are talking to a close friend on the subject of infertility.

She offers hard earned advice on how to survive and stay sane during infertility. Do you have to attend your cousin’s baby shower? If you do, how do you cope? Other sticky situations such as deciding who to tell (or not tell) about your infertility treatment are also discussed. Dealing with all the unsolicited advice you might get from friends or family is a topic most books on infertility do not address. Throughout the book, the author weaves in content about the large online infertility community. The internet is one place patients can discuss their situations and pose questions of other infertiles while still remaining anonymous. The book also serves as a field guide to diagnostic testing, infertility treatments, adoption, third-party reproduction, and living child free.

Melissa Ford is a mother of twins conceived via fertility treatments and runs an award winning blog called Stirrup Queens.

What Is Diminished Ovarian Reserve?

2009-08-14T15:57:00.000-04:00

By: Ervin E. Jones, MD, PhD, FACOG Reproductive Endocrinologist

Diminished ovarian reserve is a term used to describe a woman's potential for successful pregnancy--the desired end-point of all fertility investigation and treatment. In order for a pregnancy to occur, a normal egg must be available. The presumed ability of a woman to produce normal eggs underlies all so-called tests of ovarian reserve. There is no single test or group of tests capable of answering this question directly. All tests of ovarian reserve are indirect nonnumeric estimates of a woman's ability to produce normal eggs and of how many normal eggs remain in her ovaries. Such endocrine tests include, but are not limited to, cycle day 3 follicle-stimulating hormone and estradiol levels, the clomiphene citrate challenge test and measurements of other endocrine substances such as Inhibin-B and anti Müllerian hormone. These tests are often combined with what is referred to as the antral follicle count, i.e., the number of small follicles that can be seen on ultrasound during the early follicular phase.

Tests of ovarian reserve should be viewed as global estimates of ovarian competence. No test of ovarian reserve is completely predictive of a woman's ability to have a child. Instead, tests of ovarian reserve are used for counseling, decision making with respect to choice of treatment, and for inclusion and exclusion criteria. A normal test of ovarian reserve does not insure a woman's ability to produce normal eggs and embryos and an abnormal test of ovarian reserve does not always predict for failure. If they do not achieve pregnancy with their own eggs, women with significant diminished ovarian reserve often find that donor egg is a great option for achieving pregnancy.

When Staying Pregnant Is The Problem: Recurrent Pregnancy Loss

2009-08-12T13:00:00.000-04:00

By: Harvey J. Stern MD, PhD

The loss of a pregnancy is a very unsettling experience for couples, but when multiple miscarriages occur, the effect is even more devastating. The American Society of Reproductive Medicine (ASRM) defines recurrent pregnancy loss (RPL) as a condition, distinct from infertility, characterized by 2 or more failed pregnancies. Some experts consider 3 or more losses in a woman less than 35 years of age as warranting evaluation. Although about 15% of all clinically identified pregnancies end in miscarriage, less than 5% of women experience 2 consecutive losses and only 1%experience 3 or more. In women who have a history of 2 miscarriages, the subsequent risk of pregnancy loss rises to 25%, while 3 losses raises the risk of a fourth to 33%.

Often, the patient's obstetrician will initiate an evaluation of couples with recurrent pregnancy loss, but frequently, experts in reproductive medicine and medical genetics are also asked to provide consultation to these patients. At GIVF, we offer our experience in reproductive medicine and genetics to couples with RPL and work with their obstetricians to devise an appropriate evaluation and treatment plan.

There are many causes of RPL, and in at least 50% of couples who undergo evaluation, no explanation for RPL is identified. Possible reasons for RPL include:

Chromosomal abnormalities in embryos from egg or sperm, particularly in women over 40 years of age

Endocrine (hormonal) abnormalities

Diabetes and other metabolic disorders

Anatomical abnormalities of the uterus

Autoimmune disorders

Thrombophilias (clotting disorders)

Sperm chromatin abnormalities

Possibly some infections, lifestyle factors, or exposure to toxins

The typical evaluation will include a comprehensive medical and family history, physical exam, blood tests for chromosome analysis, measurement of hormone concentrations, autoimmune and thrombophilia testing, semen analysis and bacterial culture of the male and female reproductive tracts. For women, the anatomy of the uterus is evaluated with transvaginal ultrasonography, hysterosaplingography or saline hysterosonography. Any findings in the male can be further evaluated by a urologic specialist.

Testing can take several weeks to complete and, when results are available, the couple returns for a detailed discussion with their physician. All reproductive options are discussed, including assisted reproduction by IUI, IVF or donor gamete where appropriate. A comprehensive medical summary and treatment recommendations are forwarded to the patient's obstetrician.

Most patients do not need IVF and, in many cases, couples can be successful with natural conception. For patients identified with structural rearrangements of the chromosomes, IVF with preimplantation genetic diagnosis has been shown to be very effective. Patients with thrombophilia are often treated with anticoagulation, and surgical correction of structural uterine anomalies is generally possible.

The chance of having a successful full-term pregnancy is dependent to some extent on the number of miscarriages and whether any previous conceptions ended in a live-born child. Other significant prognostic factors include the maternal and paternal ages, presence of polycystic ovaries or other hormonal defects, maternal BMI and lifestyle choices such as smoking and alcohol consumption. In women with RPL without an identifiable cause, approximately 70-75% of women are able to have a successful pregnancy.

Disclosing Fertility Treatments To Others

2009-08-07T13:00:00.000-04:00

Couples frequently struggle with disclosing their infertility problems with friends, family and co- workers. An article on The American Fertility Association website titled Pros and Cons of Disclosing Fertility Treatment to Others discusses the stressful decision of deciding if and who to tell about your reproductive treatment. It is important to make the decision jointly with your partner. You will need to decide which "groups" of people you are going to include if you decide to disclose- immediate family and friends, extended family, or work colleagues. The author decribes some issues on disclosing:

Reasons to share:

Support- having a support system during the emotional rollar coaster of infertility treatments can be very beneficial.

Understanding- compassion from those whom you confide in can give you peace of mind but be prepared to also educate people about the physical and emotional demands of treatment.

Honesty- keeping secrets from family and friends can be a heavy burden to bear and can add an extra level of stress during a difficult time.

Reasons not to share:

Fear of censure- you may find that people do not agree with the path of treatment you have chosen and can be critical based on physical, emotional/spiritual, or financial concerns.

Fear of failing- with the emotional ups and downs of infertility treatment you may not feel like talking about cycle failures.

Fear of career interruption- some people worry that revealing infertility treatment to work colleagues may mean they are passed up for promotions or projects.

Some patients find that talking to a mental health professional who has experience in the area of infertility can be extremely helpful. Therapists can teach couples coping techniques and help them agree on choices that confront them.

Clinic Offers PGD Discount

2009-08-05T13:00:00.000-04:00

In celebration of GIVF's 25th anniversary they are offering a 25% discount off the cost of PGD for procedures performed between August 1 and December 31, 2009. To learn more about Preimplantation Genetic Diagnosis (PGD) at GIVF please click here.