GIVF eNews

January 2013 eNews

Happy New Year!

Ten Things to Do Now If You Want to Get Pregnant in 2013

If you want to have a baby soon, there are several steps you can take now to prepare:

  1. Improve your overall health.
    Consider your Body Mass Index (BMI). Being in good shape and good health will improve your likelihood of having a healthy pregnancy and a healthy baby. Obese women may have difficulty conceiving and they are at risk for weight-related complications during pregnancy, including high blood pressure and diabetes. Underweight women may have irregular cycles or stop ovulating altogether. Your weight does not have to be perfect. Sometimes just a 5% or 10% weight reduction (or increase if you are underweight) makes a significant difference when trying to conceive. If you smoke, quit before you become pregnant. Smoking during pregnancy is linked to miscarriage and to low birth weight for babies.

  2. Stop taking birth control pills.
    If you are taking birth control pills, stop at least two months before you want to become pregnant. Birth control pills can affect your hormones, so your body needs time to readjust after you stop them. You can switch to another form of birth control until you are ready to become pregnant.

  3. Find out about new technologies and testing.
    If you have had difficulty conceiving or successfully carrying a pregnancy in the past -- even with assisted reproductive technology -- find out whether recent advances in treatment and testing (including Preimplantation Genetic Diagnosis (PGD) with the 24 Chromosome Microarray test) could help you. GIVF's reproductive endocrinologists and genetics specialists can advise you.

  4. Take folic acid pills.
    Folic acid helps to prevent neural defects in developing babies, even in the very early stages of pregnancy. Start taking folic acid pills as soon as you decide it is time to become pregnant -- don't wait for a positive pregnancy test.

  5. Talk to your doctor about any medications, supplements or vitamins you take.
    Many medications (including some used to treat depression, high blood pressure and other common conditions) and over the counter supplements can be harmful to a developing fetus. Find out now if you need to change your regimen.

  6. Make an appointment to see your primary care provider or gynecologist for pre-conceptual counseling.
    Your doctor may suggest some general screening tests or identify an issue (such as irregular menstrual cycles or poor egg quality) that would require referral to a specialist sooner rather than later.

  7. Find out what your health insurance covers.
    Will your insurance cover all or part of the medical costs of a fertility assessment (for both partners), fertility treatment (if you need it), pregnancy, delivery and infant health care? If you need donor eggs, is that treatment covered? Talk to the benefit experts at work, call your insurance carrier and/or read your policy. Consult the financial counseling team at GIVF. You may qualify for a discount, refund or other program at GIVF. (Visit Financial Programs & Pricing for specific information about infertility treatment and health coverage.)

  8. Find your perfect sperm or egg donor.
    If you need donor sperm or donor eggs to become pregnant, you can begin choosing a donor for 2013 without leaving your living room. An enormous amount of information about donors is available online. To learn more about fresh and frozen egg donors, visit our Donor Egg IVF page and to learn about more than 100 available sperm donors, visit www.FairfaxCryobank.com.

  9. Time intercourse properly.
    When you are ready to get pregnant, make sure you are having sex at the "right time of the month." Multiple studies have shown that the best chances for pregnancy are when intercourse occurred within 3 days of ovulation. After ovulation, pregnancy rates decreased dramatically. For men, studies have shown that with abstinence intervals of 10 days or more, semen quality worsens. In general, the ideal abstinence interval is thought to be 2-5 days. However, there are studies that have shown that even men with low sperm counts may have good semen analysis results with daily ejaculation. For information about more precise ways of determining the best times for conception, talk to your physician.

  10. Reserve the time you need.
    Explore your options for taking time off for medical appointments before your baby arrives and for parental leave after delivery. If you are married or have a partner, check out leave options for both of you. Some couples take serial leave -- first one and then the other -- to provide care for an infant. Look at everything available to you: medical leave, parental leave, vacation time, unpaid leave, etc., to make a plan. You might find that skipping a few days of vacation now will allow you to spend more time with your new baby later.

What's New:

  • Support The Family Act
    Congress is currently considering legislation that would create tax credits that could help tens of thousands of middle class families afford the out-of-pocket medical costs associated with infertility treatment and with preserving fertility if they are diagnosed with cancer. Please join GIVF and RESOLVE: The National Infertility Association in supporting The Family Act (Senate Bill S965 and House Resolution HR3522). The benefits of The Family Act would be available to couples filing jointly with adjusted gross income of less than $222,520, but the credit would be smaller for those earning between $182,500 and $222,520.

    • The Family Act covers the out-of-pocket costs associated with in vitro fertilization (IVF) including diagnostic tests, laboratory charges, professional charges, and medications for IVF.
    • The Family Act covers the out-of-pocket costs of fertility preservation procedures if the man or woman is diagnosed with cancer and the cancer treatment or disease itself may result in infertility.
    • The Family Act has a cost sharing provision allowing 50% of all applicable medical expenses to be covered up to a lifetime maximum of $13,360. You would need to have out-of-pocket costs totaling $26,720 to claim the entire credit in your lifetime.
    • If you do not owe taxes in a particular year, do not owe enough taxes to use the whole credit, or do not reach the maximum amount in one tax year, it carries over to the next year for a maximum of five years after the first year you use the credit.

    You can help to make The Family Act become law. Contact your Senators and Congressional Representative today to state your support. Visit www.house.gov and www.senate.gov to identify and contact your representatives. Your opinion counts!

    RESOLVE: The National Infertility Association, established in 1974, works to ensure equal access to all family building options for men and women experiencing infertility or other reproductive disorders. Through education, advocacy and support systems, RESOLVE improves the lives of women and men living with infertility. Please join GIVF in supporting RESOLVE's important work. To donate to RESOLVE, please visit 2012 Year End Appeal Donation Form - RESOLVE: The National Infertility Association.

  • Expanded Multicycle IVF Program
    GIVF is offering an expanded Multicycle IVF program for women up to age 42 who might have been excluded from other programs due to their age or test results. The two year agreement includes up to three IVF cycles, freezing and storage of embryos produced in the IVF cycles, but not transferred at that time and associated frozen embryo transfer cycles. Patients may choose to add additional services, including preimplantation genetic diagnosis, non-surgical sperm aspiration or assisted hatching for a fee.

    To find out more about this exciting Multicycle option, call 800.552.4363.

  • IVF Plus: A Discount Program for Past and Future GIVF Patients
    GIVF is happy to introduce IVF Plus, a new financial program that allows GIVF patients to put 25% of base fees they have already paid for standard IVF at GIVF towards the cost of a Donor Egg IVF cycle. Click here for details about the program or call 800.552.4363 to speak with a GIVF financial counselor to learn more.

  • FREE SEMINAR: Understanding Prenatal Testing
    Join Dr. Harvey Stern on Saturday, January 26, 2013 at 10AM and learn the differences among prenatal testing options. Find out more and register for the seminar here.

Chromosomal Microarray versus Conventional Karyotyping for Prenatal Diagnosis of Fetal Cytogenetic Disorders
By Harvey J. Stern MD, PhD
Director of Reproductive Genetics and the Fetal Diagnostic Center

Since the discovery in 1959 that individuals with Down syndrome have an extra chromosome number 21, chromosome analysis after amniocentesis or chorionic villus sampling (CVS) has been the accepted "gold standard" for fetal prenatal diagnosis. This "conventional" cytogenetic testing (karyotype) was able to identify extra whole chromosomes such as trisomy (three copies) of chromosome 21, 13 or 18 as well as other structural rearrangements that were a size greater than 5-10 million base pairs (5-10MB) of DNA, which is the resolution of what could be seen under the microscope. In 2005, genomic techniques were introduced that had the ability to identify smaller "submicroscopic" alterations called copy-number variations (CNVs) that are of a size of 1-10 thousand base pairs or 1 kilobase (KB), which represents a one-thousand fold higher resolution. Chromosomal microarrays (CMA) have been used for several years in the pediatric setting, where it is the first-line test for children with autism or other intellectual deficiencies. In these cases, 12-14% of children have a significant pathologic CNV despite having normal conventional chromosome analysis. Use of CMA in prenatal genetic diagnosis has been introduced more recently as our knowledge of the significance of CNVs has increased dramatically due to the development of databases linking the observed CNV with a clinical syndrome such as autistic spectrum disorder.

In a 5-year study funded by the National Institute of Child Health and Human Development (NICHD), Dr. Ron Wapner of Columbia University recently published in the New England Journal of Medicine, an article entitled "Chromosomal Microarray versus Karyotyping for Prenatal Diagnosis." In this study, the accuracy, efficacy and incremental detection of CMA versus conventional chromosome analysis were compared in 4,406 women who underwent prenatal diagnosis for varying indications including advanced maternal age, history of a previous abnormal fetus or ultrasound abnormalities in a current pregnancy. Samples obtained at amniocentesis or CVS from 29 participating centers were divided in half and both conventional cytogenetic testing and CMA were carried out. Array comparative genomic hybridization was used as the CMA test. In this test, DNA from prenatal samples was isolated and labeled with a green fluorescent dye. DNA from a normal individual was similarly labeled with a red dye. The two labeled samples are mixed together in equal amounts and then exposed to a glass slide where known segments of DNA called probes are fixed. An equal mix of red and green binding to the probe will yield a yellow color on the slide and indicate an equal amount of DNA at that spot for the test and known normal samples, which implies a normal result. If excess DNA is present in the test sample, the color will be shifted to green indicating excess amount of DNA at that probe site. Conversely, deficiency of green DNA in the mix will yield a red color indicating absence of the DNA sequence in the test sample. These microdeletion or microduplication syndromes are produced by CNVs that can vary in size from 1KB to several MB. All of us carry multiple CNVs which are generally small and are felt to be benign changes. Pathologic CNVs have been identified in children with a wide spectrum of physical and intellectual disabilities. For example, in children with autism, 1-3% carry a maternally inherited duplication involving the long arm of chromosome 15 (15q11-q13), while in other cases, a duplication of chromosome 1 (1q21.1) or chromosome 17 (17q12) is seen. Many other microdeletion/microduplication syndromes have been identified which have been linked to conditions with either physical abnormalities and/or intellectual deficiency. Data from other studies has suggested that there is a cumulative relationship between the number of specific CNVs and the development of intellectual deficiency or increasing severity of previously described syndromes with mental retardation and other physical anomalies.

In the study, CMA was able to correctly identify all chromosome anomalies seen on standard chromosome analysis. In addition, CMA revealed CNVs in 1400 cases of which 88% were seen previously and considered benign. Overall, 1.7% (1 in 60) of cases with normal chromosome analysis had a pathologic, neurologically significant CNV. In cases where fetal ultrasound anomalies were seen, this rate increased to 6% of cases with normal chromosome analysis. This comparatively high rate of identification of clinical disorders of the genome using CMA may result in more women requesting prenatal testing with CVS or amniocentesis and CMA.

At the current time, non-invasive prenatal testing using fetal DNA in maternal plasma has gained acceptance due to the safety of the procedure. This screening test is designed to detect trisomy 21, 13 and 18 which would be expected to occur in approximately 1/500 conceptions. This is compared to the detection rate of 1.7% (1/60) for pathologic CNVs detected by CMA testing of fetal CVS or amniocentesis samples. In cases where ultrasound defects are seen, CMA detects significant pathologic CNVs in 6% of cases. The improved performance of CMA will lead some pregnant couples to seek fetal testing by CVS/amniocentesis with CMA, despite the increased risk of invasive prenatal testing. As in all situations in medicine, patient decisions are primarily determined by the perceived benefit/risk ratio. Finally, it is the opinion of many specialists in Genetics and Fetal Medicine that CMA will likely replace conventional karyotyping as the procedure of choice in prenatal diagnosis.

Harvey J. Stern, MD, PhD, FACMG, FAAP is the Director of Reproductive Genetics and the Fetal Diagnostic Center at the Genetics & IVF Institute.

The Genetics & IVF Institute (GIVF) regularly publishes an informative newsletter featuring the latest infertility news and developments. The newsletter is sent electronically via email. To subscribe, click here.