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Study links ICSI to greater chance of birth defects…or is it just the infertility?

Sunday, May 6th, 2012

In a widely reported study, the ICSI procedure was found to result in a greater chance of congenital abnormalities than either in the general or infertility population. It's well-known that couples dealing with infertility have a higher chance if birth defects so the real question is whether the increase seen in this study is due to the procedure or just the severity of the infertility warranting the ICSI procedure.

Many have weighted in on this issue.

Linda Giudice MD, PhD, President-elect of the American Society for Reproductive Medicine (ASRM) said, “This study confirms what has been known for quite some time: Patients who need medical assistance to conceive have a somewhat higher risk of having children with birth defects than parents able to conceive on their own.  Patients considering medically assisted conception have been, and should continue to be, counseled on those risks prior to undergoing any treatment.”

Glenn Schattman, MD, President of the Society for Assisted Reproductive Technology (SART) said “It is important to note that women with a history of infertility who did not undergo ART treatments also had a higher increase of having children with birth defects. This combined with the finding that those using ICSI (Intra Cytoplasmic Sperm Injection) also had slightly elevated risks of birth defects suggest that  the underlying problem that led them to seek medical assistance in the first place is likely contributing to the elevated risk of birth defects in their children. Some results in this study are reassuring for patients: in cycles not including ICSI, the adjusted odds ratio for IVF conceived children did NOT show a significant difference in birth defects children born following embryo freezing had no higher risk of birth defects than naturally conceived children. These are interesting and important findings and we will need much more research to allow us to help patients overcome their infertility with treatments that are as safe as possible for them and the children born from the treatments.”

RPMG's Dr. David Meldrum, who is on the editorial board of the journal Fertility & Sterility commented, " Infertile patients have an increased risk, and ICSI allows couples to conceive that otherwise might not become pregnant at all. It is still unclear whether there is any increase with IVF compared to infertile controls."

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Asian egg donors in demand

Friday, May 4th, 2012

According to an article in the May 4th edition of the Los Angeles Times Asian egg donors are in such demand that they are being paid more than the fees that other ethnicities are getting.

Read the srticle and please comment on the ethics of this practice.

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The New Face of Infertility: Under 35 and Frustrated

Tuesday, April 24th, 2012

There is an interesting article in USA Today, "The New Face of Infertility: Under 35 and Frustrated."

I have news for them: there is nothing new about being under 35, infertile and frustrated. It's just that the focus of infertility has been the stereotype of the career women who have waited until after 40 to start trying.

One of the biggest problems we have in helping infertile couples no matter what their age is getting them into treatment with real infertility specialists when they have not been able to conceive in six months to a year. I wish we could get the message across to people who we could really help easily, most without high level fertility treatments.

This is National Infertility Awareness Week: help me get the message out.

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Can embryo co-culture overcome embryo quality issues?

Monday, April 16th, 2012

 This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.

One of the most difficult issues to overcome is persistent poor embryo quality. For some time Reproductive Partners has  been using embryo co-culture (cultureing the embryos along with other cells just as occurs in the body) as one of our startegies to improve embryo quality. Now a study reported at ASRM supports this practice.

Eggs were randomized between regular culture and co-culture using autologous clusters of granulosa cells (the cells that surround the egg in that patient's body). Day 3 embryos had improved morphology, more developed to day 5 and more were chosen for transfer. As with other studies of cumulus co-culture, improved embryo morphology was confirmed. It could be considered in any case where reduced embryo morphology has been previously observed or when reduced egg quality is expected.

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Improving IVF success rates in women over 38 without increasing multiples

Tuesday, April 10th, 2012

This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.

One of our greatest challenges has been trying to improve overall IVF success rates in women over 38 without increasing the risk of multiple pregnancies including twins. The conventional approach has included transferring more embryos than in younger women. But inherent in that strategy is a increased risk of twins or more, creating riskier pregnancies. Now a new approach reported at ASRM in 2011 may help solve this problem.

 

In a retrospective study, women mean age 38.4 who had blast comprehensive chromosome screening  (CCS) and frozen embryo transfer (FET) of a single normal blast had higher implantation and ongoing pregnancy rate (61%) than women having elective single embryo transfer (eSET) (fresh or frozen) without CCS. This may become the way to avoid twins in women over 35 while keeping IVF success high.

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Most miscarriages are due to abnormal chromosome configuration

Tuesday, March 27th, 2012

This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.

One of the most common questions I hear when women miscarry is, "Why did this happen." Conventional wisdom is that is is usually caused by some abnormality in the chromosomes of the embryo. Now a study reported at ASRM in patients with recurrent pregnancy loss confirms that point of view.

In 177 cycles of couples with recurrent pregnancy loss, preimplantation genetic screening (PGS) using CGH was done by day 3 (143 cycles) or day 5 (34 cycles) biopsy. 63% of embryos were abnormal. But by transferring only chromosomally normal embryos he miscarriage rate was only 6% in this high risk group compared to an expected rate of 35%. This study confirms that idiopathic recurrent pregnancy loss is mostly caused by chromosome abnormalities, and that the chance of fetal loss is dramatically decreased using PGD. using only day 5 biopsy would be expected to produce even more reliable results without influencing the chance of success (although here 40% had ongoing pregnancies). Also, the ability to do an elective single embryo transfer (eSET) is a further benefit of CGH, not only for women under age 35.

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Is IVF the correct first treament for unexplained infertility?

Monday, February 13th, 2012

This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.

 Women over 38 with at least 6 months of infertility and a normal work up (unexplained in fertility) were randomized to clomiphene with IUI, injectables with IUI or immediate IVF. After two cycles, per cycle pregnancy rates were 6.7, 7.7, and 24.7%.

It's expected that there would be a higher pregnancy rate with immediate IVF. This is not "one size fits all." The length of infertility should determine the appropriate starting treatment. For instance for someone trying for only 6 months, immediate IVF is too aggressive. For someone trying for two years it may be appropriate.

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Many IVF patients are not following lifestyle recommendations

Friday, February 10th, 2012

Accoring to a study reported at the 2011 American Society for Reproductive Medicine annual meeting a surprising percentage of IVF patients are not following their center's lifestyle behavior recommendations based on their responses to an online Lifestyle and Health Habits Questionaire.

Their center recommended they decrease their exercise regimen. One hundred percent of patients expercised during their cycles. Nearly half (49.5%) consumed alcohol even they were instructed in writing to eliminate alcohol consumption. This particular center advised their patients to limit caffeine consumption to less than 50 mg daily which is less than one cup of coffee. Three-fourths reported caffeine consumption and almost half drank caffeine daily, most often coffee which has 60 to 200 mg of caffeine per cup. Twelve percent took herbs during their cycle even though they were explicitly told not to take herbs.

We believe that these lifestyle behaviors can have an adverse impact on outcome. For more on these issues, please see our Lifestyle & Fertility pages.

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Rejuvenating Eggs From Older Women

Tuesday, February 7th, 2012

Can this be true? It may be true, at least in mice.

A study being conducted in mice indicate that administering coenzyme Q10 to one-year old mice-the equivalent to women in their 40s-for three to four months significantly increased the number of ovulated eggs as well as the number of successful pregnancies. The treated mice also had an average of 11 pups per litter compared to six per litter in age-matched controls. The Toronto team is now conducting human trials.

For more information on supplements, please visit our Lifestyle and Fertility pages.

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More embryos do not lead to better success rates

Tuesday, January 17th, 2012

Haven't we been saying this for a long time?

 

 

A new study of fertility treatment in found that women who get three or more embryos have no better odds of having a baby than those who get just two embryos.

They also have a greater chance of risky multiple births.

“Women who have gone through infertility treatment want the best chance of having a baby, but we need to explain that the data shows transferring more embryos doesn’t actually do that,’’ said Dr. Scott Nelson, head of reproductive and maternal medicine at the University of Glasgow, who co-authored the study published in Thursday’s issue of Lancet.

In Western Europe, where some countries pay for in-vitro fertilization, or IVF, many authorities recommend a single embryo transfer for women under 37 and a maximum of two embryos for women 37 to 40. For women over 40, three is often the limit by law.

In the United States, there are relatively lax guidelines and a lack of regulation. That country has seen a rise in multiple births, including the highly publicized case of Nadya Suleman, labeled the “octomom.’’ She had octuplets in 2009 after her doctor transferred 12 embryos. She already had six children through IVF.

Most fertility treatment in the U.S. is paid for privately which experts believe encourages the use of more embryos in the belief it will improve odds.

The American Society for Reproductive Medicine recommends single embryo transfers for women under 35, but there is no enforcement of that. For women 35 to 37, they advise two to three embryos, and three to four embryos for women ages 38 to 40.

In their study, Nelson and Debbie Lawlor, of the University of Bristol, analyzed data for all 124,000 IVF cycles in the U.K. between 2003 and 2007, resulting in more than 33,500 live births. The women were 18 to 50 and had varying histories of infertility. During IVF, eggs are fertilized with sperm in a lab dish and then put in the womb.

For women under 40 who had two embryos transferred, the live birth rate was 33 percent overall. With three embryos, that dropped to 25 percent, though researchers weren’t sure why. Nelson said it might be due to the higher risk of miscarriage in a multiple pregnancy and that miscarrying one fetus would jeopardize the entire pregnancy.

For women over 40, the live birth rate was 13 percent whether they had two or three embryos transferred.

Nelson said patients going through IVF may pressure doctors to transfer more embryos, believing it may boost their chances of having a baby and avoiding more treatment.

 

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