Archive for the ‘Education’ Category

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.

 

Dietary DHA linked to sperm health and male fertility

Monday, January 16th, 2012

We have known for some time that male fertility depends on sperm-cell architecture. When a man has a low strict morphology (a detailed study of sperm shape) the chance of natural conception is very low and often requires IVF with intracytoplasmic sperm injection ( ICSI)  to achieve a pregnancy. 

A University of Illinois study reports that a certain omega-3 fatty acid is necessary to construct the arch that turns a round, immature sperm cell into a pointy-headed super swimmer with an extra long tail. Normal sperm cells contain an arc-like structure called the acrosome that is critical in fertilization because it houses, organizes, and concentrates a variety of enzymes that sperm use to penetrate an egg.

The study shows for the first time that docosahexaenoic acid (DHA) is essential in fusing the building blocks of the acrosome together. Marine fish, such as salmon or tuna, are excellent sources of this omega-3 fatty acid. For those who do not wish to eat fish numerous supplements are available.

For more information please check out our Lifestyle & Fertility section,

Your fertility: the eggs age at a different rate than the rest of the body

Sunday, December 18th, 2011

I have often heard these distressing words: "I eat right, exercise, don't smoke and take good care of myself. How come my ovaries are failing prematurely." My answer has been, "The ovaries don't care how you take care of yourself, they age based on genetics." According to a new article, they age independantly of the rest of the body. Of course, one can engage in habits, like smoking, which will make them age faster.

Reproductive and somatic aging use different molecular mechanisms that show little overlap between the types of genes required to keep oocytes healthy and the genes that generally extend life span, according to Coleen Murphy, Ph.D., of Princeton University, who described her new findings on oocyte aging at the American Society for Cell Biology Annual Meeting in Denver.

The different genetic pathways help explain why a woman's fertility begins to decline after she is 35 years old, while her other cells do not show significant signs of aging until decades later, Murphy explained. To compare the molecular mechanisms that are switched on or off with the aging of oocytes and somatic cells, Murphy's lab turned to the model organism, Caenorhabditis elegans (C. elegans), the worm-like nematode that set off the whole field of longevity research with the discovery in the 1990s that gene mutations affecting insulin regulation doubled the worm's life span. Insulin/insulin-like growth factor (insulin/IGF) signaling pathways also have been identified in humans. These pathways also seem to regulate longevity in humans.

Using DNA microarrays to measure the expression levels of genes, Dr. Murphy and her colleagues noted a distinctive DNA signature for aging eggs. They also found that the eggs of aging insulin and transforming growth factor-beta (TGF-beta) mutant mice had the same DNA profile that characterized young females.

Finding ways to delay oocyte aging would reduce an older woman's risk of giving birth to a child with birth defects, Murphy said.

 

Another danger to sperm: wi-fi laptops

Monday, December 5th, 2011

Males who place a laptop on their laps with the WI-FI on might have a greater risk of reduced sperm motility and more sperm DNA fragmentation, which could, in theory, undermine their chances of becoming fathers, researchers reported in the journal Fertility and Sterility this week.

This study was done in an artificial setting. The male participants were not tested with the laptops on their laps – semen samples were taken, placed under laptops for four hours, and then analyzed.

Previous studies had already shown that placing a laptop on a man's lap could potentially affect his fertility, especially if this occurs frequently and for long periods. The laptop can cause scrotal hyperthermia (elevated testicle temperature), which can considerably affect the quality of his sperm

In this new study, the authors explain that not only might the laptop-on-lap undermine semen quality, but also the Wi-Fi, if the laptop is near semen. They found that there was less damage when there was no Wi-Fi signal than when there was.

The double-whammy of the Wi-Fi signal and laptop temperature can cause:

  • A decrease in human sperm motility
  • Sperm DNA fragmentation – irreversible changes in the genetic code

Perhaps the electromagnetic radiation emitted by Wi-Fi damages the semen, the scientists suggested.

 

Thursday, December 1st, 2011

RPMG's Dr. David Meldrum announced the publication of his new book, "Survival of the Firmest" today. The book offers a new approach to erectile dysfunction.

After decades of medical research and a Nobel Prize-winning discovery that led to the development of Viagara and other drugs for erectile dysfunction (ED), Dr. Meldrum and other UCLA researchers offer a safe and effective alternative for erectile and heart health in a new book, Survival of the Firmest.  The recommendations in the book are based on scholarly reviews of  the research which were published in the International Journal of Impotence Research (Nov. 2011), the American Journal of Cardiology (Aug. 2011) and Fertility and Sterility (Dec. 2010).

            ED occurs in about 40% of men at age 40 and 70% of men at age 70, with 95% of cases having a likely medical basis, not psycholgocial as previously thought.  In 1998, a UCLA researcher shared the Nobel Prize for identifying nitric oxide as the key to erectile and vascular health.  Generated through a series of pathways in blood vessels, nitric oxide allows the vessels to relax and penile tissues to become engorged for an erection.  Exercise, a healthy diet, Omega 3 fatty acids and antioxidants aid nitric oxide production. 

            “With the aging of baby boomers and our society’s poor eating habits, obesity, infertility and ED are on the rise,” said David Meldrum, MD, who is also a clinical professor at the David Geffen School of Medicine at UCLA and lead author.  Referring to the ten steps, which also include weight loss (especially belly fat) and penile specific exercise, Meldrum said: “I’ve seen positive results in my own life and in patients who’ve made similar changes.” 

For more information, go to the erectile-function website.

If you’re over 40 consider IVF first

Tuesday, November 15th, 2011

Bypassing superovulation steps and proceeding directly to in vitro fertilization (IVF) technology appears to improve pregnancy outcomes for older women who have unexplained infertility, researchers reported at the annual meeting of the American Society for Reproductive Medicine.

This randomized trial found that older women with unexplained infertility were significantly more likely to achieve pregnancy and a live birth if treated immediately with in vitro fertilization rather than stepwise with superovulation techniques first.

Clinical pregnancy was achieved in 21 women in 24.7% of 85 cycles if these women were treated with in vitro fertilization as a first stop, compared with clinical pregnancy in 13 women in 7.3% of 178 cycles in which they were initially treated with superovulation treatments, a statistically significant difference (P=0.0008).

In addition, 13 women (15.3% of cycles) in the immediate in vitro fertilization group took home a baby, compared with 9 women (5.1% of cycles) who were treated at first with superovulation techniques (P=0.017). Most of the women who received superovulation treatments still underwent in vitro fertilization due to pregnancy failure.

"Beginning treatment with immediate in vitro fertilization compared to initial treatments of superovulation results in a significantly higher number of live-born infants and with significantly more couples pregnant, during the initial cycles of treatment," the author said in his oral presentation.

In the population of women who have unexplained infertility, going directly to in vitro fertilization reduced the number of cycles of therapy required to get pregnant and that the majority of their infants will be conceived through in vitro fertilization anyway.

Day 5 embryo biopsy for PGD or PGS less harmful to embryo than Day 3

Monday, October 24th, 2011

A study presented at the American Society of Reproductive Medicine Conference in Orlando last week, aimed to compare the safety and efficacy of embryo biopsies conducted for the purposes of screening for genetic disease at day 3 (cleavage stage) versus day 5 (blastocyst stage) of embryonic development. The impact that biopsy has on an embryo's ability to implant and develop into a baby had never previously been studied.

For twenty years, embryo biopsy for genetic disease screening prior to IVF transfer had been conducted on day 3, known as the cleavage stage, when only 6-8 cells have formed.. Day 3 biopsy involves removing 1-2 cells for testing. and removal of such a proportionately large percentage of the embryo reduces the embryo's chances of implantation.

More sophisticated techniques now allow biopsy on day 5, the blastocyst stage, when 200 or more cells are present.  The reason that day 5 biopsy does no apparent harm is that a dramatically smaller portion of the embryo is removed. Another reason is that the sample is taken from the outer layer of the embryo destined to form the placenta, called the trophectoderm (TE). The cells that form the baby are undisturbed, preserving the embryo's true potential.

Another advantage to the Day 5 biopsy is that a number of cells can be evaluated, reducing the chance for an error when one cell of an eight cell embryo may not reflect the remainder of the cells in an embryo, a phenomenon called mosaicism.

At Reproductive Partners we have been performing Day 5 biopsies for some time and find that it is a real advantage over Day 3 biopsies,

The Family Act of 2011-Contact your senator

Wednesday, October 5th, 2011

A bill to create a tax credit for the out-of-pocket costs associated with infertility medical treatment has been introduced in the U.S. Senate by Senator Kirsten Gillibrand (NY).  Aptly named the Family Act of 2011, S 965, this bill will potentially help thousands of people seek medical treatment that otherwise would be out of reach for them.

 

Key provisions of the bill:

  • 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 max amount in one tax year, it carries over to the next year for a max of five years after the first year you use the credit. 
  •  The Family Act is available to couples filing jointly with adjusted gross incomes of less than $222,520, but the credit is smaller for those earning between $182,500 and $222,520.

The goal is to get as many Senators as possible to co-sponsor this bill and to seek a hearing on the bill in the appropriate Senate Committees.   Please ask your two U.S. Senators to co-sponsor Family Act of 2011, S 965.  Please urge your family and friends around the country to send a letter as well.  We need thousands of letters flooding the U.S. Senate!

 

Is male infertility linked to cardiovascular disease?

Monday, October 3rd, 2011

A man who has never had any children has a greater chance of dying from cardiovascular disease than fathers, researchers from Stanford University School of Medicine, California, reported in the journal Human Reproduction. The authors say that they do not know whether male infertility is associated with an increased risk of cardiovascular disease. They tracked 137,903 men who were members of the AARP (American Association of Retired Persons) for a period of ten years. They had set out to find out whether there might be link between the number of offspring a man has had with his long-term health. They found a link between parental status and cardiovascular risk. However, they stress that their findings in no way provide proof of a cause and effect.

They restricted the list to men who were either married or had been married because they wanted to compare males who had the intent and the opportunity to have children. Men with previous underlying diseases, such as stroke,, heart disease or some related condition were excluded. Hence, the men in their list started off in relatively good health. Approximately 10% of the men died during the study. About 20% of those deaths were caused by cardiovascular disease. They found that a childless man had a 17% greater chance of dying from a cardiovascular disease compared to fathers. Mortality from all causes was slightly higher among the childless men. However, this increase was nearly completely due to cardiovascular disease. If cardiovascular disease risk was taken out, there was no statistically significant difference between the groups.

In this study, there was no way of assessing a man's reproductive intent.. However, by not including unmarried men in this study, childlessness was brought a step closer to being a proxy for infertility.

Another reproductive issue that raises the risk of cardiovascular disease is erectile dysfunction as detailed in Dr. Meldrum's book, "Survival of the Firmest: The Canary in the Coalmine." I highly recommend it for men with erectile dysfunction.

 

Sperm bank wants no more red-heads

Monday, September 26th, 2011

What's the matter with people today? I was a red-head as a kid and now I feel rejected.

The world's biggest sperm bank, Cryos International, whose main office is in Aarhus Denmark, says it does not want any more sperm from red-haired donors because they have more than enough to meet current demand. Ole Schou, agency director for Cryos, told msnbc.com that their stock was "about to explode".

"We have nothing against red-haired donors," said Schou, explaining that they just had too much stock for the demand at present. The current stock amounts to around 140,000 doses of sperm from redheads. He told the Danish press their clients tend not to choose a redhead, unless a partner, for example a sterile male, has red hair. Or perhaps less commonly, when a lone woman has a preference for redheads. Schou said the only reliable demand for sperm from red-haired donors was in Ireland, where it was selling "like hot-cakes".

I hope this is not a world-wide trend since I think it was cool to be a red-head.