Archive for the ‘Education’ Category

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Another factor that reduces IVF success-dirty air

Sunday, April 18th, 2010

There is so much one can't do when going through an IVF cycle; now you can add another, breathing. Dirty air, that is.

A study reported in Science Daily and published in Human Reproduction showed exposure to an increased level of air pollutants, especially nitrogen dioxide, has been associated with lower likelihoods of successful pregnancy among women undergoing in vitro fertilization. They examined the outcomes of the first pregnancy attempt of 7,403 women undergoing IVF in Hershey, PA, Rockville, MD and New York, NY over a seven-year period from 2000 to 2007.

The main culprit appears to be nitrogen dioxide as higher nitrogen dioxide exposures consistently was associated with the lower success rate, regardless of which indictor was used — positive pregnancy test, clinically confirmed intrauterine pregnancy or live birth.

The answer to this is to have your IVF done in Redondo Beach or La Jolla, CA where the ocean breezes keep the air cleaner.

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Length of storage of frozen embryos does not influence success

Wednesday, April 14th, 2010

Every couple who is fortunate enought to have extra embryos to freeze is concerned about how long they can remain in cryopreservation and still be able to create a healthy pregnancy. At Reproductive Partners our experience has convinced us that the time in the freezer does not significantly impact their chance of creating a successful, healthy pregnancy. Most of us feel that the embryos can survive throughout the reproductive life of the female partner. As I recall we have had at least one successful pregnancy after embryos were frozen for 14 years. Now a study in the March 2010 edition of Fertility & Sterility confirms our suspicions.

They found that the length of storage time did not have a significant effect on postthaw survival for IVF or egg donation cycles. There was no significant impact of the duration of storage on clinical pregnancy, miscarriage, implantation, or live birth rate, whether from IVF or oocyte donation cycles. The length of storage time or developmental stage at freezing were not predictive of embryo survival or pregnancy outcome. Only age of the patient at time of the freezing, survival proportion, and number of transferred embryos were positive predictors of pregnancy outcome.

They concluded that cryostorage duration did not adversely affect postthaw survival or pregnancy outcome in IVF or oocyte donation patients.

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Diet matters in making sperm

Tuesday, April 6th, 2010

We have all had the experience of being told that we need to eat a good, balanced diet. Turns out that's true, at least in order to produce normal sperm.

A study in the March 2010 issue of Fertility & Sterility examined the diets of 30 men with poor semen quality and 31 normospermic control subjects of couples attending a fertility clinic. They recorded dietary habits and nutrient consumption using a food frequency questionnaire. They found that control subjects had a significantly higher intake of carbohydrates, fiber, folate, vitamin C, and lycopene and lower intakes of proteins and total fat. Based on that they concluded that a low intake of antioxidant nutrients was associated with a poor semen quality.

RPMG's Dr. David Meldrum has a lot of information on the role of diet in male reproductive health on his website, Life Choices and Fertility.

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New Lifestyle and Fertility Article

Monday, April 5th, 2010

In a new fertility education article, Dr. Meldrum presents exciting new findings that indicate possible ways to influence the health of eggs and sperm in younger and older couples alike. From diet and exercise to smoking and stress, the modification of many lifestyle choices can increase a couple's chances of being successful.

Read the full Lifestyle and Fertility article here.

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Psychological stress may affect sperm parameters

Saturday, April 3rd, 2010

One of the most frequent questions I am asked by both men and women is whether stress may be affecting their fertility. There is a lot of evidence that stress can adversly affect a woman's fertility.There are studies showing that interventions with acupuncture and Mind-Body programs can have a positive influence on the chance of IVF success.

Now a multi-center study in the March 2010 issue of the journal Fertility & Sterility shows that more than two recent stressful life events decreased sperm parameters. In order to decrease the affect of variables that they may have found in infertile men, they examined the sperm of 744 fertile males. They found that men reporting more than two recent stressful life events had an increased risk of being classified below standard thresholds for “normal” defined by concentration, motility and morphology criteria, compared with men reporting less than two stressful life events.

The authors conclude that stressful life events may be associated with decreased semen quality in fertile men. Based on these findings the experience of psychosocial stress may be a modifiable factor in the development of male infertility.

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All we need from a sperm is its DNA.

Tuesday, March 30th, 2010

And its appearance is not a reflection of the DNA. That's what I've been telling couples when the male has severe abnormalities in his semen parameters. This especially applies to the appearance of the sperm (teratozoospermia), the strict morphology. Now a study in the March 2010 issue of Fertility & Sterility confirms the accuracy of my statement.

They looked at couples going through cycles of IVF with ICSI and correlated their outcomes with the degree of abnormality in the measurement of sperm appearance, the strict morphology. Fertilization rates were high (74%–77%), and clinical pregnancy rates ranged from 60% (subgroup with 0% normal sperm) to 56% (subgroup with ≥7% normal forms). The highest pregnancy and live birth rates were actually observed in eggs fertilized with sperm from specimens with the most severe teratozoospermia. The percentage of high-quality blastocysts was significantly greater in the severely teratozoospermic patients compared with patients with ≥5% normal sperm (37% vs. 28%). This is likely because in the lower morphology subgroups, female factors are less prevalent and the primary infertility problem is male factor.

So, according to this study,  those couples needing IVF with ICSI for severe teratozoospermia can rest assured that they do not have to worry that this abnormaility will adversly affect the outcome of their IVF cycles.

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Monozygotic twinning not increased in blastocyst embryo transfer over cleavage stage transfer

Tuesday, March 16th, 2010

One of the discussions we may have with patients prior to a blastocyst transfer is the supposed increased chance of an embryo at the blastocyst stage splitting and becoming an identical twin pregnancy.

In this study in the February 2010 issue of Fertility and Sterility, the authors monitored almost 2000 IVF cycles and found in this group of single-embryo transfers there was no statisically significant difference observed in the probability of monozygotic twinning between the cleavage-stage (Day 3) and the blastocyst group (Day 5).  The odds of an identical twin pregnancy was 2.6% in the cleavage-stage group (8/308) and 1.8% (5/271) in the blastocyst group The odds ratio for the incidence of monozygotic twinning after Day-5 embryo transfer was calculated to be 0.71 compared to the Day 3.

Despite the stage of the embryos at the time of transfer, one must be mindful of the almost 2% chance of monozygotic twins when selecting the number of embryos to transfer.

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Obesity impairs IVF success

Monday, March 8th, 2010

One of the issues I discuss with new patients when it's pertinent is weight loss in order to improve the chance of IVF success.

The latest evidence supporting this is in an article in the February 2010 edition of Fertility & Sterility looking at the outcomes in different groups based on BMI (body mass index as kilograms per square meter). They compared lean (<20 kg/m2); normal (20–24.9 kg/m2); overweight (25–29.9 kg/m2); and obese (≥30 kg/m2) women in 6500 IVF cycles. Although there was no difference in insemination procedure, fertilization rate, day of transfer, mean number of embryos transferred and cryopreserved embryos, percentage of blastocyst transfers, or embryo quality on day 2 and 3 among groups, pregnancy and live birth rates were reduced progressively with each category of increase in BMI. In addition, the cumulative pregnancy rate after four IVF cycles was reduced as BMI increased.

This confirms other studies that being obese or even just overweight overweight has a negative effect on IVF success.

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Does preimplantation genetic screening (PGS) improve IVF success rates in women over 35?

Friday, March 5th, 2010

Some fertility centers promote preimplantation genetic screening as a way of improving IVF success rates in women over 35 (defining advanced maternal age).

Now a study in the January 2010 edition of Fertility & Sterility shows that PGS does not significantly improve implantation, pregnancy or live birth rates. In this randomized control study from Belgium, the clinical implantation rate per embryo transferred was compared between the PGS group (analysis of chromosomes 13, 16, 18, 21, 22, X, and Y by FISH) and the control group without PGS.

No differences were observed between the PGS group and the control group for the clinical implantation rate, the ongoing pregnancy rate at 12 weeks and the live born rate per embryo transferred.  A normal chromosome component was observed in only 30.3% of the embryos screened by PGS.

In this randomized controlled trial, the results did not confirm the hypothesis that PGS by FISH in 3-Day embryos results in improved reproductive outcome in patients with "advanced maternal age.".

In the future newer techniques of chromosome analysis such as comparative genomic hybridization (CGH) which can analyze all chromosome pairs and the ability to analyze blastocyst cells, freeze the embryos and transfer only chromosomally normal embryos may result in better outcomes and the need to transfer fewer embryos and reduce high-order multiple pregnancies as well.

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How many embryos to transfer in a frozen embryo transfer?

Wednesday, February 24th, 2010

In a variation on the theme of transferring fewer embryos to reduce high-order multiple pregnancies, an article in the January 2010 issue of Fertility & Sterility shows that transferring two instead of three embryos leads to equal success and a lower triplet rate.

In reviewing 145 frozen embryo transfers, doctors at the University of Connecticut found that transfer of two instead of three frozen embryos in patients less than 35 years old resulted in a significant decrease in multiple pregnancy rate without compromising pregnancy or live birth rate. Transferring additional embryos when a patient had an unsuccessful fresh cycle was not warranted. In the age group 35–39 years, transferring two instead of three embryos did not decrease pregnancy or live birth rate and had no effect on the risk of high-order multiples.

So even in frozen embryo cycles the trend is to transfer fewer embryos.

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