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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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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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Dr. Wisot quoted in article in Globe

Friday, February 24th, 2012

RPMG's Dr. Arthur Wisot is quoted in the March 5th 2012 issue of Globe magazine on the tragic death of Whitney Houston. Rumors were circulating that Ms. Houston was pregnant when she died. Dr. Wisot addresses the small chance that a 48-year-old could get pregnant with her own eggs naturally.

GL10004A1_2012

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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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Egg freezing is accepted as preventing disease and age-related fertility decline…in Israel

Sunday, August 28th, 2011

According to an article in the August 2011 issue of Fertility & Sterility, the Israel National Bioethics Council (INBC) issued recommendations permitting egg freezing to prevent both disease and age-related decline in fertility. The INBC considers age-related infertility a medical problem and treats the new technology favorably as preventive medicine. As a comparison, the major regulatory bodies in Europe and the U. S. consider the procedure experimental for fertility preservation unless for a medical reason such as cancer treatment. Treating this as preventive medicine allows women to avoid the need for egg donation and ineffective infertility treatments at an advanced age.

Two recent studies demonstrated that the risk of congenital anomalies is similar to natural conception as well as conception from IVF cycles. But since the technology is so new, there are no long-term data concerning the health or emotional well-being of children conceived from frozen eggs.

I believe that the Israelis are way ahead of other western countries in accepting this technology and that it will ultimately be accepted in Europe and the U. S. as more experience is gained. At Reproductive Partners we have seen that this is an effective technique to preserve fertility for both medical and social reasons.

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How many eggs do you need to have a good chance of a successful IVF cycle?

Tuesday, August 23rd, 2011

Two? Five? Twenty?

I have always said that it's not about quantity; it's more about quality. Now a study in the August 2011 issue of the medical journal Fertility & Sterility shows that more eggs after you reach a certain threshold does not make success more likely. They studied 737 women having their first IVF cycle with their own eggs. They found that there was an advantage to obtaining six or more mature eggs compared with five or fewer eggs. But there was no advantage to obtaining 10 or more eggs compared to 6-9 eggs.

Actually less stimulation might result in better egg and embryo quality accounting for the fact that larger numbers of eggs did not provide an advantage.

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New evidence shows antioxidants may be helpful in infertility

Wednesday, August 17th, 2011

A growing body of evidence suggests that antioxidants may have significant value in addressing infertility issues in both women and men, including erectile dysfunction and researchers say that large, specific clinical studies are merited to determine how much they could help.

A new analysis, published online in the journal Pharmacological Research, noted that previous studies on the potential for antioxidants to help address this serious and growing problem have been inconclusive, but that other data indicates nutritional therapies may have significant potential.

The findings were made by Tory Hagen, in the Linus Pauling Institute at Oregon State University, and Francesco Visioli, lead author of the study at the Madrid Institute for Advanced Studies in Spain. The results from early research have been equivocal, Hagen said, but that may be because they were too small or did not focus on antioxidants. Laboratory and in-vitro studies have been very promising, especially with some newer antioxidants such as lipoic acid that have received much less attention.

RPMG's Dr. David Meldrum has written extensively on the effect of diet and supplements including his book, "The Survival of the Firmest." For more information see the Lifestyle and Fertility pages of our website.

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Octomom’s doctor’s license is revoked; Dr. Wisot has the last word

Thursday, June 2nd, 2011

According to an article in today's LA Times:

The medical ethics controversy that erupted when Nadya Suleman gave birth to octuplets two years ago took a decisive turn Wednesday when the California medical board announced it will revoke the license of the Beverly Hills fertility doctor who helped the single mother of six conceive eight more children.

The "Octomom" case focused national attention on what critics have called "the Wild West" of fertility medicine. And Dr. Michael Kamrava, who assisted Suleman by implanting her with 12 embryos, became a symbol to some of the problems in the burgeoning industry.

Of course Dr. Wisot had the last word in the article:

"Dr. Arthur Wisot, fertility specialist with Reproductive Partners in Redondo Beach, said he believes the case may discourage doctors who previously might have been tempted to implant more than the recommended number of embryos.

"That's a good outcome," he said."

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RPMG’s Dr. Wisot quoted in National Enquirer

Friday, July 2nd, 2010

Yes folks, the National Enquirer.

It's in the July 12th edition cover story on Kelly Preston's (Mrs. John Travolta) twin pregnancy at age 47.

Yes folks, twins at 47 and although they acknowledge it's an IVF pregnancy, they deny it's egg donation. OK.

Unfortunately she is still early and something has happened that has required her to restrict her travel. The article claims that one of the fetuses is low in the uterus.

We hope everything goes well for the Travoltas. The last thing this family needs is another tradegy.

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Dr. Wisot quoted in L. A Times

Tuesday, January 5th, 2010

In the January 5, 2010 edition of the L. A. Times RPMG's Dr. Arthur Wisot was quoted in an article about Octo-Mom's doctor being charged with gross negligence by the Medical Board of California.

From the article:

Fertility doctors said that it's difficult to judge whether fresh or frozen embryos should have been used, but that the medical board seems to be "throwing the book at him," said Dr. Arthur Wisot of the Redondo Beach-based Reproductive Partners.

Fighting the accusations could prove difficult, experts said.

"There's no doctor that I've talked to that would get on the stand and feel comfortable defending his actions," Wisot said.

You can read the entire article at the L. A. Times website.

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