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Archive for the ‘RPMG News’ Category
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Thursday, August 19th, 2010What causes poor embryo quality? Could it be the sperm?
Friday, August 6th, 2010One of the misconceptions about fertility treatment in our book, "Conceptions & Misconceptions" is the notion that "more is not necessarily better; better is better." In other words, quality is more important than quantity. This is especially important when considering embryos.
When a couple ends a cycle with poor quality embryos the focus is usually on the eggs. But now there is more focus on sperm quality as a cause of poor embryo quality, specifically the degree of DNA fragmentation in the sperm. In an article in the July 2010 issue of Fertility & Sterility the percentage of normal sperm with fragmented DNA (normal SFD) was correlated with embryo quality and pregnancy outcomes.
A highly statistically significant negative correlation was found between the percentage of normal sperm with fragmented DNA (SFD) and embryo quality. When the percentage of SFD was less than 17.6 %, the likelihood of pregnancy was 3.5 times higher. The authors concluded that the DNA fragmentation of morphologically normal sperm negatively impacts embryo quality and probability of pregnancy in ICSI cycles.
This is an issue that we have been looking at for some time, performing a Sperm Chromatin Structure Assay (SCSA) when couples have experienced repeated IVF failure, especially associated with poor embryo quality. Strategies to reduce DNA fragmentation include lifestyle changes when appropriate, antioxidant vitamins, shorter intervals of ejaculation prior to the IVF specimen and in rare cases, obtaining sperm by testicular biopsy (TESE).
How do fertility patients choose to dispose of unused embryos?
Wednesday, August 4th, 2010IVF success rates have become so good that there are now many couples, especially those starting young, who find themselves with remaining frozen embryos after they have completed their family. Options for dealing with unused frozen embryos include discarding, donating them for research or donating them to another couple. Each ootion involves complex issues in making this difficult decision.
A survey in the July 2010 issue of Fertility & Sterility examined the choices made by parients at one fertility center. Of 149 patients from Washington University in St. Louis, 59% donated them to scientific research, 38% discarded, and 3% donated to a known or anonymous person/couple for attempted pregnancy. There was no significant difference in the choice selected between patients who achieved a pregnancy with delivery compared with those who did not. In addition, the patient's age at retrieval and at the time of disposition as well as the total time in storage was not significantly different between patients electing to discard and those donating to research.
My experience at Reproductive Partners is that most couples avoid making this difficult decision and just keep their embryos frozen indefinitely. For highly successful couples the optiion of donating to another couple who has exhausted their options is a a way of giving something back when they have been so fortunate. But, as we can all understand, it can be difficult to have one's biologic offspring out there without having any knowledge or control of their future.
A few years ago there was an estimate of 400,000 frozen embryos in IVF centers throughout the United States, lending credability to the difficuty in making a decision to release them.
RPMG’s Dr. Wisot quoted in L.A. Times
Wednesday, July 14th, 2010Dr. Arthur Wisot was quoted in the July 14th edition of the Los Angeles Times on the additional charges by the Medical Board of California against Octomom's doctor.
In response to a question about how this reflects on the fertility industry Dr. Wisot replied, "Most people understand that these are the actions of somebody who is way, way out of bounds and doesn't represent the mainstream of fertility treatment," said Dr. Arthur Wisot, fertility specialist with Reproductive Partners in Redondo Beach . "He has been shunned by the medical community as much as you can possibly shun somebody….He's totally out there, flying solo."
Genetic screening for sperm donors
Monday, July 12th, 2010According to a survey of 26 sperm banks reported in the July 2010 edition of Fertility and Sterility, sperm banks vary considerably in their practices of genetic screening of donors.
Cystic fibrosis carrier screening, chromosome analyses, and hemoglobin evaluations are performed on the majority of sperm donor applicants. Tay-Sachs disease carrier screening is performed on most donors with Jewish heritage but there is significant variation in screening for other disorders .
Since the screening of sperm donors is not usually complete, we recommend that all of our patients do a fairly comprehensive screening of themselves or their partner (if they are using their partner's sperm) for recessive genetic diseases. We use Counsyl screening which screens over 100 recessive diseases using a saliva specimen. Of course there are still some genetic diseases not covered such as the ones that are dominant and others that are not in Counsyl's panel. One still needs to rely on family history and ethnicity to determine if any other testing is needed.
We are fortunate that technology exists to determine if anyone is a carrier of an abnormal gene since we can now employ preimplantation genetic diagnosis (PGD) for single gene defects to detect whether an embryo is affected before transfer, thus reducing the chance of a child with the genetic disease without needing to consider termination of a pregnancy.
Egg freezing is very effective in otherwise fertile women
Tuesday, May 11th, 2010The process of egg freezing by vitrification has developed as a clinical technique just in the last few years. Now a study in the March 2010 edition of the medical journal Fertility & Sterility shows that it is very effective way of preserving an otherwise fertile woman's fertility potential for the future.
Nineteen women agreed to have their eggs frozen for six months before warming, fertilization and transfer. Three hundred ninety-five eggs were warmed, of which 81.0% survived. Two hundred eighty-five eggs were microinjected for fertilization; 72.3% fertilized, and 53 embryos were transferred. Of the 20 transfers, 16 resulted in clinical pregnancy (80%), 3 miscarried (15%), and 13 (65%) went on to produce live births, respectively.
Egg freezing is an appropriate option for young women without partners who want to delay childbearing and for women needing to take medications or other treatments that can damage eggs such as chemotherapy for cancer. Reproductive Partners uses vitrification for egg freezing.
The quality of sperm may be more than meets the eye
Friday, May 7th, 2010For a long time we have been able to assess a man's sperm quality by looking at the number of sperm, the effective motility of the sperm and the shape of the sperm to evaluate a man's fertility potential. But we now know that what we can see only tells us part of the story. In recent years a lot of attention has been paid to the presence or absence of DNA damage in the sperm of men whose partners are not succesful in reproducing even though the female partner's factors predict they should be successful.
An examination of the fragmentation of the DNA in the sperm can be evaluated by a test called Sperm Chromatin Sturcture Assay (SCSA). I have used this test in couples with no other reason for repeated early pregnancy loss and those who have not succeeded with IVF with unexplained poor embryo quality or when I expected success and couple did not achieve it. When we find a high degree of fragmantation the options include life style changes and antioxidant vitamins (about which RPMG's Dr. David Meldrum has written extensively in his Lifestyle & Fertility page on our website) or obtaining immature sperm by testicular biopsy (TESE) before the DNA fragments as the sperm goes through the maturation process. The immature sperm can be used in intracytoplasmic sperm injection (ICSI). In the March 2010 issue of Fertility & Sterility a study confirms that in men with high DNA fragmentation and who have failed antioxidant treatment, ejaculated sperm showed a threefold higher DNA damage when compared with testicular samples (39.7% vs. 13.3%).
I have had a number of couples in which this strategy has worked well. it is something to be considered in IVF failure for no apparent reason or unexpected poor embryo quality or in couples with recurrent pregnancy loss without a documented cause.
RPMG moves to CGH for PGS for chromosomes
Tuesday, April 27th, 2010RPMG will now be using comparative genomic hybridization (CGH) for preimplantation genetic screening (PGS) for chromosome screening of embryos (including for sex selection). CGH is a technique that involves amplifying the DNA and uses many thousands of probes to check all 23 chromosome pairs. As long as an intact nucleus is biopsied, it is virtually error-free, whereas with the older technique, fluorescence in-situ hybridization (FISH), many errors may occur because FISH relies on binding of a single probe to each chromosome, and there are potential cell fixation artifacts, overlapping signals, and a subjective microscopic analysis is required. It also does not analyze all chromosomes. Unfortunately many normal embryos have been discarded with that technique due to these artifacts, and false negative results have also occurred where an embryo appeared normal but was actually abnormal.
RPMG’s Dr. Wisot quoted in Life & Style
Friday, March 12th, 2010RPMG's Dr. Arthur Wisot was quoted in the March 22nd issue of Life & Style. He commented on the effect on the extremes of weight on the ability to conceive. In a story on E! anchor Giuliana Rancic's difficulty conceiving, he pointed out the effects of very low and very high BMI (body mass index) on the reporoductive process. Dr. Wisot, who does not treat Rancic, stated that "the ideal is to get pregnant in the normal-weight category."
Dr. Gregory Rosen honored as a “Patients’ Choice” doctor
Monday, February 15th, 2010Reproductive Partners' Dr. Gregory Rosen has been chosen as a "Patients' Choice" doctor for the second year in a row. The honor is the result of actual patients' online feedback about their experiences with their doctors. They rate various components such as bedside manner, doctor-patient face time, degree of follow-up, courtesy of office staff and overall opinions. Only physicians who get rave reviews are given the honor.
Dr. Rosen is available to see patients in Reproductive Partners' Beverly Hills and Westminster offices.
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