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."
 

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.

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.

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.

For more information on PGS for chromosomes please check our our PGS for chromsomes page.

Dr. Rosen is available to see patients in Reproductive Partners' Beverly Hills and Westminster offices.

At Reproductive Partners we want to encourage patients to do everything possible to enhance the chance of a successful outcome. We have designed the Success Prime IVF Program to recognize those who take vital steps in preparing for pregnancy.

Among other characteristics, prime candidates using their own eggs must be under the age of 34, have a BMI under 30 and both partners must be non-smokers for at least six months. If the patient is using an egg donor, the egg donor must meet all the requirements of a prime candidate.

The IVF success rate data at RPMG shows couples and donors who meet these prime candidate characteristics often succeed in their first cycle.

For complete program details, please see the Success Prime IVF Program page.
 

Drs. Gregory Rosen and David Meldrum were in Los Angeles Magazine's "Southern California Super Doctors 2010" as published in the January 2010 edition of the magazine and Dr. Arthur Wisot was named in the 2009 edition. The "Super Doctors" honor is also based on the recommendation of peers reflecting who they would call if they needed a physician.

Here's the latest. A study reported in the January 2010 edition of Fertility & Sterility shows a higher pregnancy rate when the period of abstinence before an IUI was less than 2 days. This shorter interval resulted in the highest pregnancy rates per cycle compared with longer intervals of ejaculatory abstinence. This higher conception rate occurred despite a lower total number of motile spermatozoa inseminated. This makes sense in view of our observation that a shorter interval may reduce DNA fragmentation in sperm.

Remember that it's best to follow your own doctor's advice in this regard because some men may have issues that may not make this practice ideal for them.