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.

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 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.

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.
 

PBDEs have been used as flame retardants for four decades and are found in foam furniture, electronics, fabrics, carpets and plastics. The chemicals are being phased out nationwide, and certain PBDEs have been banned for use in California. But they are still found in products made before 2004. Californians may have higher exposures compared with residents of other states because of the state's strict flammability laws, according to the study authors, from UC Berkeley."

I have been impressed with the increasing numbers of men I am seeing with motility and morphology issues with no apparent reason and have thought that environmental factors may be partially to blame. This is just another of those potential threats.

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.

One study shows that although the prothrombin gene mutation results in an increased risk for the development of certain pregnancy complications in asymptomatic women, another thrombophilia, MTHFR, may actually protect against those complications. Their overall conclusion was that the majority of asymptomatic women who carry an inherited thrombophilia mutation have a successful pregnancy outcome. The other study showed no association between the prothrombin G20210A mutation and pre-eclampsia, premature separation of the placenta or small-for-gestational age babies in a low-risk group of women. These findings raised the question of the need for screening asymptomatic women for this mutation.

Based on these studies and others, Dr. D. Ware Branch wrote an editorial expressing concern that doctors are prescribing heparin and other anticoagulants too frequenlly after testing women who had almost any adverse pregnancy experience. The enthusiasm for using heparin and its derivatives comes from success in heparin treatment of antiphospholipid syndrome in pregnancy. He believes that a primary cause of an adverse pregnancy outcome may be inflammation, not thrombosis which would not be helped by anticoagulants. Using heparin and related drugs can lead to serious complications.

Regarding this question, infertility specialists deal mostly with patients who have experienced recurrent early pregnancy and Dr. Branch points out that two prospective trials show no improvement in live birth rates using low molecular weight heparin in women with antiphoispholipid antibodies and recurrent miscarriage. Years ago there was a great deal of enthusiasm for testing women with recurrent miscarriage and other pregnancy complications for thrombophilias and antiphospholipids and, when found, treating with heparin or one of its derivatives. Now the tide seems to be turning against even testing. Definitive multi-center studies are needed to determine "The Truth."

In response to her negative views, Dr. Wisot commented, "I can't speak about her personal choices, but I think that we live in an era of reproductive freedom and everybody is welcome to reproduce in whatever way they wish,” fertility specialist Arthur Wisot of Reproductive Partners in Southern California told Tarts. “If (Jennifer Lopez) isn't accepting it, then it may impair her ability to have children in the future, but it's based on her own moral and ethical principles.”