Posts Tagged ‘IVF’

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.

 

Don’t throw out the baby with the bath water

Monday, January 9th, 2012

Those of us who are interested in helping infertile couples conceive and have successful pregnancies must be very careful to make sure that in their zeal to outlaw abortions, the right-to-life movement does not inadvertently or purposefully take away our most effective fertility options.

According to a January 8th editorial in the New York Times, "Republicans Versus Reproductive Rights," this is not so far-fetched. According to the editorial, "Mr. Huntsman opposed the “personhood” initiative in Mississippi that would have given human fertilized eggs the legal rights and protections that apply to people, and outlawed abortion as well as some of the most widely used forms of contraception and in vitro fertilization. Mississippi voters resoundingly rejected the measure in November as going too far.

Mr. Romney denied supporting the measure once it was defeated. But before the vote, in an interview with Mike Huckabee, the former Arkansas governor and a Fox News personality, he created a different impression. When asked whether as Massachusetts governor he would have supported a constitutional amendment establishing that life begins at conception, he said, 'Absolutely.' "

The consequences of an amendment that life begins at conception would have all sorts of consequences for advanced reproductive technology. We need to make sure that all infertile persons have the right to pursue effective advanced treatments to help them complete their families.

Big surprise: The incidence of twins is up

Thursday, January 5th, 2012

 

An analysis of three decades of twin births (2009 data are the most recent year included) finds large increases in twin birth rates for all age groups, among all racial and ethnic groups and in the U. S. The overall U.S. twin birth rate increased 76%, from 18.9 in 1980 to 33.2 per 1,000 births in 2009.

And for mothers age 35 and over, those twin rates have skyrocketed. Among women 35-39, rates rose by nearly 100%, and among those 40 and over, rates rose more than 200%, finds the report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

While the chance of having twins does increase with a mother's age, the report suggests that fertility treatment provides the backdrop for this baby bonus, says CDCstatistician Joyce Martin.

"We found that about one-third of the increase over three decades was attributed to older maternal age and two-thirds likely the result of fertility-enhancing therapies — both drugs and technologies like in-vitro fertilization," she says.

As for women in their 20s who had twins, Martin says a small proportion of women in that age group do receive fertility treatment.

 

The analysis finds that although the pace of these increases in twin birth rates slowed from 2005 to 2009, twins now make up 3.3% of all births, up from 1.9% in 1980. The number of twin births increased from 68,339 to more than 137,000 in each year between 2006 and 2009.

As pregnancy rates with reproductive technologies have improved, we've been working hard at Reproductive Partners over the past several years to reduce the multiple birth rate. We can do that by returning fewer embryos to the woman's uterus. In many cases it's possible to achieve IVF success by transferring one embryo in women with a favorable prognosis.


If you’re over 40 consider IVF first

Tuesday, November 15th, 2011

Bypassing superovulation steps and proceeding directly to in vitro fertilization (IVF) technology appears to improve pregnancy outcomes for older women who have unexplained infertility, researchers reported at the annual meeting of the American Society for Reproductive Medicine.

This randomized trial found that older women with unexplained infertility were significantly more likely to achieve pregnancy and a live birth if treated immediately with in vitro fertilization rather than stepwise with superovulation techniques first.

Clinical pregnancy was achieved in 21 women in 24.7% of 85 cycles if these women were treated with in vitro fertilization as a first stop, compared with clinical pregnancy in 13 women in 7.3% of 178 cycles in which they were initially treated with superovulation treatments, a statistically significant difference (P=0.0008).

In addition, 13 women (15.3% of cycles) in the immediate in vitro fertilization group took home a baby, compared with 9 women (5.1% of cycles) who were treated at first with superovulation techniques (P=0.017). Most of the women who received superovulation treatments still underwent in vitro fertilization due to pregnancy failure.

"Beginning treatment with immediate in vitro fertilization compared to initial treatments of superovulation results in a significantly higher number of live-born infants and with significantly more couples pregnant, during the initial cycles of treatment," the author said in his oral presentation.

In the population of women who have unexplained infertility, going directly to in vitro fertilization reduced the number of cycles of therapy required to get pregnant and that the majority of their infants will be conceived through in vitro fertilization anyway.

Giuliana Rancic discovers breast cancer during IVF cycle

Monday, October 17th, 2011

Giuliana Rancic revealed Monday that she has early-stage breast cancer — then went out of her way to thank husband Bill Rancic for letting her cry, and the baby she doesn't yet have for most likely saving her life.

E! Entertainment host Giuliana and original "The Apprentice" winner Bill have been trying to get pregnant through in vitro fertilization, a journey chronicled on their reality show, "Giuliana & Bill." After two failed IVF attempts, Giuliana Rancic ended the show's most recent season by heading back for a third round of fertility treatments.

This time, however, one doctor insisted the 36-year-old get a mammogram first, she said Monday on the "Today" show.

"He said, 'I will not get you pregnant' " without ruling out her small risk of breast cancer, " 'because if you get pregnant it will accelerate the cancer, all the hormones will accelerate the cancer,' " said an emotional Rancic. She said she fought the idea at first, as she hadn't planned on getting that type of scan until the recommended age, 40.

She went ahead with the egg retrieval portion of the IVF treatment, as well as the scan. And then the bad news came.

"They called me the next day and told me, 'We need to you to come back, we see something.' " The Rancics have since put off a third attempt to get pregnant until after she's completed her treatment, which will include surgery this coming week and then 6½ weeks of radiation.

After praising her husband for supporting her and letting her cry when she needs to cry, she also thanked the baby they hope to have in the future. "I truly believe that God was looking out for me," she said, and that there was some sort of "master plan" behind the failure of her previous IVF attempts, including one that ended in a miscarriage after eight weeks.

The Family Act of 2011-Contact your senator

Wednesday, October 5th, 2011

A bill to create a tax credit for the out-of-pocket costs associated with infertility medical treatment has been introduced in the U.S. Senate by Senator Kirsten Gillibrand (NY).  Aptly named the Family Act of 2011, S 965, this bill will potentially help thousands of people seek medical treatment that otherwise would be out of reach for them.

 

Key provisions of the bill:

  • The Family Act covers the out-of-pocket costs associated with in vitro fertilization (IVF) including diagnostic tests, laboratory charges, professional charges, and medications for IVF.
  • The Family Act covers the out-of-pocket costs of fertility preservation procedures if the man or woman is diagnosed with cancer and the cancer treatment or disease itself may result in infertility.
  • The Family Act has a cost sharing provision allowing 50% of all applicable medical expenses to be  covered up to a lifetime maximum of $13,360. You would need to have out-of-pocket costs totaling $26,720 to claim the entire credit in your lifetime.
  •  If you do not owe taxes in a particular year, do not owe enough taxes to use the whole credit, or do not reach the max amount in one tax year, it carries over to the next year for a max of five years after the first year you use the credit. 
  •  The Family Act is available to couples filing jointly with adjusted gross incomes of less than $222,520, but the credit is smaller for those earning between $182,500 and $222,520.

The goal is to get as many Senators as possible to co-sponsor this bill and to seek a hearing on the bill in the appropriate Senate Committees.   Please ask your two U.S. Senators to co-sponsor Family Act of 2011, S 965.  Please urge your family and friends around the country to send a letter as well.  We need thousands of letters flooding the U.S. Senate!

 

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.

Obesity is a factor in IVF success

Tuesday, July 5th, 2011

We have said it before and now a new study in the July 2011 edition of Obstetrics & Gynecology again confirms it: obesity has an adverse effect on the chance of IVF success.

They reviewed the records of 1,721 women undergoing their first IVF cycle with their own eggs. Women with a normal BMI were compared with women with class II obesity (BMI 35-39.9) and class III obesity (BMI >40). They found lower numbers of fertilized eggs and lower peak estrogen levels when correcting for age and numbers of eggs. Most importantly women with class III obesity had a 50% lower clinical pregnancy and live birth rate.

The message here is simple and clear: it is advisable for women to maintain a normal weight before, during and after attempting to conceive. For further information on lifestyle issues see our Lifestyle & Fertility pages.

AMH- a new test to predict response in IVF ovarian stimulation

Monday, June 20th, 2011

According to s new study reported in Science Daily, AMH (anti-Mullerian Hormone) has been shown to be of predictive value in determining the response of IVF patients to various stimulation protocols.

According to the study to be printed next month in the American Journal of Obstetrics & Gynecology and reported online, AMH is made by small follicles in the ovary and helps regulate their growth. AMH levels in the blood are an indicator of how many follicles a woman has at the time of the hormone measurement.

The research team measured AMH levels in 190 IVF patients, ages 22 to 44, both at the beginning and end of their preparatory course of follicle stimulation hormone treatment. They counted the eggs that were eventually harvested and then performed blood tests and later an ultrasound to confirm pregnancy.

The researchers found that women with low AMH levels in the first test (less than one nanogram per milliliter) on average yielded only about six eggs, while women who had more than three times as much AMH provided about 20 eggs on average.

In this study, AMH similarly predicted whether pregnancy became established. Only about a quarter of women with less than one nanogram of AMH were pregnant five to six weeks after the IVF procedure. Among women with more than three nanograms, three in five were pregnant at that stage. Most other studies have not found an association of AMH levels and pregnancy success though delivery.

At Reproductive Partners we have been using the test for some time in selected patients to help fine-tune stimulation protocols when other factors gave conflicting information. Now we predict the test will soon come into universal use based on the finding this and other confirmatory studies.

New session of Yoga 4 Fertility starts July 9th

Friday, June 17th, 2011

There is still time to sign up.

Reproductive Partners'  four-session yoga for fertility workshop (STRONG Yoga™ 4 Fertility ) has been a huge success. In fact, one of the participants in the initial program is now pregnant.

Studies have shown that alternative medicine techniques such as acupuncture and Mind-Body programs can improve the success rates for couples in fertility treatments such as in vitro fertilization.

The latest sessions have been scheduled on Saturdays, July 9th through July 30th from 2-4PM at the Beach Cities Health District, 514, N. Prospect, next to our Redondo Beach office. The cost is $240 and includes the course, Fertility Ball and course materials.

STRONG Yoga™ 4 Fertility is an alternative proprietary approach for fertility created by Brenda Strong, the former national spokesperson for the American Fertility Association. This program uses the ancient healing approach of yoga and applies it to the modern problem of reproductive difficulty. Using specific postures and breathing techniques STRONG Yoga™ 4 Fertility attempts to relieve tightness in muscle and connective tissue, increasing blood flow to the reproductive organs and inviting the mind and body to facilitate its own healing capacity.

To register or more information, call Jackie at (818) 769-3857 or email strongyoga4fertility@gmail.com