Posts Tagged ‘IVF’

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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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Are frozen eggs as good as fresh in creating IVF pregnancies?

Monday, April 30th, 2012

This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.

As egg freezing becomes more widely available, the most obvious question is whether frozen eggs are as good as fresh in creating IVF pregnanciies.

When live birth rates per egg retrieved were analyzed for both frozen eggs and for fresh IVF, they were similar (4.5 and 5.1%), indicating that egg freezing is not less efficient. Some have have even advocated egg rather than embryo cryopreservation for their multiple freeze-all cycles in poor responders in order to do one ICSI,, and for freeze-all for high responders to avoid the problem of excess embryos and to increase the likelihood of excess eggs being donated. This abstract and the finding that the pregnancy rate with donated eggs is equal whether fresh or vitrified both support their approach.

This study is reassuring for women freezing their eggs for fertility preservation as well as potential recipients of egg donation who may be planning to access frozen egg banks because of convenience and lower cost.

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Can embryo co-culture overcome embryo quality issues?

Monday, April 16th, 2012

 This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.

One of the most difficult issues to overcome is persistent poor embryo quality. For some time Reproductive Partners has  been using embryo co-culture (cultureing the embryos along with other cells just as occurs in the body) as one of our startegies to improve embryo quality. Now a study reported at ASRM supports this practice.

Eggs were randomized between regular culture and co-culture using autologous clusters of granulosa cells (the cells that surround the egg in that patient's body). Day 3 embryos had improved morphology, more developed to day 5 and more were chosen for transfer. As with other studies of cumulus co-culture, improved embryo morphology was confirmed. It could be considered in any case where reduced embryo morphology has been previously observed or when reduced egg quality is expected.

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Miscarriage and social media

Monday, April 16th, 2012

As noted in this recent article in USA Today, couples deal with loss and bereave miscarriages in different ways.

For many, it easier to keep the loss to a very small circle and mourne
the loss privately.  These couples prefer not to involve even close
friends for various reasons.  One reason is that they prefer to keep
the privacy of the miscarriage.  Another reason is that they do not
want to burden others with their loss.  The use of social media to
announce the loss of a pregnancy demonstrates another way of dealing
with a difficult time.  For these couples, they do not mind the
openness of their loss.  It is balanced by an outpouring of support
from friends and family around them that helps them deal with the
loss.

For many who are comfortable with this avenue of communication,
Facebook and social media offers a new way to gain support.
Miscarriage is not an uncommon event and can occur in 1 out of 5
pregnancies.  Having friends and family around who can share their own
personal experiences can often help women and couples overcome this
difficult time to try again.  Besides social media, there are many
other options such as online forums like this, and groups that help
specifically with pregnancy loss. Couples should each find what method
works best for them.

 

Andy Huang, M. D.

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Improving IVF success rates in women over 38 without increasing multiples

Tuesday, April 10th, 2012

This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.

One of our greatest challenges has been trying to improve overall IVF success rates in women over 38 without increasing the risk of multiple pregnancies including twins. The conventional approach has included transferring more embryos than in younger women. But inherent in that strategy is a increased risk of twins or more, creating riskier pregnancies. Now a new approach reported at ASRM in 2011 may help solve this problem.

 

In a retrospective study, women mean age 38.4 who had blast comprehensive chromosome screening  (CCS) and frozen embryo transfer (FET) of a single normal blast had higher implantation and ongoing pregnancy rate (61%) than women having elective single embryo transfer (eSET) (fresh or frozen) without CCS. This may become the way to avoid twins in women over 35 while keeping IVF success high.

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Is the male partner’s age a factor in fertility?

Monday, April 2nd, 2012

This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.

Until recently there has been little evidence that the age of the male partner had a role in IVF success. Now in cases of egg donation where egg quality from young donors should be consistently good, the malke partner's has been identified as a factor in unsuccessful cycles.

Failure to conceive with oocyte donation was associated with male age and strict morphology on semen analysis. Other studies have also shown an effect of male age. Aging may be related to subtle or frank DNA fragmentation, as a number of studies have shown increased fragmentation with age. Antioxidants and frequent ejaculations prior to producing the specimen for the IVF cycle is advisable, particularly for males over age 40.

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Is IVF the correct first treament for unexplained infertility?

Monday, February 13th, 2012

This is one of a series of news items from abstracts of studies presented at the Annual Meeting of the American Society for Reproductive Medicine as complied by Dr. David Meldrum, Scientific Director of Reproductive Partners. We appreciate the enormous amount of work it takes to compile and comment on these abstracts.

 Women over 38 with at least 6 months of infertility and a normal work up (unexplained in fertility) were randomized to clomiphene with IUI, injectables with IUI or immediate IVF. After two cycles, per cycle pregnancy rates were 6.7, 7.7, and 24.7%.

It's expected that there would be a higher pregnancy rate with immediate IVF. This is not "one size fits all." The length of infertility should determine the appropriate starting treatment. For instance for someone trying for only 6 months, immediate IVF is too aggressive. For someone trying for two years it may be appropriate.

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Many IVF patients are not following lifestyle recommendations

Friday, February 10th, 2012

Accoring to a study reported at the 2011 American Society for Reproductive Medicine annual meeting a surprising percentage of IVF patients are not following their center's lifestyle behavior recommendations based on their responses to an online Lifestyle and Health Habits Questionaire.

Their center recommended they decrease their exercise regimen. One hundred percent of patients expercised during their cycles. Nearly half (49.5%) consumed alcohol even they were instructed in writing to eliminate alcohol consumption. This particular center advised their patients to limit caffeine consumption to less than 50 mg daily which is less than one cup of coffee. Three-fourths reported caffeine consumption and almost half drank caffeine daily, most often coffee which has 60 to 200 mg of caffeine per cup. Twelve percent took herbs during their cycle even though they were explicitly told not to take herbs.

We believe that these lifestyle behaviors can have an adverse impact on outcome. For more on these issues, please see our Lifestyle & Fertility pages.

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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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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.

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