Posts Tagged ‘IVF’

IVF fertilization improved when men take omega-3′s

Tuesday, April 26th, 2011

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.


 A poster presentation showed that omega-3 fatty acids are beneficial in improving the fertilization rate in IVF cycles.

   98 couples with unexplained fertilization failure were randomized to 1,000 mg omega-3’s versus no treatment. The fertilization rate was higher (76.5% versus 50.4,%), there were more good quality embryos, and the implantation rate was increased. These results suggest that the prominent role of omega-3 fatty acids in sperm membranes may increase fertilization and that they also may influence sperm DNA (see previous post), therefore influencing embryo quality and implantation. It is not clear whether the female partner was also treated.   

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Male partners need to watch their weight too

Monday, March 14th, 2011

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.


Most of the evaluatation and treatment of infertility is focused on the female partner. Of course the male's semen parameters are carefully evaluated and lifestyle issues are addressed. But weight is rarely mentioned as a lifestyle factor. A poster presentation at ASRM shows that male weight may be more of a factor than we realize.

In this study the chance of clinical pregnancy decreased 28% for each 5 unit increase of male partner BMI when controlled for female BMI. This may be because the oxidative stress associated with obesity could increase sperm DNA fragmentation. In the female it clearly has the potential for causing reduced granulosa cell, egg, and embryo quality. Increasing antioxidant intake may be helpful for both overweight male and female partners. For more lifestyle information see the Lifestyle & Fertility pages on our website. 

No caffeine, please

Monday, March 7th, 2011

 

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.


We advise all couples trying to conceive to stop caffeine. Many are relectant to give it up. Now here's more evidence of how important it is.

In a poster presentation, a dose-dependent decrease of the pregnancy rate with IVF was observed according to caffeine intake (33% with none and decreasing to 12% with the equivalent of 2 cups of coffee). Enough said?

Here's more: In a mouse model, ovarian response, fertilization, and blastocyst development were decreased.

This confirms the previous study showing no caffeine is important to IVF outcome.

Infertility and diet

Monday, January 3rd, 2011

 

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.


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When patients ask about a good diet for infertility they are usually told to eat a well-balanced, healthy diet. It's not bad advice but until recently has been based more on common sense and not scientific evidence. Two reports at the Annual Meeting of ASRM addressed dietary specifics. In one serum fatty acids were analyzed in 52 women before IVF. Good embryo morphology was positively correlated with DHA, one of the two main omega 3 fatty acids in fish and fish oil, and also with DPA, a minor omega 3 in fish and fish oil. Endometrial thickness was negatively correlated with saturated fat levels. 

DHA is a main omega 3 in fish and fish oil and is now commonly added to prescription prenatal vitamins. Omega-3’s are important constituents of plasma membranes and increase nitric oxide and therefore blood flow. A healthful diet appears to be beneficial for both infertile men and women. Supplementation with 500-1000 mg of omega 3’s is reasonable for all infertile couples. However, antioxidants should always be increased along with the omega3’s because these unsaturated fats are very sensitive to oxidation. Trader Joe’s has a 600 mg capsule with the odor removed. If these levels are taken the more expensive PNV containing DHA is not needed.  Reproductivepartners.com's page on lifestyle and fertility links to Dr. Meldrum site.

In the second study, serum trans fats were negatively correlated with birth rates in women having IVF. Compared with women with levels in the lowest third, women in the middle and upper thirds had birth rates that were 80-90% lower. This study shows the strongest negative effect of a poor diet on fertility published to date. Trans fats may be just a marker for a diet with lower levels of other positive nutrients such as antioxidants and omega 3’s, and because the male partners’ diets would tend also to be poor, this effect could even be a combined effect. It also may be that trans fats, found in fried foods, doughnuts, French pasteries, and various prepared foods containing hydrogenated oils may be the predominating negative factor, being as foreign to the body as eating plastic.

Message for the New Year-don’t drink and….do IVF

Wednesday, December 29th, 2010

And you thought it was going to be "and drive." Well, you shouldn't do that either.

In the January 2011 issue of the journal "Obstetrics & Gynecology an article quantitates the effect of drinking alcohol on IVF success. In examining 4729 IVF cycles the authors found that women drinking at least four drinks a week had 16% less odds of a live birth than those who drank fewer than four drinks a week, When both the partners drank at least four alcoholic drinks a week, the odds of live birth were 21% lower compared with couples in which both drank fewer than four.

So in this New Year, don't drink and drive or do IVF. Seriously this is a factor over which you have control. Many factors are out of your control. Control what you can.

Another factor in selecting single embryo transfer (eSET)

Monday, December 27th, 2010

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.


 There are many reasons that the use of the elective single embryo transfer (eSET) is being recommended more often when the clinical situation and embryo quality make it an appropriate choice. Primarily it's a strategy to reduce the chance of having even twins with it's inherent additional risks to a pregnancy. A presentation at the meeting brings up another reason to choose eSET.

Using CDC data, singleton births having a good outcome (as defined by term birth and weight more than 2500 grams) was better when only one fetal heart was detected in early ultrasounds. Women with a history of a prior birth also had a better outcome. This study shows an adverse effect from the so-called vanishing twin. The most likely factor for this observation is the effect on the absorbtion of the additional tissue.

Improving IVF outcomes in women with endometriosis

Monday, September 13th, 2010

It has been known for some time that women with endometriosis have had a poorer prognosis for success with IVF than women who do not suffer from the condition.

In an attempt to reverse this negative effect from endometriosis, several strategies have been employed including  surgery to remove endometriomas and cauterize endometrial implants and pretreatment before the IVF cycle with prolonged Lupron or drugs like letrozole and norethindrone.

Now a study reported in the August 2010 issue of Fertility & Sterility shows that six to eight weeks of pretreatment with birth control pills gives women with endometriosis the same chance of success as women having IVF for other reasons. The study also concluded that the prolonged regimen of birth control pills did not adversely affect egg production.

It sounds almost too good to be true. As we start to use this simple method of pretreatment we will get a sense if it works out as well as this study claims.

For unexplained infertility-IUI with drugs or IVF, which is best?

Monday, August 30th, 2010

Conventional treatment for couples experiencing unexplained infertility has usually consisted of three cycles of clomiphene (CC) with IUI, followed by three cycles of gonadotropins (FSH) with IUI and then IVF if those conservative measures did not work.

A study in the August 2010 issue of Fertility & Sterility looks at the time it took to establish a pregnancy that led to a live birth and cost-effectiveness of either conventional treatment with three cycles of clomiphene citrate CC/IUI, three cycles of gonadotropins FSH/IUI, and up to six cycles of IVF or an accelerated treatment that omitted the three cycles of FSH/IUI.

An increased rate of pregnancy was observed in the accelerated arm compared with the conventional arm. Median time to pregnancy was 8 and 11 months in the accelerated and conventional arms, respectively. Per cycle pregnancy rates for CC/IUI, FSH/IUI, and IVF were 7.6%, 9.8%, and 30.7%, respectively. Average charges per delivery were lower in the accelerated arm compared to conventional treatment. The observed incremental difference was a savings of $2,624 per couple for accelerated treatment.

In my experience many couples are bypassing the option of FSH/IUI, not only because of the increased time and expense to success, but also because IVF provides more control over high-order multiple pregnancies as we transfer fewer embryos.

Arthur L. Wisot, M. D.

Does IVF increase the chance of identical (monozygotic) twins?

Tuesday, July 20th, 2010

It does, at least according to a study in the July 2010 issue of Fertility & Sterility.

The authors surveyed 4976 clinical pregnancies from one large IVF center and found ninety-eight cases of monozygotic twins (MZTs) were diagnosed after first-trimester ultrasound evaluation (2% incidence). In naturally conceived pregnancies the incidence is about 0.25-0.5%. 

The incidence in women transfering embryos from their own eggs was 1.7% but was 3.3% with donor eggs; however, younger women (<35 years old) using their own eggs displayed a similar rate (3.1%) to women using donor eggs.

Eighty MZTs occurred after fresh day-5 transfer; only 14 followed fresh day-3 transfer (2.6% vs. 1.2%). The MZT incidence in day-3 transfers without assisted hatching was not different from those with hatching (1.3% vs. 1.1%). In addition, MZT incidence did not differ significantly whether or not ICSI was performed (2.4% vs. 2.0%). Four MZTs occurred after frozen-thawed embryo transfer (0.8% incidence).

The good news is that ninety-five percent of all placental arrangements were confirmed as having two amniotic sacs on obstetric ultrasounds, making them safer pregnancies than when both babies are in the same amniotic sac.

The take-home message is that this is a good reason for young women and those using eggs from a young donor to seriously consider elective single embryo transfer (eSET) so if a set of identical twins does occur and the other embryo implants one does not have to deal with a triplet pregnancy.

IVF or IUI for Women Over 40?

Monday, June 7th, 2010

Selection of a treatment method for women over 40 whose main limitiation in conceiving is their age can be difficult. If they are in the "unexplained infertility" group with open tubes, no significant gynecologic problems and a partner with normal sperm parameters the common choices are to try injectable fertility drugs (COH) with artificial insemination (IUI) or in vitro fertilization (IVF). A recent study in Fertility & Sterility compared groups of women aged 38-39 with a group over 40.

The women who were 38–39 years old had an overall live birth rate of 6.1% per cycle, with no live births occurring after the second cycle, and women  over 40 years old had an overall live birth rate of 2.0% per cycle, with all births occurring in the first cycle. These data suggest that the efficacy of COH/IUI cycles significantly decreases with age, but women aged 38–39 years had reasonable success during the first two cycles. However, for women aged over 40 years, no benefit after a single cycle of COH/IUI was observed. Women over 40 years should be considered for in vitro fertilization as the first choice or after one failed COH/IUI cycle.