Princeton

ICSI is best for male infertility

Over 2 decades ago, ICSI (intracytoplasmic sperm injection) revolutionized the treatment of male infertility. The ICSI procedure involves injection of a single sperm into each egg at the time of IVF (in vitro fertlization). Before the development of ICSI, couples with sperm issues, what we call "male factor," had very low fertilization and pregnancy rates, even when undergoing IVF. Now a days, because of the use of ICSI, poor sperm quality is a very unusual reason for an IVF cycle to be unsuccessful or to blame for poor fertilization. Over concerns about potentially poor fertilization, many fertility centers have chosen to use ICSI routinely to ensure optimal fertilization even when the male partner's sperm is perfectly normal. At Princeton IVF, our philosophy has always been to allow fertilization to happen "naturally" in the dish when there is no history of sperm issues or poor fertilization. While ICSI had been shown to be quite safe, we feel that a more natural selection process makes more sense and research in the past has suggested that ICSI is only beneficial in male factor patients. A recent large-scale study recently published in the Journal of the American Medical Association has borne this out. ICSI  when used in IVF cycles used in couples without sperm issues had lower fertilization and lower implantation rates than non ICSI cycles.

New study confirms IVF is safe for women

IVF-safety-embryoOne of the chief concerns couples have is the about the safety of the procedures that fertility specialists use to help them achieve pregnancy, such as IVF (In vitro fertilization). Most of us in the field know that serious complications to the mother-to-be can occur but are quite rare. A recent study with the lead author from Emory University looked through nationwide database of IVF clinics across the country over the past 12 years, and confirmed that while IVF does entail risks for women, those risks are quire small.

Artificial eggs and sperm- are they on the horizon ?

Sperm-eggs-synthetic-artificialCould a cure for real cure for infertility be on the horizon? Today many causes for infertility can currently be successfully treated such fertility issues caused by damage to fallopian tubes, ovulation disorders, endometriosis and low sperm counts or motility. These treatments currently available to us include fertility drugs, insemination, surgery and IVF. However, there are still issues in assisting women have very few or no eggs left or men who produce no sperm at all. This is a particular problem for women since women produce all they eggs they will in a lifetime while still in their mother's womb, and by their mid 40s have hardly any normal eggs left. These couples can be successfully treated only with the use of donor eggs or sperm. While these donor procedures are often quite effective, the children who result from these pregnancies do not carry the DNA of one or both of the parents. This is a problem since most couples who seek out the help of a Reproductive Medicine specialist want their own genetic children. With our current state of reproductive science this may not be possible.

One potential way around this would be using stem cells in the lab using cloning technologies.  A group of scientists at the Weizmann Institute in Rehovot, Israel and Cambridge in the UK have brought us a little closer to this cure, figuring out how to more efficiently get these stem cells to grow into cells that will eventually develop into eggs and sperm. Their findings were recently published in the journal Nature.

The researchers have yet to take the next step; producing eggs and sperm from these stem cells. While it may become technically feasible, besides the technical issues, there are ethical concerns, perhaps even greater than when IVF when first introduced to overcome before this proceeds. IVF was enormous breakthrough when it was developed, but it is still merely a replication of natural conception, albeit in a laboratory dish. If this next step is even possible, it could bring reproduction to entirely new level. These technologies may make it possible to have genetic children without ovaries, without testes and without age limits, shattering our concepts about parenthood, even more so than it is today. It is not clear if society is ready for this yet.

Scratching your way to pregnancy- Endometrial biopsy before IVF

endometrial-biopsy-princeton-ivfIn recent years, endometrial scratching, irritating the endometrium (lining of the uterus) to help in making the womb more receptive for pregnancy has emerged as a new and unsual way to help couples get pregnant.  Recently, a group from Turkey presented data at the American Society of Reproductive Medicine meeting suggesting that performing an endometrial biopsy prior to IVF can improve pregnancy rates in women undergoing IVF by about 20%. In fact over the years, seeming against common sense, there have been a number of studies suggesting  that a biopsy and/or hysteroscopy may improve the chances for IVF success. At Princeton IVF, we have been using this technique for years, first in patients who failed cycles without any good explanation and then routinely in all our IVF patients. Although no one is quite sure why it helps, it is likely that the repair process from endometrial trauma helps to make the uterus more receptive to embryos.

First baby born after a uterine transplant

uterusAs we reported in our blog earlier this year, fertility specialists in Sweden transplanted uteri into women who were unable to carry a pregnancy to help them. They were presumably motivated by one of the remaining challenges in Reproductive Medicine, helping women who were born without a uterus, or have had their uterus removed or have severe scar tissue in the uterus making it difficult or impossible to carry a pregnancy. The only options for these couples until now has been to use a gestational carrier with IVF to carry the pregnancy for them, what most people think of as a “surrogate.” Picking up on research that began over a century ago, doctors in Sweden used modern surgical techniques and medications to enable transplantation of the uterus. There is now some good news on this front. One of these transplants in Sweden resulted in a healthy live birth. The pregnancy and birth were not without complications. The baby was born 9 weeks early and the mom developed pre-eclampsia, a serious condition in pregnancy also known "toxemia" whose symptoms include high blood pressure and swelling. The doctors are also unsure if the uterus will be usable for a second pregnancy. Still, this an exciting first in Reproductive Medicine.

Smoking and grandchildren- What's the connection?

Smoking while pregnantThere are plenty of reasons to quit smoking. The health effects of smoking are well known and well documented, not just on your fertility, but a whole number of health issues including heart disease and cancer. Now, there's yet another reason to quit smoking if you are pregnant  or trying to get pregnant. Cigarettes may actually affect a woman's male offspring's sperm quality. As reported in Human Reproduction, the male offspring of pregnant mice exposed to high levels of cigarette smoke had sperm with lower counts, lower motility and more abnormally shaped sperm (low morphology), and these male mice took longer longer to impregnate female mice who in turn gave birth to fewer mouse pups. So, what does this all mean? While we don't yet know if this is true in humans (or even 100 % sure it is true in animals), exposure to tobacco smoke could not only harm your fertility (among other things) but also could harm your unborn son's chances of fathering children. This is another good reason to quit.

Breast cancer drugs to treat infertility ?

clomiphene-letrazoleThis sounds kind of odd. Why would fertility specialists use a drug intended to treat breast cancer patients to help couples conceive? To those in the field, the concept is nothing new. Clomiphene (Clomid) is a close relative of Tamoxifen, a drug used for years to prevent the recurrence of breast cancer.  These drugs which block the action of the female hormone estrogen, cause hormone fluctuations that stimulate eggs to grow.  Over the past decade, doctors have begun to use another breast cancer drug called Femara or Letrozole to treat couples in with infertility. Like tamoxifen, letrozole is used to prevent recurrence in breast cancer patients, and like clomiphene, it can also be used to stimulate ovulation (release of an egg). Until now, clomid has been the gold standard to help make women ovulate since it is relatively inexpensive and safe. Recently, however, a large study was published suggesting that letrazole may actually be more effective than clomiphene  and result in fewer multiple births. Over time, it is likely that letrazole may replace clomiphene as  a first line fertility drug.

Do birth control pills cause infertility?

birth-control-pills-NJThis is one of the most common questions patients ask their fertility doctors and/ or their OBGYNs. Fortunately the short answer is no and this is backed up by large research studies. While their purpose may be to prevent pregnancy, the contraceptive effect of the pill wears off rather quickly. In some women the return to normal cycles and fertility can take a number of months, but usually there is not much of a delay. In other women, such as those with ovulation disorders such as PCOS, coming off the pill may actually increase the chances for conception. If your cycles have not regulated themselves 6 months after stopping the pill or they are becoming less regular over time after then and you're trying to get pregnant, it's probably not the pill, and it's time to discuss this with your GYN or fertility specialist.

Why are the pigs in Spain infertile?

infertile-spanish-pigsAnd why might this be important? Unless you are a Spanish farmer raising swine, or unless you live in Spain and are in the market for pork or ham, it should not matter. But is you work in the fertility field or are trying to get pregnant, it may be an issue. The concern over what is going on with Spanish pigs, is really about why the pigs were having trouble reproducing. It turns out that back in 2010, there was a marked drop in fertility in pig farms across difference regions of Spain. Investigators at first had trouble figuring our where there problem was. The one common thread in each of these farms was that all of the farms used plastic bags from the same manufacturer to collect semen for insemination. A researcher at the University of Zarazoga, Cristina Nerín, then analyzed the bags and found that an ingredient in the plastic bags was the cause of infertile Spanish pigs. The scary part is that this chemical (and similar compounds) are found in plastic products that are used to package foods and beverages we eat every day. The good news is that the pigs of Spain and happily producing lots of piglets again. However, there is likely more to come on this topic in reproductive medicine and potentially in other areas of medicine as well.  

Cell phones and male fertility

Sperm-motility-cell-phoneA recent study suggests that men who keeps their cellphones in their pants pockets, may have lower sperm motility. Researchers at the University of Exeter in the UK, found that men who kept cell phones in their pockets had lower sperm motility than those who did not, about an 8% reduction. Is this an issue? It remains to be seen whether this decrease really affects a couple's chances for pregnancy and truly causes infertility.  

A world where everyone has infertility- coming soon to cable

The lottery- a future where everyone has infertility Think going through fertility treatment today is stressful ? Imagine in a world in which everyone suffers from infertility, everyone needs donor embryos in order to get pregnant and there are not nearly enough embryos to around. Lifetime network plans to release a trailer for a series called the Lottery with just that story line. In the show, mankind faces extinction as no one is able to conceive and no babies are born. The only hope is in a small batch of embryos, the fate of which, and of mankind's survival is left up to a lottery.

PCOS, inflammation and pregnancy

PCOS-on-ultrasoundPolycystic ovarian syndrome (PCOS) is one the most common hormone problems in women of reproductive age as well as one of the most common causes for female infertility. While infertility caused by PCOS is often amenable to treatment, women with PCOS often have more complicated pregnancies, including problems such as gestational diabetes and pre-eclampsia.  One of the common threads with these issues is their association with inflammation. It turns out there may now be a link explaining why PCOS patients have more complications. A recent study shows that markers of inflammation are higher in PCOS women and become even worse when these women get pregnant. It could be that inflammation is the common link between in PCOS and a number of pregnancy complications.

Some interesting facts about twins...

pivf-8wk-usIn the world of Reproductive Medicine, and much to the delight of our Obstetrician colleagues, we are always looking for new ways to reduce the risk of twins and other multiple births. Multiple pregnancies significantly increase the risks of all sorts of complications for mother and baby. It was a nice change of pace when I came across this great blog entry from the Renee Jacques at the Huffington Post about some cool and interesting facts about twins. So here they are:

  1. Identical twins do not have identical fingerprints
  2. Massachusetts has the highest number of twin births in US, followed by Connecticut and third our state of New Jersey. Not surprising considering we have lots of couples going through IVF and other infertility treatments and a law mandating coverage.
  3. Mirror image identical twins have reverse asymmetric features.
  4. Identical twins are not completely genetically identical
  5. Moms of twins may live longer
  6. Tall women are more likely to have twins
  7. Women who eat more dairy are more likely to have twins.
  8. It is possible for twins to have two different fathers
  9. Twins interact with each other in utero
  10. Some conjoined (Siamese) twins can experience each others senses.
  11. 40% of twins communicate with their own language.

Be sure to visit her original article here.

 

Overweight fertility patients may need higher medication doses

cetrotide-princetonMost Reproductive Medicine specialists know that our overweight patients often need higher doses of fertility medications, whether that is pills (clomiphene or Femara), or injections (Follistim, Gonal-F, Bravelle or Menopur). When we do IVF cycles, we also add a medication to prevent ovulation such as Lupron, Ganirelix or Cetrotide, and for the most part, the doses are not adjusted based on a patients weight. It turns out that doctors in Colorado looked at one of these drugs, Cetrotide (Cetrorelix) and found that overweight women actually metabolize the drug faster, meaning that the currently used dosing may not be sufficient in these patients. So, what does that mean? If the cetrotide does not last in the system long enough, premature ovulation may occur, and your IVF cycle could be cancelled. It may mean that we need to use higher or more frequent dosing in heavier women.

Stress and infertility- have we finally found a link?

stressMost fertility specialists, obgyns and midwives (and probably even your mother-in-law), know that stress can cause infertility. We see this in practice all the time, and numerous studies have shown that stress reduction techniques can help couples with infertility. Still, we do not quite understand the connection even though we know it exists. A recently published study from Ohio State looked at women trying to conceive and the levels of an enzyme called alpha amylase in their saliva. Alpha amylase is a considered a marker for stress, and the researchers found that women with higher levels had lower monthly pregnancy rates. Is this the missing link? Probably not, but it may be a first step in finding out how the mind affects fertility.

Should we be teaching about fertility in schools?

cervixOne Australian Fertility Specialist says yes, the classroom is the perfect place to learn about this, as reported on Yahoo News 7. Surveys continually show that the public, both women and men understand very little about their own fertility, and this is perpetuated in the media by stories of miracle late life pregnancies. Many women understand very little about how their own reproductive systems work, and even less about the true effect of age and lifestyle choices on their ability to have a family. Most of us reproductive specialists see patients all the time whose infertility could have been prevented. This doctor in Adelaide sees education as a sort of preventative medicine for infertility and  is advocating making fertility education a part of the school curriculum in his country, along side with  contraception. Will it work? And could it happen here in the US?

IVF babies grow up to be healthy adults

Princeton-IVF-babyFor most couples going who use assisted reproduction, one of the foremost concerns they have is about the health of the children they will hopefully deliver. While there are some concerns about the risks of birth defects and other complications of pregnancy in IVF babies, little was known about how these children do long term. Now, there is some promising long term data coming from Melbourne, Australia that suggests IVF kids do just fine as they grow into adulthood, with generally similar quality of life, health and educational  achievement to normal conceived children.

UK agency weighs in on three genetic parent IVF

HFEA-Princeton-IVFWith government agencies in the US and UK, considering  allowing the use "cloning" technologies to prevent the transmission of mitochondrial disease, nuclear transfer has become a hot topic in Reproductive Medicine. As discussed in our prior blog post, IVF is used to obtain eggs from both the intended mother and an egg donor, and the nucleus of the egg  (which contain the mother's genetic material) is transferred into the donor egg (which contains healthy unaffected mitochondria).  British authorities have now issued a draft guidance document recommending letting research proceed on mitochondria donation. What will the USFDA recommend and will this type of research to help couples with mitochondrial diseases  move forward? Only time will tell.

Ethnicity and IVF success rates

Image A recent study from the UK showed what many Reproductive Medicine specialists noticed for some time, that a couples' chances for success with IVF vary based on ethnicity. In this paper published in the British Journal of Obstetrics and Gynecology, IVF success rates varied by race with white women having the highest pregnancy rates, followed by women of Southeast Asian descent, then African descent and then Middle Eastern descent. The reason for this is not at all clear. The number of eggs women produced, how many fertilized and the number of embryos transferred, did not differ based ethnicity.  However the implantation rate (the percent of transferred embryos that took) did differ among the groups. Why the embryos of some ethnic groups would be more likely to implant than others remains the big unanswered question.

IVF and a Good Night's Sleep

bedA  study recently presented from a fertility center in Korea showed that women who got a good night sleep (7-8 hours) had the best outcomes from IVF treatment when compared to women who got less sleep or even more sleep.  Does this mean that sleeping increases your chances for pregnancy? Probably not, but it does confirm what we already know, that a healthy balanced lifestyle and reducing your stress will improve your odds of getting pregnant.