Fishing for a baby

Fish and fertility: Princeton IVF blog
 Eating more fish may help your chances of having a baby.

Can eating more fish make you more fertile?

It might actually help your chances of of having a baby, according to researchers at Harvard

What is the connection between fish intake and fertility?

The group at Harvard looked at women who were trying to get pregnant, how much fish they consumed and how long it took them to get pregnant. They found that women with regular fish intake were more likely to get pregnant and more likely to be sexually intimate with their partners.

How much fish intake is necessary to get this benefit?

The fertility benefit was seen with as little as 2 servings of fish a week.

Does a fish-rich diet make your more fertile.

This study shows the women who eat more fish are more likely to achieve pregnancy sooner, but one should not necessarily assume that their dietary choices directly caused their higher fertility. Causation is certainly likely, but this study was not designed to prove it.

Why would fish intake improve a couples fertility?

There are good reasons to believe that eating fish might make it easier to get pregnant. Fish are very high in omega 3 oils which have been shown in multiple studies to be beneficial in both promoting better pregnancy outcomes and better outcomes with in vitro fertilization (IVF). Other nutrients found in fish and other seafood such as Zinc may also explain the fertility benefits of fish.

What about the mercury?

That is the big unknown. Many large ocean fish such as swordfish, shark, tuna and tilefish have been shown to contain accumulate large amounts of environmental toxins such as mercury. The FDA recommends limiting these kinds of fish when pregnant over these concerns. It is unknown whether that benefits of regular fish intake offsets the risks of exposure to potentially dangerous chemicals. So, it is recommended for women who are pregnant or attempting pregnancy to minimize large ocean fish in their diet.

The Golden Arches and your Fertility

Fast food and time to conceive: Princeton IVF blog
 Eating too much fast food may cause infertility

Can eating too much fast food be making it harder to get pregnant?

New research suggest that eating too much fast processed food may actually lower your chances of getting pregnant, or at least delay the time to conception.

Researchers in Australia decided look at how long it took women to conceive and compared that to how many times a week they consumed fast food and how many times a week they ate fruit. They found that women who had fast food more than 4 times a week took longer to get pregnant than those who had it 2-4 times a week, who in turn took longer than those who did not consume fast food. The exact opposite was true with eating fruit. Those women who ate fruit regularly got pregnant faster than those who did not. Interestingly, green leafy vegetables and fish conception did not speed up the time to conception.

So, what does this mean if I am trying to get pregnant.

Lay off the fast food.

Despite, the title of this post, in all fairness to McDonald’s, this is not unique to to the golden arches or any other hamburger joints. This also applies to fried chicken from the Colonel, the forth meal at Taco Bell, the greasy Chinese food place at the mall and any number of fast food restaurants. Processed, high calorie, high salt, high carbohydrate food may taste good and be quick and convenient, but it may make it harder to get pregnant. They are also not great for your health or the baby’s.

Eat whole foods.

That does not mean go to one of Amazon Inc.’s high priced supermarkets. It means avoiding processed foods, like those that are served at fast food places.

Eat fruit.

Your grandmother was right. Most fruits are good for your fertility and health.

Green leafy vegetables are still good for your pregnancy.

Even if this study did not show a benefit to speeding up the time to conception, the folic acid in these veggies can help reduce your baby’s risk of birth defects such as spina bifida.

The oils in fish is also good for your pregnancy and it may reduce the rates of some complications.

Many prenatal vitamins contain fish oils. Just be wary of getting too much mercury from large ocean fish.

Eight million IVF babies

World welcomes the 8 millionth IVF baby: Princeton IVF blog

2018 sees the number of IVF babies top 8 million

 IVF is a now a common treatment for infertility

It’s been 40 years since Louise Brown, the first IVF baby, was born in the United Kingdom. At the time, it was both a miracle and controversial. Now in 2018, it has become a common medical procedure, not just in Britain and the US, but around the world. Now we have reached a new milestone.

2018 marks the birth of the 8 millionth IVF baby

So what is IVF all about?

IVF means in vitro fertilization. In vitro literally means in glass. The eggs and sperm are removed from the body, fertilized in a dish (it’s plastic, not glass though) and returned to the womb.

Why has IVF become so common?

Because it works. While IVF is not always successful, it is the only fertility treatment that has higher pregnancy rates than those of normal fertile couples. The technology has improved, and as the developing world has become more prosperous, these technologies have spread outside the US and Western Europe. IVF is now largely accessible to infertile couples worldwide.

Why do IVF instead of other medical procedures?

IVF is not necessarily the first treatment we try. Many patients will conceive with other lower tech ways such as intrauterine insemination or fertility pills and don’t need IVF. Some couples, such as those with damaged fallopian tubes or with very poor quality sperm, cannot conceive without IVF.

10 questions about using donor sperm

Donor sperm: 10 questions from the Princeton IVF blog
 We offere donor insemination in our Lawrenceville NJ office

Thinking about using a sperm donor? Here are ten questions you may be asking yourself if you are considering doing donor insemination:

What are my chances for success using donor sperm?

The success rates for therapeutic donor insemination (TDI) treatment range from 8% up to about 25% per month, depending on your age other factors. Keep in mind that 20-25% are the normal pregnancy rates in couples who do not have fertility issues, so the success rates are actually quite good. Cumulatively up to 80% of women will conceive with IVF

How is donor insemination performed?

In our center, we use only washed sperm and perform intrauterine insemination (IUI) since this type of insemination has the highest chances for success. The sperm sample which we have received from the sperm bank is thawed out and injected into the uterus. We use ultrasound monitoring and an injection of hCG (pregnancy hormone) to assure the best timing. IUI is only slightly more uncomfortable than a pap smear.

Why choose donor insemination over other options? 

Donor insemination (TDI) is both cheaper and easier that the alternatives such as IVF and egg freezing.

Should I chose an anonymous or known donor?

 Any anonymous donor is the best choice. The FDA has very strict requirements for using donor sperm (and donor eggs). The process required to use sperm from a known donor can more difficult and more expensive than to order sperm samples from a bank where the semen has already been cleared.

How do I move forward with donor iui?

If you live in or near central New Jersey and would like to see us for your treatment, set up a consultation with the doctor. You can call us at 609-896-4984 or click here to start the process. At the time of the consultation, we will discuss how to get the process started and answer all of your questions about the process.

How do I choose a sperm bank?

All sperm banks in the US are accredited and inspected by the Food and Drug Administrations, and follow similar guidelines. We usually recommend California Cryobank and Fairfax Cryobank as they have the widest selection of donors due to their size.


What if I want a full biologic siblings for my child?

Successful donors are often retired to reduce the chances that a man and woman who find each other randomly will not turn out to be biological siblings. Once you are pregnant with a donor, we advise purchasing a number of vials for the next pregnancy in case the donor is retired. On occasion, a sperm donor will come out of retirement to help a couple have a biologic sibling.


Are there limits the number births for each donor?

Yes, for the reasons above.


Should I tell my child about how I got pregnant?

While of course the ultimate decision is yours, most psychologists and counselors who work in Reproductive Medicine recommend that you do tell your children. A counselor can help give you advice on the best way to do this.


Are there medical problems in children from donor sperm?

Children from donor inseminations are no less healthy than other children.

Dr Derman a top doctor again

Seth G Derman,MD, top doctor: Princeton IVF blog

Dr. Seth Derman listed as top doctor in Reproductive Medicine again for 2018

 A top fertility doctor in New Jersey 2018 from Inside Jersey magazine

Our medical director at Princeton IVF and a Reproductive Endocrinologist at Delaware Valley OBGYN and Infertility, Lifeline Medical Associates, Dr. Seth Derman has been named one of Inside Jersey Magazine's Top 2219 Doctors for 2018.

The candidates for the top doctor list are vetted  by Castle Connolly, and nominated and selected by their peers for inclusion in this list.

Fertility treatment in Delaware

Delaware mandates fertility treatment: Princeton IVF blog
 Delaware joins New Jersey and other states with IVF mandates

Delaware joins New Jersey in mandating IVF treatment

What does the Delaware law mandate?


How does this differ from the New Jersey IVF law?

The New Jersey Family Building Act was originally passed in 2001 and was recently amended. The NJ law differs in several ways:

  • The NJ law only covers 4 cycles

  • The Delaware mandate limits how long an insurance carrier to require patients to do IUI before their IVF coverage kicks in.

  • Only the Delaware law requires coverage for fertility preservation for cancer patients.

Want to find out if your insurance plan will cover fertility treatment?

Surrogacy is now legal in New Jersey

NJ surrogacy law passes: Princeton IVF blog

Gestational carrier agreements are now allowed in the state of New Jersey

What is gestational carrier IVF?

IVF, also know as the test tube baby procedure, is a treatment for infertility in which an egg is fertilized with the sperm outside of the body, and the embryo that results is implanted into the womb. With standard IVF, the embryo is implanted into the woman whose eggs were used, that is the intended mother. With a gestational carrier IVF, the embryos is implanted into another women who will carry the baby for her.

How does gestational carrier differ from surrogacy?

To most folks, gestational carrier and IVF are the same thing, but they are not. With traditional surrogacy, the surrogate is both both the biologic mother (since the eggs come from her) and the birth mother (since she will give birth to the baby). It was possible to this even before the invention of IVF. This is rarely done nowadays. With gestational carrier IVF, the intended mother is still the biologic mother, since her eggs are used, and the gestational carrier is the birth mother only.

Was using a gestational carrier illegal before?

Technically no, but in reality it was in New Jersey. There was a case called the Baby M many years ago in which a surrogate mother refused to hand the child over to the intended mother, even though she had a written agreement to do, and the baby’s biologic father was married to the intended mother. The NJ supreme court gave custody to the birth mother. Since that time, attorneys have advised their clients seeking to use a carrier to utilize a carrier who will give birth in another state, one in which the rights of intended parents to recognize these contracts are protected by law.

Why is the New Jersey Gestational Carrier Agreement Act such a big deal for fertility treatment in New Jersey?

The act allows binding legal contracts to be drawn up between intended parents and their gestational carrier. For the first time, couples in New Jersey can use a gestational carrier and do treatment near home knowing that they will actually be able to keep their own child.

What kind of stipulations are required for surrogacy contracts under the new law?

This is a not a substitute for the advise of an attorney who is knowledgeable in Reproductive Law, but here are a few the more important points:

  • Both parties must have legal representation

  • The carrier must be at least 21

  • Appropriate psychological counseling is required

  • If the intended mother is married or in a civil union, whether heterosexual or lesbian, their partner must be a party to the agreement

  • The gestational carrier is required to hand the baby over immediately upon birth, and the intended parents must accept the child as their own regardless of the baby’s medical condition.

  • The intended parents cover the gestational carrier’s medical costs associated with the pregnancy.

How do we get started?

If you need IVF and think you need to use a gestational carrier, the first thing to do is see a reproductive medicine physician. Many couples who think they need a carrier actually do not, so it is best speaking to a specialist at the outset. If you would like to come to our practice, click here to help set up an appointment.

Should we try Femara first?

letrozole-femara-fertility

For years clomiphene has been the main medication that fertility doctors and obgyns use to help women with polycystic ovarian syndrome and irregular cycles to get pregnant

That may be starting to change. In fertility practices such as ours, we have switched to a different drug, letrozole, also known by the brand name, Femara.

What is Letrozole?

Letrozole is a medication that blocks an enzyme in the body that converts testosterone into estrogen. It causes the estrogen levels to drop which lead to the pituitary gland to produce more of a hormone called FSH. FSH (follicle stimulating hormone) is the hormone the causes the eggs to start growing. By doing this, letrozole stimulates ovulation The most common use for letrozole is to help women with breast cancer reduce their risk of recurrence.

Why would you want to use letrozole instead of clomid?

Stimulation with letrozole results in fewer eggs than clomiphene, resulting in fewer multiple births. It is also less likely to cause the side effects of hot flashes and mood swings that are common with clomid.

So, what do the experts say about Femara?

The American College of Obstetrics and Gynecologists has endorsed letrozole as first line treatment for women with PCOS and infertility.

 

The mediterranean diet and fertility

Mediterranean diet and fertility: Princeton IVF blog
paleo-diet-fertility.jpg

As a fertility specialist, one of the most common questions I get is about diet, what can changes can I make in my diet to help me get pregnant?

For some patients, particularly those with PCOS that answer is relatively simple. It well know that a diet high in protein and low in carbohydrates helps women with polycystic ovaries to conceive. 

For other women with infertility, the answer is less clear.

A recent study from Greece, looked at women who self-reported at following a "mediterranean diet." Women on a Mediterranean diet had a higher pregnancy rate that those who did not.

Does this prove that a diet in low in animal fats and high in vegetables and fruit can help you get pregnant? No, but it does suggest a health diet low in carbs and red meats may help your chances of having a baby.

Acupuncture and Infertility

Acupuncture and IVF pregnancy rates: Princeton IVF blog
 New study sheds doubt on whether acupuncture really helps IVF pregnancy rates

Lots of women seek out acupuncture to help them get pregnant, but does it really help?

Complementary and alternative medical treatments have become very popular for treating and preventing diseases, including the treatment of infertility. This may including vitamins and herbs and treatments such as acupuncture.

A number of researchers have found that acupuncture does improve fertility, at least in women who are undergoing IVF treatment, but some have not.

In order to figure out what it really going on, a group of doctors in Australia studies 824 women undergoing in vitro fertilization at their clinic. Half got real acupuncture (meaning the needles were placed in the right place according to acupuncture practice guidelines) and in the other half of patients, the needles were placed in locations that were not expected to have any effect. We call this last treatment "sham" acupuncture. They compared outcomes between the two groups.

They found out that women who had sham acupuncture were no more likely to get pregnant than those who had acupuncture done correctly. The pregnancy rates in these two groups were almost identical.

So what does this mean?

It is likely that acupuncture does not improve the chances for success with IVF, and if it does, the benefit is likely very small.

Were there any benefits to acupuncture in these women?

Yes. Women who received acupuncture were more relaxed and had a better sense of well being that those who had only sham acupuncture. This is not a small issue since IVF treatment is very stressful to the couples who are going through it.

Knowing this, should I still get acupuncture done?

Acupuncture is safe and comforting even if it may not be effective in IVF treatment. Other than the cost if it is not covered, there is really no risk to trying it.

Fewer complications in IVF pregnancies?

 New research suggests IVF pregnancies could have lower rates of some complications

Surprisingly, some complications might actually be less common in pregnancies that result from assisted reproductive technology such as IVF

This seems to go against what fertility doctors, obgyns and midwives have been telling their patients for years, namely that women with IVF pregnancies are more likely than "regular" pregnancies to experience pregnancy complications.

What complications were actually less common in IVF pregnancies?

A group looking at IVF outcome data submitted through the Society for Assisted Reproductive Technology (SART) to the Centers for Disease Control (CDC) found that risk of perinatal mortality (the risk of stillbirth or newborn death) in very premature births was lower in women who conceived with IVF than those who did not. They found this to be true with both single births and multiple births (twins triplets, etc.) This informations was recently presented at the American College of Obstetricians and Gynecologists.

Does this mean getting pregnant with IVF is actually safer than getting pregnant on your own?

Probably not. Women who conceived with IVF were less likely to lose a premature baby than those who got pregnant on their own. We have no idea why this is the case. It could be due to more careful prenatal care with IVF pregnancies, or a higher socioeconomic level in couples doing IVF, rather that a results of what is actually going on with the pregnancy. 

Why is this surprising?

There are many studies show a higher rate of complications in pregnancies that result from assisted reproduction such as IVF, and some others that show no effect. It was surprising to find out from such as large database, that at least one serious complication was less common.

Can menopause be reversed with stem cells?

Restoring fertility with stem cells: Princeton IVF blog
 New research suggests bone marrow stem cells could be used restore estrogen and fertility in women with early menopause.

It may become possible in the near future

Women who suffer from premature menopause, also known as primary ovarian insufficiency (POI) or primary ovarian failure (POF) have either run out of eggs or no eggs capable of being stimulated.

This can occur for a number of reasons but early menopause causes 2 major problems for women who suffer from it. One is infertility, and this type of infertility can usually only be successfully treated with donor egg IVF. The other problem is hormonal. With the depletion of ovarian follicles, levels of reproductive hormones, especially estrogen, drop dramatically. The low levels of estrogen can cause a number of problems including vaginal dryness, difficulty with intercourse, hot flushes, bone loss and loss of sleep to name a few.

So, if there was a safe way to restore eggs to an ovary that has shut down prematurely, it might be a great advance in women's health care.

With that in mind, the ROSE trial was undertaken. The researchers injected cells from the bone marrow, which is rich in stem cells into the ovaries in an attempt to help regenerate new eggs.

Obtaining cells from the bone marrow is a fairly routine medical procedure and injecting substances into the ovarian is also not a new procedure. What is new about this is combining the two and using stem cell to restore ovarian function.

The few patients in the trial had an increase in the size of their ovaries and higher estrogen levels even a year out of from the procedure.

It will still take time and more studies to determine how safe and effective stem cells from the bone marrow are at restoring functioning ovaries and fertility to women with premature menopause / POI, but the results so far are encouraging. 

 

Celebrities having babies over 40

Pregnancy in your 40s- how realistic is it?: Princeton IVF blog
celebrity-mothers-over-40.jpg

The media shows plenty of Hollywood stars having babies in their 40s, but are they telling the whole story?

For many it is exciting to hear about the celebrities they adore having babies. Like many women in the society at large, many celebrities have chosen to delay having children for a variety of reasons. It should come at surprise, then, that many of the celebrity moms depicted in the magazines are in their 40s.

Knowing how women trying to start a family (or growing her current family) as they get older face an uphill battle,  are the media who cover these stories doing a disservice to women's reproductive health?

To answer this question, researchers at New York University looked at all the issues of 3 popular magazines widely read by women of reproductive age over a 4 year period.

This is what they found:

  • There were 1,894 references to pregnancy or fertility
  • 1/3 of the issues had cover stories related to fertility
  • There 240 celebrities, who averaged age 35
  • Only 2 articles on 40+ year olds using donor eggs
  • There were 10 stories about adoption and 5 about using a gestational carrier. Not one of these mentioned that they had previously suffered from infertility

It is understandable that a celebrity (or anyone else for that matter) would not want to share the very personal details of what it is like to go through fertility testing and treatment.  Still, the stories presented to the public are far from complete. While there is nothing that appears to be inaccurate in the articles, they present an unrealistic view of normal fertility after 35.

Modern fertility treatments have revolutionized the ability of couples suffering from infertility to get pregnant, but it has not been able to eliminate reproductive aging. Implying that waiting to have children is not harmful to your fertility through human interest stories is doing a disservice to women. 

Is the traffic outside affecting your chances of having a baby?

Living near a highway and IVF pregnancy rates: Princeton IVF blog
 Women who live in high traffic areas are more likely to miscarry

Living in a high traffic area may hurt your chances for success with IVF

Research from Harvard presented at the annual meeting of the American Society for Reproductive Medicine suggests that women with a higher exposure to automotive traffic have lower IVF success rates than other women.

The researchers looked at 660 IVF cycles done over a 14 year period and compared their success rates to  how far they lived from a class A roadway. A class A roadway means an interstate, state or US highway. 

Women who lived more than a kilometer (0.6 miles) from a major roadway were 70% more likely to have a baby than those who lived within 200 meters (about 2 football fields) of a major roadway.

Interestingly, both groups of patients had similar pregnancy rates, but the those who live closed to the highway were more likely to miscarry.

Does this mean moving to a low traffic area will improve your chances  of having a baby?

Not necessarily. It does show what we already know, that the environment we live in and the air we breathe plays a role in reproduction, as it does in other aspects of health.

 

When is it time to give up on IVF?

 Couples continue to get pregnant with IVF put 8 cycles.
When is it time to stop IVF: Princeton IVF blog

Any couple who has gone through IVF knows what a rough and wild ride it can be, both physically and emotionally. For that reason, many couples give up on IVF early on, perhaps too early.

Why do women drop out of IVF treatment?

The reasons why women quite IVF are usually financial, when their insurance coverage or access to funds to pay for treatment run out, or emotional, when the thought of going through another cycle and the prospect of all the drugs, office visits and prospect of disappointment becomes overwhelming.

But, what happens to couples who persist and continue to go through IVF treatment cycles?

Fertility doctors in Bristol in the UK, sought to answer that question and what they found was encouraging. In their program, 1/3 of patients conceived on the first IVF cycle. In the next 3 cycles (1-4) the pregnancy rate was about 20% per cycle. While the rates were lower in cycles 5 and 6, they were not zero. Pregnancies continue to happen.

After 6 cycles of IVF, the cumulative pregnancy rate was 68%. In women between 40 and 42, there were successful pregnancies through the 9th cycle.

We've failed a few cycles of IVF. Should we give up?

Only you and your partner can answer that question. IVF tends to be more successful on the first round, but successful pregnancies do continue to happen with repeated attempts, sometimes even when it seems futile.

 

Do I need to have a period before starting Clomid?

 It may be OK to start clomid without a period.   

It may be possible to ovulate without a period.

For many couples suffering from infertility, the treatment journey starts with Clomid (clomiphene). These fertility pills help to stimulate ovulation, and when used properly, are safe and effective as a first line treatment for many couples.

One of the more frustrating parts of about taking Clomid is having to wait for a menstrual period to start the medications.

Traditionally, Clomid is started on the 3rd or 5th day of the menstrual cycle, and it is not uncommon for doctors to proscribe progesterone-like medication to bring on the period before starting fertility drugs. If you are seeing an obgyn physician for your fertility treatment and your cycles are irregular, this is likely what will happen.

It turns out it is no longer necessary to have a period in order to start fertility drugs.

Fertility specialists have adopted this new way of thinking after a article came out a few years ago, suggesting the having a period is not necessary in order for fertility pills to be successful.  Not only that, but the chances for success may even be lower if medications are used to bring on the period. This is referred to as the "stair step protocol." So, what does this mean?

The stair step protocol means less time to make you ovulate and a shorter time to conception.

So, why does my doctor not use clomiphene that way?

Most obgyn doctors have been trained to use Clomid in the traditional way. Fertility specialists tend to be more current on the latest treatments and more likely to offer the stair step.

Can the stair step be used with other fertility drugs?

In our practice, we routinely use letrozole (Femara) in place of clomiphene with the stair step and it works just fine. Injectable fertility drugs can also be started without a period, but those treatment cycles are different.

Does this mean we can start clomiphene at any time?

No. Your doctor will need to determine that you are not pregnant and did not ovulate already before starting fertility drugs. Using these drugs as the wrong time of the cycle can cause more harm than good.

 

Could your fertility be a gauge of your health?

 Infertility may mean health risks in the future

Research suggests that women with infertility may be at higher risk for health problems in the future

As a fertility specialist, I hear this all the time. I am healthy and take good care of myself, so there should be no reason I am not be getting pregnant. Naturally, we go on to discuss how one's fertility can be quite separate from your general health, as is quite often the case. Perhaps, though, that is not completely true.

A study out of the University of Pennsylvania and the National Cancer Institute followed women long term for health issues. 

They were mostly followed for cancer related issues, but were also asked about a history of infertility as a part of the study.

What they found though was interesting, including:

  • overall, women with a history of infertility had a 10% risk of dying over the 13 year study time
  • women with a history of infertility had a 20% increased risk of dying from cancer
  • women with a history of infertility had a 44% increased risk of dying from breast cancer
  • women with a history of infertility had a 70% increased risk of dying from diabetes, even though they were no more likely to have diabetes
  • uterine and ovarian cancer were no more common in women with a history of infertility

Does these mean the infertility causes poor health? Probably not, but it does mean that infertility could be sign of underlying health issues.

It means that women with a history of infertility, whether they were treated or not, whether they were successful or not, need to pay attention to their general health. 

 

 

Should I stop alcohol before pregnancy?

 Moderate alcohol does not harm fertility but not safe during pregnancy.

Many women stop all alcohol when starting to attempt pregnancy, but does it really help?

Probably not. Research suggests that moderate alcohol intake will likely not harm your fertility.

Before we go any further, this means prior to pregnancy. No one including your doctor or midwife can reassure you that alcohol is safe to take in any amount during pregnancy, and that includes the week that you are pregnant before the pregnancy test comes out positive.

Anyhow, getting back to the story, researchers in Denmark compared a group of women who more moderate drinkers (between 1 and 14 glasses of wine per week) to another group of women who did not drink at all while attempting pregnancy. The researchers did not find any difference in the chances for pregnancy between the 2 groups. The same was not true for heavier drinkers. Those who drank the equivalent of 2 bottles of wine per week or more were actually less likely to conceive.

So what this mean for drinking alcohol when trying to conceive?

According this study, light to moderate alcohol likely does not affect your chances of having a baby, but heavy alcohol consumption likely does.

Can I drink when I'm trying to get pregnant?

In moderation, alcohol consumption before a pregnancy implants in the uterus is fine.  A pregnancy implants about a week before you expect your period, and it is impossible to say if it is safe to drink from that time on.

What about alcohol during the rest of pregnancy?

Heavy and moderate alcohol are well known to cause serious birth defects. Ask your doctor or midwife. They will almost certainly agree.It is not clear whether have an occasional glass of wine will increase your risk of birth defects or not. In the absence of information to reassure our patients, most of obstetricians and midwives will advise against it.

Live birth after uterine transplant

Live birth after uterine transplant: Princeton IVF blog

Doctors at Baylor University deliver the first US baby born following uterine transplantation

A few years back, doctors in Sweden performed the first successful uterine transplant. Several academic fertility centers in the US have tried to replicate this here, and doctors at Baylor announced they were the first to do so.

Why would one want to transplant a uterus?

It is impossible to carry a baby without a uterus, also known as the womb. The early embryo implants itself into the wall the uterus about a week after conception and through the placenta and umbilical cord, its interface to the uterus, the fetus gets all of the nutrients and oxygen it needs to grow and even to survive.

Some women are born without a uterus (such as in the Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome), some have scar tissue in the uterus and others have had their uterus removed (a hysterectomy) for fibroids, cancer or some other reason. While there have been many many cases of ectopic pregnancies, where a pregnancy implants outside the uterus, these pregnancies nearly always need to be terminated early on since they can result on the death of the mother, and almost never results in a live birth of a baby. There is also interest in using a transplanted uterus in transgender women.

Are there alternatives ways to have baby without a uterus?

Currently, there is a very effective way of having a baby without a womb, and it is called Gestational Carrier IVF.  The eggs are harvested from the intended mother, sperm is collected from the intended father, and fertilization is performed in the IVF laboratory. The embryos are grown and transfered into the uterus another woman, referred to as a gestational carrier after her uterus is prepared for pregnancy using hormonal treatments. This can be costly (but much less so than a uterine transplatation), is illegal in some states and most importantly, the pregnancy is carried and delivered by someone else other than the intended mother.

How is a uterine transplant performed?

The uteri used for transplantation can be obtained from living donors or women who have recently passed away and offered their organs up for donation. Using an open incision (laparotomy in medical jingo), the donor uterus is attached the various blood vessels to ensure it has good supply and to attached to nearby structures to hold it in place. It is not attached to the fallopian tube.

How does a woman get pregnant after uterine transplantation?

IVF (in vitro fertilization) is required to achieve pregnancy since without a connection between the tube and uterus, pregnancy would otherwise be impossible. In years past, fertility surgeons, connected fallopian tubes to the uterus, but that operation has been abandoned since it rarely worked. IVF bypasses that problem and offers the best chance for pregnancy.

Are more uterine transplant babies coming?

The doctors at Baylor have another woman pregnant after uterine transplantation and IVF, a few more attempts planned. A number of women undergoing the procedure have not been successful. Other centers are trying this as well, but the costs are so high and it is not covered by insurance, so it not clear how widespread this will become.

Twin sons from another mother: a true story

A gestational carrier with twins finds out one of the twins she was carrying was her own

Surrogate mom gives birth  to twins boys, but one only was from her IVF cycle, the others was her own.

How is that possible?

When a couple uses a gestational carrier (what most people think of a surrogacy), embryos are produced from the eggs from the intended mother and sperm from the intended father. Sometimes the eggs or sperm are from a donor instead. Regardless, the embryos are placed in the womb of the gestational carrier, the woman who will carry the pregnancy and give birth for the intended parents. The carrier will take hormones to help prepare her uterus for pregnancy. This process has been done for years by fertility specialists, is highly successful and despite its complexity usually goes off without a hitch.

Not this time though...

A California woman agreed to be a gestational carrier for another couple. They did a form of IVF and the procedure seemingly went well. The carrier became pregnant and on ultrasound they saw twins.  Since one embryo was transfered, the doctors naturally assumed the twins were identical. The pregnancy went well, the twins were delivered by cesarian section and went to live with the intended parents.

A month later, genetic testing revealed that the twins were not identical, and that the child's genetic parents were actually the gestational carrier and her husband.

How could this happen...

In a process called suprafecundation, a women who is already pregnant, or this case, in the process of becoming pregnant, can ovulate again.

When this happens, a woman who is pregnant would conceive a second pregnancy when she ovulates a month later. So, the second baby would be due a month later than the first. This type of event is exceedingly rare, but it looks like this is happened here, but on a shorter time frame.