In the news

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.

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.

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
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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. 

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. 

 

 

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.

 

Is treating infertility a crime?

Is treating infertility a crime?: Princeton IVF blog

Irish government proposes draconian new regulations of IVF treatments

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Fertility treatments, particularly IVF have been subject to strict government regulations around the world, but has the Irish government's proposals gone too far this time?

Recently, the Irish government Department of Health has decided to develop a plan to provide IVF treatment for its citizens who suffer from infertility. While this is excellent news, they are also proposing some regulations, that are a bit over the top including...

One can understand their desire to refuse to cover treatments that would be less likely to result in a healthy live birth, but to threaten jail time for doctors and staff for performing IVF. That makes no sense. Hopefully, these absurd regulations are never enacted.

 

IVF no longer covered where it all started

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The first IVF baby Louise Brown was conceived near Cambridge, England over 3 decades ago...

Now it turns out that National Health Service in Cambridgeshire will no longer cover IVF treatment in the place where it all began.

It is sad but true according the BBC...

The UK with its single payer government health system, like all other health systems, has limited funds and been forced to make a decision on where to cut. In Cambridgeshire, coverage for IVF was one of those cuts even though ivf treatment is recommended by the nhs' own guidelines.

In the United States, where we have a more fragmented system, some states such as New Jersey where we are located, mandate coverage. While the law remains intact and recently was amended to expand the definition of infertility, health care reform laws such as the Affordable Care Act (ACA, Obamacare) has actually reduced the number of women in our state who are covered for fertility treatment. When faced with multiple mandates, employers and insurers are forced to make decisions where to cut to control their premiums.

While there is plenty of talk these days about advocating a single payer government controlled system, it is not clear that such a change will benefit couples with infertility. While some countries with national health care systems do cover IVF and other treatments, it is often the first item on the chopping block when costs are getting out of control. It is certainly the case in Britain.

For those who advocate for the availability of treatment of infertile couples, be careful what you wish for. Increased access to medical care does not necessarily mean increaseD access to fertility care.

A spoonful of sugar may may the medicine go down, but will it harm your chances for pregnancy?

Sugary drinks, articifical sweeteners and fertility: Princeton IVF blog
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Recent studies suggests that sugary drinks, even those with artificial sweeteners may harm the chances for pregnancy.

Although it is far from conclusive, several recent studies suggest that sweet drinks may have an adverse effect of a woman's chance for pregnancy, including...

  • Harvard doctors found that drinking one sugary drink a day can lower the success rate of IVF by 12% and more than one sweet drink a day by 16%

  • Brazilian researchers found that consuming sugary or artificially sweetened drinks reduced embryo quality and the chances for an embryo to implant. interestingly

Interestingly this effect did not occur with unsweetened coffee.

The reason for this is not totally clear, though we know both obesity and polycystic ovarian syndrome (PCOS), which are both associated with infertility and miscarriage, and associated with changes in how the body handles sugar, can lower the chances for pregnancy.

So, what should I do?

It is a good idea to keep sugary products to a minimum when you are trying to get pregnant, and to minimize artificial sweeteners such as Splenda, Equal or Sweet-and-Low. These sugar substitutes may be just as harmful as sugar itself.

Don't panic. Women who use artificial sweeteners and drink sweet drinks still get pregnant all the time, even if the chances are a little lower. There are many factors that go into your fertility, so it is far from clear that consuming these drinks is actually harms your chances for pregnancy.

Dr. Seth Derman, Inside Jersey Top Doctor

Dr. Seth Derman- a top fertility doctor in NJ
 Seth G Derman, MD, Reproductive Medicine Specialist and Inside Jersey top doctor

Dr Derman named to the top doctor list once again for 2017

The medical director at Princeton IVF and a Reproductive Endocrinologist at Delaware Valley OBGYN and Infertility, Dr. Seth Derman has been named one of Inside Jersey Magazine's Top 2128 Doctors for 2017.

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

Editing embryos- fiction, science fiction or both?

Designer babies and gene editing: fiction, science fiction or both: Princeton IVF blog
 Researchers in Oregon 

A recent report from Oregon describes how researchers edited the genes in a human embryo.

To many of us, myself included, it sounds a bit scary.

An article in the NY times argues that it is huge leap from gene editing to designer babies, since most human traits require the interaction between a number of genes and the environment

There are thousands of what are called single gene mutation disorders that this gene editing technology may be able fix. Examples of this include Cystic Fibrosis, Tay Sachs disease and Sickle Cell Anemia. These types of diseases are due to a single gene mutation which could potentially be repaired using this technology. Many of these disorders can currently be screened for and diagnosed (if anticipated) during the IVF process using Preimplantion Genetic  Diagnosis (PGD)

Picking out your child's height, or athletic or intellectual abilities are another story. Height alone is likely to controlled by tens of thousands of genes, of which less than a thousand have been identified. Even if all of the genetics could be worked out, the task of editing those genes would be enormous.

So, for now at least, designer babies are the stuff of science fiction.

Rhode Island mandates fertility preservation

First state mandates egg freezing insurance coverage: Princeton IVF blog

First state requires fertility preservation coverage from insurers

 Egg freezing insurance coverage

What is fertility preservation?

It refers to obtaining, freezing and storing eggs, sperm or embryos for future use. 

Why would one want to preserve fertility?

There are several reasons:

  • If you are undergoing treatment for cancer or other diseases that require treatments such as chemotherapy, radiation or surgery which are likely to cause infertility.
  • If you need to defer having a baby but are concerned you may be too old when you are ready
  • If you do not have a partner, are concerned about waiting but not ready to use a sperm donor.

What is the signIficance of the Rhode Island law?

This is the first time in the US that fertility preservation insurance coverage has been mandated by law. A number of states do require treatment for infertility but not necessarily fertility preservation. That could change in the future.

Where can I learn more about the mandate?

Here is a link to the Rhode Island law.

What do I do if I am about to get chemotherapy and want to learn more?

This is a discussion you need to have ASAP with your oncologist and a reproductive medicine specialist. Ideally the process should happen before cancer treatment starts, and your oncologist will want to delay treatment as little as possible. If you are in our area and would like to see us at Princeton IVF, please call at 609-896-4984 or 609-896-0777 to set up an appointment.

 

Sperm selfies?

Testing for male fertility on your smartphone: Princeton IVF blog

Could your smartphone replace a semen analysis?

 At home, iphone and android based sperm test kit

 

Can this device replace a semen analysis with your doctor? Maybe in the future.

Based on research from Harvard University, engineers have developed a new device for an at home "semen analysis." There are already at home sperm test kits available in stores, what is so unique about this one? Simply put, it is the smart phone. This device attaches to and taps the power of your iphone or android device through it's app, to analyze the data and give you a visual display of what the laboratory folks would see under the microscope.

The pros:

  • low cost
  • quick results
  • can be done at home without the awkwardness
  • you get to see what the actual sperm look like

The cons:

  • lacks the details your doctor may need (actual sperm concentration and motility)
  • unable to accurately determine morphology (another important part of the semen analysis)

The idea is a good one.

Reliable, inexpensive testing in a comfortable setting, and a way to determine when it's time to visit the fertility doctor or urologist. The reality is not quite there yet. The information is not quite enough to replace the formal semen analysis at a clinic, but with improvements in the software, it may well be in the future.

AMA calls Infertility a disease

AMA agrees Infertility is a diesase: Princeton IVF blog

It's official now. Infertility is now what we know it has been for years, a disease, not a problem or an inconvenience.

At the encouragement of the American Society for Reproductive Medicine, the American Medical Association has voted to call infertility a disease.

According to the ASRM, 

Infertility is NOT an inconvenience; it is a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction.

Now the AMA has accepted this fact.

Sperm counts are dropping

Sperm counts are declining across the west: Princeton IVF blog

A recent publication suggests that sperm counts may be declining all across the western world

 Research suggest sperm quality is going down across the western world.

It is been all over the news lately.  Some in the media have even suggested this may bring our doom as a species. So, what's the real story behind this...


A recent paper published suggests that sperm counts may be declining in Western countries.  


While this is not entirely new, it is a continuation of a trend that has been noted for years.  This there has been a decline in sperm quality noted in the United States and other western nations. The authors compiled studies done over a number of years including:

  • 185 studies
  • over 42,000 men
  • between 1973 and 2011
  • from US, Europe, Australia and New Zealand

Over the 39 years, the sperm concentration dropped 52.4% and the total sperm count went down 59.3%, a hugh decline.

While this is concerning, it raises even more questions:

  • Have the counts really declined or is it just the techniques used to count the sperm?
  • If the counts are going down, is it actually affecting male fertility?
  • Is this a problem in the developing world or just in the west?
  • If this being caused by increasing obesity?
  • Is this being caused by something in the environment?

 

Only time and further research will answer these questions.

New Jersey updates Infertility Law

New Jersey fertility coverage mandate expanded: Princeton IVF

Governor Christie signs updated NJ fertility mandate

At least in the past, New Jersey has had among the most generous insurance coverage for infertility treatment in the US. The legal mandate for this, the New Jersey Family Building Act, passed over a decade and a half ago, required NJ employers with certain exemptions, to cover fertility treatment up to and including IUI and IVF.

Unfortunately, changes in the health care system, such the Affordable Care Act (Obamacare) have affected coverage. Fortunately, New Jersey state employees and most NJ teachers continue to be covered under the mandate. There are some gaps in this coverage, particularly for single women and those in single sex/lesbian relationships.

With an act of the NJ state legislature and the signature of Governor Christie, that has changed. The infertility mandate has been updated to reflect the new ASRM definition of infertility and includes the following:

  • A male is unable to impregnate a female;
  • A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
  • A female with a male partner and 35 years of age and over is unable to conceive after 6 months of unprotected sexual intercourse;
  • A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of IUI (intrauterine insemination) under medical supervision;
  • A female without a male partner and over 35 years of age who is unable to conceive after 6 failed attempts of IUI under medical supervision;
  • Partners are unable to conceive as a result of involuntary medical sterility;
  • A person is unable to carry a pregnancy to live birth; or
  • A previous determination of infertility pursuant to the law.

This update in coverage becomes effective in August 2017 and only applies to New Jersey state employee and teacher plans.

At Princeton IVF, we participate in the affected New Jersey State Health Benefits Program and School Employees Health Benefits Plan that are affected by these new rules, including NJ Direct  from Horizon Blue Cross Blue Shield and Aetna for NJ state employees.

One millionth IVF baby born in the US

One millionth IVF baby born in US: Princeton IVF blog

In Vitro Fertilization US reaches a new record.

 The one millionth IVF baby was born in the United States in 2016

The one millionth IVF baby was born in the United States in 2016

This year, the Society for Assisted Reproductive Technology announced that the 1 million IVF baby was born in the United States.  IVF has been around for over 30 years, and performed successfully at multiple clinics in the United States and worldwide since then.  Worldwide, there have been millions of babies born from IVF, but limited coverage in the United States has delayed reaching this milestone.

New York: fertility treatment for all women?

NY Governor Cuomo expands fertility coverage: Princeton IVF blog

New York governor changes insurance rules

Governor Andrew Cuomo has instructed insurance companies in New York to cover infertility treatments on single women and women in same sex relationships.

New York is one of fifteen states, including our own, New Jersey, that requires insurance plans to include infertility treatment in their benefits. Typically, these mandates require a period of unprotected intercourse to kick in. In New York, the governor has eliminated that requirement for women in whom that is not an option.

It is unclear how impactful this change may be since New York's infertility mandate is rather limited. It has very limited coverage for IVF, and for insemination, the cost of donor sperm is high. Donor sperm is rarely if ever covered by insurance regardless on insurance mandates.