ICSI

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.

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.

 

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.

 

Dr Derman discusses IVF and Assisted Reproduction with the Princeton Packet

HEALTH MATTERS: Assisted reproductive technologies available

By Seth G. Derman

What is in vitro fertilization with Dr. Seth Derman

 

This article previously appeared in the Princeton Packet  

Infertility – the inability to get pregnant or stay pregnant – is a common problem in the United States, affecting about 10 percent of women of childbearing age, according to the Centers for Disease Control and Prevention.

Fortunately, many couples can still realize their dream of having a child with the help of assisted reproductive technologies (ART), most commonly in vitro fertilization.

Princeton IVF in Lawrenceville, provides care for couples struggling with infertility and enables many women to deliver happy and healthy babies.

How does IVF work?

When most people talk about ART, they are referring to in vitro fertilization or IVF. IVF has been used for decades to help women get pregnant. In fact, the first IVF baby is now over 30 years old and has a child of her own.

With IVF, eggs are surgically removed from the body, fertilized with sperm and allowed to grow in the laboratory. In vitro literally means “in glass,” as the fertilization and early development happens in a laboratory dish.

Fertilization can occur naturally with the sperm selecting the egg or in cases where there are problems with the sperm, can be assisted with doctors inserting the sperm directly into the egg. After 3-6 days the embryos are inserted directly into the uterus.

While IVF was first developed to help women with missing or damaged fallopian tubes, it is now routinely used to treat infertility caused by many different problems such as sperm problems, endometriosis, unexplained infertility and any other type of infertility that does not respond to more conventional treatments.

Other methods of ART include gamete intra-fallopian tube transfer (GIFT), zygote intra-fallopian tube transfer (ZIFT) and tubal embryo transfer (TET). With these, the embryo is transferred to the fallopian tube through laparoscopic surgery instead of into the uterus, except with GIFT in which the eggs and sperm are inserted into the tube and fertilization occurs inside the body. With ZIFT and TET, fertilization occurs outside the body. These procedures are rarely performed today as their advantages in terms of pregnancy rates have been overcome by modern laboratory technology and improved methods of embryo transfer.

ART also refers to use of donor eggs and gestational carriers, which are variations of IVF.

Who is a candidate for IVF?

The majority of patients who are candidates for ART suffer from tubal problems, sperm problems, unexplained infertility or certain inherited genetic diseases, according to the Society for Assisted Reproductive Technology (SART). Candidates for ART generally have:

  • No evidence of premature menopause
  • At least one accessible ovary, and
  • A normal uterus

Menopause and ovarian function are irrelevant for candidates using donor eggs. SART recommends that all ART candidates should be in good health and have no medical conditions that would pose a serious health risk to themselves or the children they would carry.

How successful is IVF?

Success rates vary and depend on many factors. Some factors that can affect the success rate of ART include the following:

  • Age of the partners
  • Reason for infertility
  • Type of ART
  • If the egg is fresh or frozen
  • If the embryo is fresh or frozen

In addition, the clinic itself can have an impact on success rates, according to the CDC. Princeton IVF's affiliated Laboratory takes advantage of the latest in “clean room technology,” to help improve pregnancy rates.

A specialized ventilation and HVAC system allows for improved air quality, flow and temperature control. Air quality is further enhanced by the use of eco-friendly, low VOC (volatile organic compounds) paints and building materials. This type of technology can have an enormous impact on embryo quality, survival and clinical outcomes of IVF treatment, research has shown.

What are risks of IVF?

The biggest risk factor associated with ART is multiple fetuses, but that can typically be prevented or minimized in many different ways. Other risk factors include surgical risks from the egg retrieval, side effects of the fertility drugs for mom and risks associated with pregnancy.

And while ART can be expensive and time-consuming, it has enabled many couples to have children that would have otherwise not been conceived.

What is pre-implantation genetic testing?

Pre-implantation genetic testing (PGD) and pre-implantation genetic screening (PGS) can be used following IVF to diagnose genetic diseases prior to implanting the embryo in the uterus. Doctors can test a single cell from the embryo to determine chromosomal abnormalities that, among other things, can lead to miscarriage and birth defects.

Talk with your doctor

If you are one of the millions of couples struggling with infertility, talk with your doctor about ART. For many, it is a promising option that can help couples realize the joy of parenthood.

To learn more about Princeton IVF or to our physician from Princeton HealthCare System, call 609-896-4984 or visit www.princetonivf.com.

   Seth G. Derman, MD, FACOG, is board certified in gynecology and reproductive endocrinology. He is a fellow of the American College of Obstetricians and Gynecologists and a member of the medical staff at University Medical Center of Princeton at Plainsboro.

Pioneer of IVF in America Remembered

IVF-pioneer-in-US-Howard-Jones

The father of IVF in the US and his legacy

This past month the Reproductive Medicine community lost one of the giants in our field, Dr. Howard Jones. Although I never had the opportunity to work under Dr. Jones, my own mentors did train under him in Norfolk and Johns Hopkins. Like all reproductive medicine specialists in the country, not just those who trained under him, we owe a special debt to him for enabling us to do what we do.

In the early days of our specialty, fertility doctors could do little to help our patients. There were medications to help women with irregular cycles ovulate and fertility surgeries that had limited success. Still, many causes of infertility remained remained very difficult to treat. After leaving Johns Hopkins for Norfolk, Dr. Jones' team was the first in the US to perform successful IVF on an infertile couple, and his team's numerous contributions to the advancement of IVF continued for years to come.

Now, built on the foundation by Drs. Howard and Georgeanna (his late wife and partner) Jones, today we can actually help most of our patients have a baby to take home, and that is a truly a life to celebrate.

Abnormal sperm and healthy babies

The advent of ICSI (intracytoplasmic sperm injection) two decades ago has enabled men with very low sperm counts to father children through IVF.  Prior to this, as fertility specialists, we could offer these couples only donor sperm. Despite this "miracle" of modern medicine, one of the lingering concerns was as to whether using sperm from men with very low counts might lead to a more birth defects. Adding to this concern, were some studies suggesting that ICSI or even regular IVF might result in a higher than normal rate of abnormalities. Some good news, however.  A recent study from the NIH suggests that this is not a concern. The researchers found that  couples who conceived with very low sperm counts did not have children with more birth defects.

Genetically testing embryos can improve the chances for pregnancy and lower the risk of multiples

PGD embryos  biopsy

This article which appeared recently in our local paper The Trenton Times (and originaly in the Star Ledger) profiled a laboratory we work with at Princeton IVF called Reprogenetics. The test they discussed called Array cGH involves removing some cells from embryos created during IVF and testing them to compare the amount of genetic material they contain from each of the chromosomes. It enables us to diagnose disorders such as Down Syndrome and Turner Syndrome, avoid putting back most abnormal embryos and select embryos for gender. In comparison to earlier methods it is a more comprehensive chromosome screening technique. Click here to read the article.

Welcome to our blog from Seth G Derman, MD

I welcome you to the Princeton Fertility Blog. I am a specialist in Reproductive Medicine and the Medical Director at Princeton IVF in Lawrenceville, NJ. I have been caring for couples with infertility and recurrent miscarriages, polycystic ovarian syndrome, endometriosis and other reproductive hormonal disorders for the past two decades.