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Archive for March, 2011

Guys and Infertility: Injection Experts

By Tracey Minella

March 31st, 2011 at 12:00 am


So it’s the last day of the month. What better day to honor the men of infertility, right? After all, almost all the blogs and forums on infertility are geared toward and written by women for women. So, in the spirit of “last but not least”, the last blog day of the month will be devoted to the guys…or at least deal with guy-related fertility issues.

Take injection teaching, for instance. Remember that moment? The one where the doctor or nurse told your guy that his second biggest role in IVF was to inject you with needles? Remember how he tried so hard not to faint or let his jaw drop? How he played it cool for your sake. How he was the rock.

He dutifully watched the instructional tape in silence. Then, he was handed an orange to practice his technique on. An orange. Really? I remember thinking that, while the dimpled exterior might look like my butt, there had to be a better way. As if reading my mind, the nurse said to him “It’ll go into her easier than it goes into the orange. Like butter.” Butter? Really?

Over and over again, that 2 ½ inch needle pierced the orange until it succumbed like a stabbing victim. I don’t remember whether I was more worried for me or for him.

Oh, now I remember…I was more worried for me!

The big night finally arrived. The needle was affixed to the syringe. The meds were readied, checked and rechecked, and then sucked up. Air bubbles of death were flicked away. The bulls-eye was drawn. Almost ready.

I assumed the position: standing with my weight on the opposite leg, bent over the bathroom counter like some kind of sick game of Twister. The area was swabbed with alcohol. Then, swabbed again, for good measure. Then again, because we were taking too long and surely must have contaminated the area. And finally, once again.

I repeat the warnings. Don’t go too slowly or it’ll hurt. Don’t go too low or it’ll hurt. Ready? 1-2-3 Go. Wait. Are we going on 3 or on Go? Try again. 1-2-3 Go!

We both gasp at the sight of the syringe sticking out of my rear hip, momentarily paralyzed. Where the hell did that giant dagger attached to the other end go?! Eww…it’s all the way in! He smiles broadly at the realization and pushes the plunger, then withdraws the mighty sword. Done. Like a champion. Or a knight in shining sweatpants. All he was missing was his mighty steed.

Who’d have thought that all those nights playing darts at the local college bar would pay off someday!

* * * * * *

So, how is your partner at injections? Any funny or sweet stories to share?

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Infertility: Killjoy of Margaritas, Jacuzzis, Speedos, and Atomic Wedgies

By Tracey Minella

March 30th, 2011 at 12:00 am


As if not being able to have children when you want them without medical intervention and the costs associated with it weren’t bad enough, there are many other kinds of deprivation associated with infertility.

Sitting here lamenting my decision to give up chocolate for Lent, got me thinking about all the things infertile women and men give up in the quest for parenthood. Things they enjoy that may not be good for their pre-conception health or may impact the health of the baby they’re trying to conceive. Things they give up for much longer periods than the Lenten season. (Boy, I feel shame now about the chocolate thing.)

It’s like adding insult to injury.

I don’t mean quitting smoking, because that’s something a parent-to-be should give up permanently for their sake and for the health of their future children. [Look, I know it's not easy to quit, but the evidence of harm from tobacco is overwhelming and undisputed. Get help and quit. If having a healthy baby and living long enough to watch it grow up isn’t motivation to quit, than what is?] But I mean the things many of us indulge in on an occasional basis that make us happy.

Early on when we were TTC, we went on those island vacations to couples’ resorts…never really enjoying the trip because we secretly wanted to be sweating bullets in Disney on a two hour line for the Dumbo ride with a frustrated, crying toddler or two in tow. So, here’s how those trips went:

Let’s sit at the poolside bar and sip frozen margaritas all day. No can do. Alcohol.

Let’s soak in the hot tub and let the bubbles lift our spirits. No can do. Sperm killer.

Let’s whoosh down the giant waterslide at the water park and play like children again. No can do. Not only is an atomic wedgie not attractive, but pool water forced into the vagina at speeds of 120 mph is not advisable.

Hey Stud, model me that new bathing suit. No can do. Tight, tiny Speedos are like tight underwear. Another sperm killer. And so on. And so on…

Then, more deprivation as the accumulating costs of fertility treatment forces patients to forgo vacations altogether. Not only is there no money for a vacation, there’s no time available. All vacation time is saved to be used for fertility treatments.

It is no wonder infertile couples are stressed. On top of not having children yet, they have no fun and no time to really relax and indulge. And the longer this deprivation goes on, the more depressed the couple will get.

So, what’s a couple to do?

When deprivation becomes more than you can stand, consider a quick switch of strategy to moderation.

It’s like the dieter who is so rigid in her compliance that she eventually feels so deprived and ultimately quits and fails on the diet. If she had just occasionally indulged herself, it may have been all she needed to stay the course for success in the long haul.

Provided your next treatment cycle is not just around the corner, it may be okay to consider a real margarita (or two!) if a virgin margarita doesn’t do it for you. Strut that Speedo for just awhile. Maybe even dip into the hot tub if the doc says your man’s got time to “rebuild”. Lock those ankles and go for the waterslide (if there’s no chance you could be pregnant)!

Odds are your kid will puke on you after riding that elephant ride one day (or you will puke on yourself after riding It’s a Small World 18 times)… even if it doesn’t seem like that day will ever come. So until then, when deprivation gets to you, consider moderation to get you through.

* * * * * * * * * * *

What is the hardest thing you’ve given up during your journey to parenthood?

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Are Fibroids a Factor in Your Fertility?

By David Kreiner MD, and Tracey Minella

March 29th, 2011 at 12:00 am


Picture a room full of ten women. As many as three of them will have fibroids, or uterine muscle tumors. Will that affect their fertility? Did your mind just go blank when I mentioned the word “tumors”. That’s totally understandable. You came here fearful about your fertility. I said "tumors"… and now you’re probably fearful for your life. Well, don’t be. Read on for fibroid facts from an expert in the field of fertility.

Dr. David Kreiner of East Coast Fertility gives you the facts about fibroids and how they may…or may not…be a factor in your fertility:

Fertility is dependent upon so many things!

We must have healthy gametes (eggs and sperm) capable of fertilizing and implanting in a uterus with a normal endometrial lining unimpeded by any uterine or endometrial pathology. The sperm need be in sufficient number and capable of swimming up through a cervix which is not inflamed and provides a mucous medium that promotes sperm motility. The eggs need to ovulate and be picked up by normal healthy fimbriated ends (finger like projections) of the fallopian tubes. The tubes need to be covered with normal micro hairs called cilia that help transport the egg one third of the way down the tube where one of the sperm will fertilize it.

The united egg and sperm (the “conceptus”) then needs to undergo cell division, growth and development as it traverses the tube and makes its way to the uterine cavity by the embryo’s fifth day of life at which point it is a blastocyst. The blastocyst hatches out of its shell (“zona pellucidum”) and implants into the endometrial lining requiring adequate blood flow.

And you wonder why getting pregnant is so hard?

All too often patients, in some groups as many as 30% of women, are told that they have fibroids that may be contributing to their infertility. Fibroids or leiomyomata are non malignant smooth muscle tumors of the uterus. They can vary in number, size and location in the uterus including; the outside facing the pelvic cavity (subserosal), the inside facing the uterine cavity (submucosal) and in between inside the uterine wall (intramural). Fortunately, most fibroids have minimal or no effect on fertility and may be ignored.

The subserosal myoma will rarely cause fertility issues. If it were distorting the tubo- ovarian anatomy so that eggs could not get picked up by the fimbria then it can cause infertility. Otherwise, the subserosal fibroid does not cause problems conceiving.

Occasionally, an intramural myoma may obstruct adequate blood flow to the endometrial lining. The likelihood of this being significant increases with the number and size of the fibroids. The more space occupied by the fibroids, the greater the likelihood of intruding on blood vessels traveling to the endometrium. Diminished blood flow to the uterine lining can prevent implantation or increase the risk of miscarriage. Surgery may be recommended when it is feared that the number and size of fibroids is great enough to have such an impact.

However, it is the submucosal myoma, inside the uterine cavity, that can irritate the endometrium and have the greatest effect on the implanting embryo.

To determine if your fertility is being hindered by these growths you may have a hydrosonogram. A hydrosonogram is a procedure where your doctor or a radiologist injects water through your cervix while performing a transvaginal ultrasound of your uterus. On the ultrasound, the water shows up as black against a white endometrial border. A defect in the smooth edges of the uterine cavity caused by an endometrial polyp or fibroid may be easily seen.

Submucosal as well as intramural myomata can also cause abnormal vaginal bleeding and occasionally cramping. Intramural myomata will usually cause heavy but regular menses that can create fairly severe anemias. Submucosal myomata can cause bleeding throughout the cycle.

Though these submucosal fibroids are almost always benign they need to be removed to allow implantation. A submucosal myoma may be removed by hysteroscopy through cutting, chopping or vaporizing the tissue. A hysteroscopy is performed vaginally, while a patient is asleep under anesthesia. A scope is placed through the cervix into the uterus in order to look inside the uterine cavity. This procedure can be performed as an outpatient in an ambulatory or office based surgery unit. The risk of bleeding, infection or injury to the uterus or pelvic organs is small.

Resection of the submucosal myoma can be difficult especially when the fibroid is large and can sometimes take longer than is safe to be performed in a single procedure. It is not uncommon that when the fibroid is large, it will take multiple procedures in order to remove the fibroid in its entirety. It will be necessary to repeat the hydrosonogram after the fibroid resection to make sure the cavity is satisfactory for implantation.

The good news is, when no other causes of infertility are found, removal of a submucosal fibroid is often successful in allowing conception to occur naturally or at least with assisted reproduction.

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TTC? Do You Need a Cyber-Shoulder to Cry On?

By Tracey Minella

March 25th, 2011 at 12:00 am

Mind if I pick your brain? It’s for your own good.

Are you TTC and think you need help but are afraid to “come out” about your infertility? Maybe you’re already getting help, but are reluctant to join infertility support groups or online forums for fear of your cover being blown?

Do you secretly stalk infertility blogs, faithfully reading when no one’s around…but don’t join in the discussion or ask any questions out of privacy concerns?

Do you prefer to read the blog off the website instead of through social networking sites like facebook or twitter?

Are you reluctant to “like” ECF’s facebook page because it means others will see our connection… but you still visit the page?

And for those who have “liked” the page, do you share ECF blog posts or other information with others, or are you not that open yet?

Would you welcome an occasional e-newsletter on new and important developments in the field of reproductive medicine? Or would you prefer a paper newsletter discreetly mailed to the home?

What would it take for you to openly join our online community, either through facebook or the blogs/website forums? Polls? Discussions? Would a contest of phenomenal proportions coax you out of the closet? Or, as tempted as you are, is no prize worth the price of your privacy?

I realize and appreciate the fear and the reluctance some may have about such a personal matter becoming public. I was in your shoes before the social media revolution, so I never had the chance to get online support and information in the privacy of my home. (That probably sounds like when your parents say, “Back when I was a kid, I had to walk ten miles to school in the snow in snowshoes…”) You do have that chance, but of course it has to be right for you.

I know people are enjoying the mix of humor, personal stories, and medical information provided on the blog because I’ve gotten mostly private feedback to that effect.

But I’d really appreciate your suggestions so I can give you more of what you want…how you want it. If you are concerned about your privacy, you can email me privately at tracey@eastcoastfertility.com and I will respond privately (or not at all, if you prefer.).

So please remember…whether you come out or not…online support is just a click away. And no one has bigger cyber-shoulders to cry on than East Coast Fertility.

Thanks in advance to all who respond, publicly or privately.

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IVF Freak Show: Ethical, Moral and Legal Concerns

By Tracey Minella, David Kreiner, MD

March 24th, 2011 at 12:00 am


Questions: What do you get when you cross a freak and a skank? Or a slob and a deadbeat? Or a whore and her sister? Or a loser and his married lover?

Answer: Potential fertility patients.

Face it. When the door swings open and a potential new patient walks in, an infertility doctor never knows what he’s gonna get. Often, it’s just a straightforward, “traditional” married couple using their own eggs and sperm. But often enough… it’s not. Which can be totally fine, too. But sometimes, it’s downright ugly or complicated. Like a real-life soap opera.

Must he treat them? Should he treat them?

Dr. Kreiner of East Coast Fertility gives us a glimpse of what it’s like to be on his side of the desk at a new patient appointment:

Those of us who work in the infertility field are often presented with situations that make us ponder whether we should assist in endeavors that make us feel a bit, well, uncomfortable. I suppose it’s common to have these experiences in our field as family building is a cornerstone of our society. But manipulating a family affects not just the people directly involved, but all of us.

There are the straightforward illegal and unethical cases: The married woman who presents with a proposal to conceive with a man other than her husband (without the husband’s consent) or the married man “donating” his sperm to a “friend” other than his wife (without his wife’s knowledge). These are the easy ones that don’t even make me pause.

I come across more difficult questions, however, that require much more intense contemplation and research. On a daily basis, the way most of us professionals try to deal with ethical and legal dilemmas is to resort to an evaluation of the “yuk factor.” It’s an internal cliff notes version of societal morality and law that many of us professionals rely on to make daily decisions when we can’t read the whole book on an issue. Sure, there’s a potential downside of going down the slippery “yuk” slope, but when was the last time the approach “if you’d be ashamed to see it on the front page of the New York Times, then don’t do it” led you down the wrong path?

Yet, I still have difficulty understanding what’s ethically and/or legally right in some situations. The go-ahead is clear to me if an unmarried man and woman present as a couple, each using their own gametes, and both sign consent acknowledging their rights and responsibilities to the future child. Less obvious is the case of the unmarried lesbian couple who present with only one partner participating biologically. They live as a couple, but the law doesn’t necessarily recognize the partner who isn’t participating biologically as having parental rights. Should they be signing as a couple for use of donor sperm to create a baby and, if so, what –if any– are the ramifications? Is this situation different if the unmarried-yet-cohabiting partner who is not participating is a male? Does the unmarried lesbian partner have the right to adopt the baby? Does this change if the partner is a transsexual?

It would seem to me that if the couple decides that they will have a baby together, despite the fact that only one is contributing biologically, that there should be parity recognized legally based on the emotional and financial contributions the other partner makes, especially if she were willing to adopt the child and legally take on parental rights. For me the “yuk” factor becomes the legal system if that unmarried partner who is unable to contribute biologically is unable to retain parental rights in a split.

So now I’m off to the clinic to see what murky issues the day will present.

Every day is different.

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Are You a Debbie Downer Acting Like a Perky Polly?

By Tracey Minella

March 23rd, 2011 at 12:55 am

Honestly, who comes up with this stuff?  National Acting Happy Week. Who the hell thought of that one? I say we start the National Freakin Miserable Week…no, make that Month!

If you are infertile, you’re miserable inside. Why should you have to expend any energy whatsoever on “acting happy” on the outside, even for just one week? Don’t we have enough on our plates without having to add “actress” to our resumes? Don’t we have enough on our minds without having to worry about smiling?

I think many of us do try to act happy …for the sake of others. At least for awhile.

Like partners. Sometimes we don’t want our spouses to know how down we really are, especially in cases where the problem may be a male factor issue. We don’t want him to feel worse than he does already, either about his diagnosis or his inability to protect and provide for us in every possible way, like a stereotypical good husband would do. Acting happy is shutting ourselves off to our partners. How can that be good?

Or parents. Sometimes we keep our true depression from our parents, too. We may have guilt over not making them grandparents yet. We may want to spare them the frustration of not being able to make our problem all better, to heal us or stop our pain…as they’ve done since the day we were born. But if you act happy in front of your parents, you’ll miss out on the unconditional love and support of probably your biggest cheerleaders. Why do it?

Or bosses. Sometimes we act happy at work for survival. We need our jobs and the insurance they sometimes provide. On the job, we not only hide our depression over not being pregnant yet, but many have to hide the stress TTC adds to what may already be a stressful job. And if we can’t be open with the boss about doing fertility treatments for fear of losing our jobs, then there’s even more to feel unhappy about. But, still we act happy.

As for the others, like friends and family… We don’t want to bring others down with us. We feel guilt over our moping in public. Deep down, we’re just Debbie Downers trapped in a world of Perky Pollys.

Do we allow ourselves to express how we feel inside? Or should we “act happy” this week? If we act like Perky Polly, will we become a Perky Polly? Does it take one to know one and will acting happy beget happiness? Or is Debbie Downer such a part of our being that we need to be true to her and let her misery shine through until we finally achieve that pregnancy? Or will acting happy be enough to keep us from hitting the lowest depths of despair and let us hold on long enough to get pregnant?

Do you think you should “act happy”? Or be your true emotional self?

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TTC? Consider Clomid A First Step

By David Kreiner MD, and Tracey Minella

March 22nd, 2011 at 12:00 am


If doing IVF compares to swimming the English Channel, then Clomid is like dipping your toe in the water. You’ve got to get your feet wet somewhere when moving on from conceiving naturally to conceiving with medical assistance… and Clomid is that first step for many women.

Dr. David Kreiner of East Coast Fertility answers all your questions about Clomid therapy:

It has become commonplace for women who have been frustrated with repeated unsuccessful attempts to conceive naturally on their own to see their gynecologist who often times will try clomid therapy on them. Clomid, the traditional brand name for clomiphene citrate, is a competitive inhibitor of estrogen. It stimulates the pituitary gland to produce follicle stimulating hormone (FSH) which in turn will stimulate the ovaries to mature follicle(s) containing eggs. Estrogen normally has a negative effect on the pituitary: Clomid blocks estrogen and leads to pituitary FSH production and ovarian stimulation.

Infertility patients — those under 35 having one year and of unprotected intercourse without a resulting pregnancy and those over 35 having six months without pregnancy — have a two to five percent pregnancy rate each month trying on their own without treatment. Clomid therapy increases a couple’s fertility by increasing the number of eggs matured in a cycle and by producing a healthier egg and follicle. The pregnancy rate with clomid therapy alone is approximately ten percent per cycle and 12 -15 percent when combined with intrauterine insemination (IUI). Women who are unable to ovulate on their own experience a 20 percent pregnancy rate per cycle with clomid, the equivalent to that of a fertile couple trying on their own.

Clomid and Your Cervical Mucus

Women who are likely to conceive with clomid usually do so in the first three months of therapy, with very few conceiving after six months. As clomid has an anti-estrogen effect, the cervical mucus and endometrial lining may be adversely affected.

Cervical mucus is normally produced just prior to ovulation and may be noticed as a stringy egg white like discharge unique to the middle of a woman’s cycle just prior to and during ovulation. It provides the perfect environment for the sperm to swim through to gain access to a woman’s reproductive tract and find her egg. Unfortunately, clomid may thin out her cervical mucus, preventing the sperm’s entrance into her womb. IUI overcomes this issue through bypassing the cervical barrier and depositing the sperm directly into the uterus.

However, when the uterine lining or endometrium is affected by the anti-estrogic properties of clomid, an egg may be fertilized but implantation is unsuccessful due to the lack of secretory gland development in the uterus. The lining does not thicken as it normally would during the cycle. Attempts to overcome this problem with estrogen therapy are rarely successful.

Side Effects

Many women who take clomid experience no side effects. Others have complained of headache, mood changes, spots in front of their eyes, blurry vision, hot flashes and occasional cyst development (which normally resolves on its own). Most of these effects last no longer than the five or seven days that you take the clomid and have no permanent side effect. The incidence of twins is eight to ten percent with a one percent risk of triplet development.

Limit Your Clomid Cycles

Yet another deterrent to clomid use was a study performed years ago that suggested that women who used clomid for more than twelve cycles developed an increased incidence of ovarian tumors. It is therefore recommended by the American Society of Reproductive Medicine as well as the manufacturer of clomiphene that clomid be used for no more than six months after which it is recommended by both groups that patients proceed with treatment including gonadotropins (injectable hormones containing FSH and LH) to stimulate the ovaries in combination with intrauterine insemination or in vitro fertilization.

Success rates

For patients who fail to ovulate, clomid is successful in achieving a pregnancy in nearly 70 percent of cases. All other patients average close to a 50 percent pregnancy rate if they attempt six cycles with clomid, especially when they combine it with IUI. After six months, the success is less than five percent per month.

In vitro fertilization (IVF) is a successful alternative therapy when other pelvic factors such as tubal disease, tubal ligation, adhesions or scar tissue and endometriosis exist or there is a deficient number, volume or motility of sperm. Success rates with IVF are age, exam and history dependent. The average pregnancy rate with a single fresh IVF cycle is greater than 50 percent. For women under 35, the pregnancy rate for women after a single stimulation and retrieval is greater than 70 percent with a greater than 60 percent live birth rate at East Coast Fertility.

Young patients sometimes choose a minimal stimulation IVF or MicroIVF as an alternative to clomid/IUI cycles as a more successful and cost effective option as many of these patients experience a 40 percent pregnancy rate per retrieval at a cost today of about $3,900.

Today, with all these options available to patients, a woman desiring to build her family will usually succeed in becoming a mom.

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Infertility, Spring, and Surviving all the $#@%! Baby Showers

By Tracey Minella

March 21st, 2011 at 12:06 am


Ahhh. Spring is here. Finally!

Do you see it as the season of rebirth? The end of the cold and gray isolation of winter?  A time of new hope? Or is it just another season… in a long line of seasons…and you’re not pregnant yet?

The winter and the holiday seasons are tough emotionally. Even generally happy, fertile folks can be affected by seasonal depression during the dreary months. Add fifty feet of snow, another 5 unwanted periods, and some hormone injections and it’s a recipe for disaster.

Yet, it can also be hard to face the spring with all its focus on new life.  Sometimes we don’t even notice the birds singing and the flowers blooming.  And when we do notice, we think, who cares? But the real challenge of Spring is facing the mailbox each day. 

It’s another @*#%! baby shower invitation!

Really, is there anything else in the mailbox that brings such dread? And at this time of year, they’ll be coming in droves!

Are you happy to be included because you believe in your heart that someday it will be your turn?  Or is opening that little confetti-filled envelope like a big, fat paper cut to your heart?

Is the thought of buying, wrapping, and dragging one more @#*%! baby swing to the happy affair enough to send you over the edge? Do you put off shopping until the only things left on the 58 page registry are the $1,200 crib and the $4 nasal aspirator? (And don’t even get me started on the diaper genie…eww)

And worst of all: How many minutes will it take before some idiot relative corners you and loudly blurts out “the inevitable question”? And, more importantly, after she does, how do you resist shoving her fat #!%@* into the wishing well?

When you can’t get out of going, here are a few tips that may help:

1.      Consider arriving a bit late (but not at the time the honoree is expected to arrive) or, better yet, show up just after she arrives so you can miss all that mingling time when guests have nothing better to do than ask you annoying personal questions. Once the honoree arrives, you sit at your assigned table with only 8 people (instead of mingling with 80) and the focus shifts to her and how fat she got, how ugly her face is… so she must be having a girl…, etc.

2.      If you simply can’t handle shopping in a baby store or choosing a baby gift, order online from a registry, give a gift card, or give a check. The wishing well gift can be a trinket for the new mom, not the baby, like a mani/pedi certificate.

3.      Stay busy. If the shower’s in a home, offer to “work” it, by helping serve or clean up, or pass appetizers. If at a restaurant, offer to help with the gift opening jobs, like noting who bought what, or help with any games that are played. If you stay on the go, you can’t be pinned down for personal conversations.

4.      Allow yourself your privacy. Just because someone asks you a personal question, doesn’t mean they are entitled to an answer. If you don’t have (or don’t want to deliver) a snappy comeback to the insensitive clod who asks you if you are ever going to have a baby, consider this… a long, silent stare followed by a curt “Excuse me” and then turning and walking away. Trust me; it works almost as well as asking “Are you ever going to lose those final 40 pounds from your last baby?”

5.      Reward yourself for making it through. Promise yourself a product or a service as a treat for surviving. New jeans? A massage? A week in Hawaii? (Well, maybe that one’s over the top.) After all, look at what you’ve decided to endure in the name of being a great friend or family member. When it gets tough at the shower, think of that reward.

So when the baby shower invite comes, do you go? If not, what do you say? And if so, what tricks do you have to help you survive it?

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TTC? Try Separating and Washing Your Sheets

By Tracey Minella and David Kreiner MD

March 18th, 2011 at 12:00 am

Not the ones you sleep on, silly. I’m talking about your sheets of cumulus cells. If you want to improve your chances for pregnancy, washing and separating these sheets of cells at the time of your IVF retrieval, and placing them in the dish with your embryos, may be just what the doctor ordered to get your pee stick to come back positive.

This revolutionary procedure is known as co-culture. Unfortunately, many IVF programs do not offer this pregnancy rate-boosting option. So, when seeking an IVF program, be sure to ask if co-culture is available.

Dr. David Kreiner of East Coast Fertility explains the benefits of this exciting and promising weapon in the IVF arsenal:

Successful IVF is dependent on many factors.  The quality of the egg and embryo, the placement of the embryo into the uterus and the environment surrounding implantation are all paramount to the ultimate goal of creating a pregnancy that leads to a live baby.

Typically, patients present with their own gametes so the genetics and pregnancy potential of the eggs and sperm is usually predetermined when patients first present to an IVF program.  As a specialist in REI and IVF, I have dedicated my career to optimizing those other factors that we may influence.

In the late 1990’s I recorded data on all my embryo transfers including distance the catheter tip was placed into the uterine cavity, number of cells and grade of the embryos, difficulty of the transfer, use of tenaculum etc.  I presented my results at the ASRM in 2000 that highlighted the two step transfer to the middle of the uterine cavity and replaced the tenaculum with a cervical suture when needed and this radically improved pregnancy rates.

The uterine environment has been optimized through screening for anatomic issues in the uterine cavity with a hydrosonogram to identify polyps, fibroids and scar tissue that may impede implantation.  Hormonally, we have supplemented patient’s cycles with progesterone through both vaginal and parenteral (intramuscular) administration as well as estrogen that we monitor closely after embryo transfer and make adjustments when deemed helpful.

The greatest improvement in pregnancy rates for the past several years however has been due to a “Culture Revolution” in IVF that is the media environment bathing and feeding the embryos.  All these advances have had a great impact on IVF success rates to the point that 50% of retrievals will result in a pregnancy.  Unfortunately, older patients and some younger ones have yet to share in this success.

Many IVF programs have reintroduced the concept of utilizing a co-culture medium to improve the quality and implantation of embryos. Co-culture is a procedure whereby “helper” cells are grown along with the developing embryo. Today, the most popular cell lines include endometrial cells (from the endometrium, or uterine lining) and cumulus cells from women’s ovaries.  Both cell lines are derived from the patient, thereby eliminating any concerns regarding transmission of viruses. Endometrial cells are much more difficult to obtain and process, while cumulus cells are routinely removed along with the oocytes during IVF retrieval.

Cumulus cells play an important role in the maturation and development of oocytes.  After ovulation cumulus cells normally produce a chemical called Hyaluronan.   Hyaluronan is secreted by many cells of the body and is involved in regulating cell adhesion, growth and development. Recent evidence has shown that Hyaluronan is found normally in the uterus at the time of implantation.

Co-culture of cumulus cells provides an opportunity to detoxify the culture medium that the embryos are growing in and produce growth factors important for cell development.  This may explain why some human embryos can experience improved development with the use of co-culture.

Preparation of co-culture cells starts with separation of the cumulus cells from the oocytes after aspiration of the follicles. These sheets of cells are washed thoroughly and then placed in a solution that permits the sheets to separate into individual cells.  The cells are then washed again and transferred to a culture dish with medium and incubated overnight. During this time individual cells will attach to the culture dish and create junctions between adjoining cells. This communication is important for normal development. The following morning, cells are washed again and all normally fertilized oocytes (embryos) are added to the dish. Embryos are grown with the cumulus cells for a period of three days to achieve maximum benefit.

Performing co-culture of embryos has improved implantation and pregnancy rates above and beyond those seen with the IVF advances previously described. More importantly, it promises to offer advantages for those patients whose previous IVF cycles were unsuccessful.

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Wanna Get Lucky? I Meant with Fertility Lucky Charms!

By Tracey Minella

March 17th, 2011 at 1:09 am


Top o’ the Morning, Laddies and Lassies! (Okay, that sounds wrong on so many levels…too cheerful and, well, odd. And what’s up with the Lassie comment? Too…canine.)

I am half Irish and on this St. Patrick’s Day I’d like to set the record straight. That “luck o’ the Irish” thing is a farce. A scam.

If I was really lucky, would I have needed seven IVF cycles? Would I have needed help conceiving at all? And I sure could have used that pot o’ gold to finance it all. But no…I had to settle for a beer to drown my sorrows in. (Okay so there’s a benefit to being Irish after all!)

But all this faith and begora stuff today got me thinking about lucky charms and fertility. Face it, there’s nothing fun about infertility treatment. But if you add a little whimsy to the picture, what’s the harm?

Do a little internet research and you will find more symbols associated with good luck and fertility than you can shake a shillelagh at! There’s frogs, acorns, and of course, eggs. You can buy statues and jewelry of these and other symbols. I once bought a cheap pewter Chinese fertility symbol on a thin black leather necklace because I thought it looked nice and figured it couldn’t hurt, right?

But the real fun with fertility lucky charms isn’t with the ones you buy for yourself. It’s when you give one to someone or they give one to you. Those are more meaningful and, I’d guess, more powerful…if only because the receiver would believe more in its magical power.

When I was TTC and felt like it’d never happen, a casual friend from work who was moving away gave me a gift just before she left. It was a small mirrored compact with a beautiful ivory cameo-type figure of an angel on the top. She told me it would bring me good luck getting pregnant. I had it with me for the retrieval when I got pregnant with my daughter. I put it away, figuring I’d give it to my daughter one day and tell her the story behind it.

But a few years later, when another friend of mine who was TTC was about to move away, I thought of my lucky compact. I told her the story and gave it to her on the following condition: She was to use it as long as she needed it and then pass it along to someone else who was TTC.

This compact is making its way all over America, leaving little angels in its wake.

Now that’s worth doing a jig over.

Have you given or received a lucky charm? What is it and what is the story behind it?

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