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Archive for March, 2012

Are At-Home Sperm Tests Any Good?

By Tracey Minella

March 30th, 2012 at 1:40 pm

 

Nothing can substitute for a complete, professional medical evaluation of your sperm. And these kits don’t even come close.

The new at-home sperm test kit may be convenient and private, but even in the best light, it only gives a small amount of information…information that many men might misinterpret. And it can’t definitively answer your question about whether you can father a child.

It’s the last blogging day of the month, so this post is dedicated to the guys.

At-home sperm tests only test sperm count. You mix your semen with drops from the kit and, similar to a woman’s ovulation test kit, you wait for a reaction and try to interpret what the lines mean. Simply put, if the lines show, your count is considered in “Normal” range, or at least 20 million per milliliter. If you get a negative result, your count is considered “Low”, or under 20 million per milliliter.

The danger here (aside from doing the test wrong or interpreting it wrong) is that the guys who get a “normal” result may wrongly assume their sperm is fine, and not follow up with an evaluation by a Reproductive Endocrinologist or Urologist specializing in male infertility.

And their sperm may NOT be fine at all.

There is more to an evaluation of sperm than measuring the count. You need to know the motility…which is how the sperm moves. You need to know the morphology…which is how the sperm is shaped. These at-home tests do not evaluate these two crucial factors in determining if male infertility is an issue.

A man with a normal sperm count may make enough sperm, but what if they don’t swim (move) well enough to meet the egg? What if they have two-heads or other mutations (morphology) that would affect their ability to fertilize an egg?

Consider all the time, expense, and sometimes invasive testing a woman has to undergo for her own complete evaluation. Shouldn’t the man who wants to father a child have a complete, thorough semen analysis (and any other recommended fertility-related tests) by a medical professional rather than relying on a $40 OTC kit, that doesn’t answer the question “Can I father a child?”

Long Island IVF’s male reproductive specialist, urologist Yefim Sheynkin, MD, can answer your questions and more. Read about his qualifications, specialties, and expertise here: http://www.longislandivf.com/employee.cfm?id=17

So, here’s the re-cap:

You take the at-home test, get a positive result, and interpret it to mean you have no sperm issues. Maybe you do, maybe you don’t. You have no idea if you can father a child. And you’re out $40.

Or, you take the test, get a negative result, and hopefully, that result at least forces you to make the appointment with the medical professional to investigate the reason for the low count, and to find out if there are other issues with your sperm, hormones, and/or anatomy that will give you an idea if you can father a child. And you’re out the $40.

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Would you rely on an at-home sperm kit? (Or let your partner rely on one?)

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What’s on Your NIAW Wish List?

By Tracey Minella

March 27th, 2012 at 10:42 pm

National Infertility Awareness Week is next month.

And we plan on rolling out a major contest to kick-off NIAW, so be sure to bookmark us or follow us on Facebook so you don’t miss out on the details.

We’ve got an awesome Grand Prize in mind already, but aren’t telling just yet. But we’re still working on what smaller prizes we’ll also be giving away. Any particular books, shows, events, or gift cards you think would make a great gift for our infertile friends? Let us know. Maybe we’ll agree. We want to pamper you a bit on your journey.

Are you planning on doing anything special to celebrate or spread awareness of NIAW? It begins April 22-28. It could be something big like taking part in an event, march, or protest to effect change in the area of infertility coverage or benefits. Or it could be something small and private and more personal that helps you mark the week in a meaningful way. Let us know.

This year’s NIAW theme is “Don’t Ignore Infertility”. There’s some great information on events all over the nation at http://www.resolve.org/national-infertility-awareness-week/home-page.html  

Infertility is such a devastating personal experience and many patients prefer to suffer through it alone for a number of reasons. Understandable. I did the same thing for years. But once I finally unburdened myself of the secret, it made those nagging loudmouths stop their nagging. (Though to be honest, then they started asking all the nosy medical questions next!)  Just remember, LIIVF has great support groups and counselors ready to help you each step of the way if you’re considering opening up this year. (One subtle trick used by a woman who wanted to open up but didn’t know how to tell people, was to “LIKE” her reproductive endocrinologist’s Facebook page.)

Click here if you want to “like” Long Island IVF’s Facebook: http://www.facebook.com/longislandivf

Each year, patients tell us that they’ve been inspired to come out of hiding during NIAW. Maybe this is your year?

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So how are you going to mark National Infertility Awareness Week this year?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=8077&picture=gift

 

 

 

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The “Dream Team”

By David Kreiner MD

March 26th, 2012 at 10:23 pm

I once had a dream that my lab would be staffed by the most skilled embryologists I could find and that my physician partners would be the recognized experts in the field. 

Throughout my career, I have met some of the world’s best specialists in Reproductive Endocrinology and IVF from my time at the Jones Institute and in my 24 years of practice since I left Norfolk to found Long Island IVF with Dr. Dan Kenigsberg. Together, in 1988, we developed the first successful IVF program onLong Island. 

I am most excited to announce that we have assembled since the merger of Long Island IVF and East Coast Fertility such a “Dream Team”. Three of our embryologists have been directors of very successful IVF labs. The other embryologists by virtue of their experience, advanced degrees, and skills could start a successful IVF lab of their own. Instead, we have assembled under the leadership of Dr. Glenn Moodie arguably the strongest embryology team in the nation. 

Likewise, Drs. Joseph Pena, Michael Zinger and myself have joined nationally recognized, Castle Connolly’s “Best Doctors in America”, Drs. Dan Kenigsberg and Steven Brenner, as well as Drs. Kathleen Droesch and Satu Kuokkanen. 

This “Dream Team” of Reproductive Endocrinologists and embryologists in our first three months together produced remarkably successful IVF as good as anywhere in the country.  

For women under 35, during our first three months as a combined program, October 1, 2011 through December 31, 2011, Long Island IVF achieved 35 clinical pregnancies in 53 fresh transfers (66.0%).  For women 35-37, 18/30 (60.0%), 38-40, 20/37 (54.1%) and for women 41 and 42, 8 of 28 (28.6%) achieved clinical pregnancies. 

Additionally, the East Coast Fertility MicroIVF program featuring minimal stimulation and a cost of $3900 achieved 5 pregnancies in 8 women under 38 yrs of age. 

It is apparent that the whole of the combined Long Island IVF is greater than the sum of its independent parts of the two merging practices (East Coast Fertility + Long Island IVF). 

There is perhaps no more rewarding work than to help build families for those who would otherwise never be able to do so but for our efforts. Working as part of the Long Island IVF “Dream Team” is that much more enjoyable knowing that we can give our patients their very best chance to realize their own dreams of creating their families.

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Survey: How Do Infertile Women Feel About The Hunger Games?

By Tracey Minella

March 24th, 2012 at 11:34 pm

Chances are you’ve at least heard of The Hunger Games unless you’ve been hiding under a rock lately. It is the first book in a trilogy by Suzanne Collins and the movie of the same name just opened yesterday.

The books are being devoured by people of all ages from tweens to old folks. The hype surrounding this movie is on par with Harry Potter.

THG is set in a disturbing futuristic world where freedom and food is scarce. The world consists of the Capitol and its 12 chronologically-numbered, outlying Districts. It is the story of a 16 year old girl named Katniss, from District 12.

Each year, a bizarre lottery run by the government is held wherein one boy and one girl (age 12-18) from each of the 12 districts are chosen as “Tributes” to represent their respective districts in The Hunger Games. This is no honor; it’s a death sentence.

Horrified when her young sister, Prim, was chosen as a District 12 Tribute, Katniss volunteered to go in her place. She was the first volunteer in history.

THG, a several day event, is a vicious fight to the death… with only one winner. A fight among children.

Think of The Running Man, Rambo, Survivor, American Idol, and the Olympics… combined. But with children.

Twenty-four kids released into the wild. Hand-to-hand combat, throat slashing, neck-snapping…all by children to children, commencing with a bloodbath that takes out half of the kids. And these “Games”… broadcast via hidden cameras all over the arena… are viewed by all of the citizens of the world.

District inhabitants, eyes glued to large screen monitors, root for their own Tributes, and mourn them when they die. Meanwhile, the garishly-dressed, wealthy Capitol residents “sponsor” their favorite Tributes by providing money to pay for things Tributes need to survive during the games, like medicine delivered by remote-controlled parachutes.

So adding to the mental stress of being chosen, Tributes must win the hearts of the public by heeding the advice of their district’s mentors who advise them on how to act, what to wear, and what to say on tomorrow’s version of the Oprah show.

In an age where so much of our entertainment consists of rehashing, remixing, re-recording and re-telling the same old music, movies, and stories over and over again, THG story is a refreshingly new and amazingly creative tale.  But how do you imagine a world in which parents succumb to the government taking their children away to fight and die in the name of entertainment?

And how do you feel about children fighting to the death? Is it just another film to be shrugged off as today’s style of entertainment…something that’s a welcome and entertaining two hour diversion from life’s daily grind? Or is it disturbing?

And if it’s unsettling to you, do you think you’d feel differently if you weren’t trying so hard to conceive?

While you are pondering that, I’ll leave you with this closing thought:

I wish you the same thing people wished the Tributes going off to battle: “May the Odds Be Ever in Your Favor.”

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What did you think about The Hunger Games and do you think your feelings have been affected by your infertility journey? If you saw the movie, what was your favorite…or least favorite…part?

 

Photo credit Public domain clip art: http://seanandonandon.tumblr.com/

 

 

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IVF With Donor Embryos Can Be Citizenship Nightmare

By Tracey Minella

March 20th, 2012 at 10:59 pm

 

Here’s a lesson on family building and citizenship:

If a child is born in America, it is an American citizen, whether its parents are American or not.

If a child from abroad is adopted by an American citizen, it’s eligible to become an American citizen.

So, you knew those two facts already? Well, did you know this:

If an American citizen gets pregnant from IVF with donor embryos (donor eggs and donor sperm) and delivers abroad, the child is NOT eligible for citizenship …unless one of the DONORS is American!

And good luck trying to prove that with all the confidentiality regulations surrounding donors.

That’s right…an American woman delivers her [donated embryo IVF] baby outside of America and the baby that emerges from the American’s womb is not an American citizen. If she delivers in America, it is an American citizen because anyone born here is. Or if it was her egg, no problem.  What?

Should all the focus be on the origin of the egg and sperm? Should the uterus from which the baby emerged get equal weight?

Don’t believe this? Well, according to news reports, it happened to a Chicago woman who delivered in Israel. http://commonhealth.wbur.org/2012/03/ivf-insanity-is-your-donor-a-u-s-citizen

We’ve been covering the recent “Personhood Amendment” proposals and how devastating such legislation could be to the future of IVF. Here’s another example of government complicating the lives of IVF patients. And, if an IVF patient affected by this regulation leaves the country and delivers abroad, the citizenship consequences are serious.

So, if you are planning on using donor embryos and want your baby to be an American citizen, stay off that transatlantic flight or world cruise any time after the baby is viable and park your pregnant butt firmly on American soil until the delivery. Or see if you can get acceptable documentation to prove the citizenship of one of the donors before wandering off.

It’d be a real shame if after all you’ve gone through to get pregnant, you end up having a baby who can’t grow up to be the President!

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Did you know this? What do you think of this seemingly bizarre regulation?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=12502&picture=fourth-of-july

 

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Fertility and the Mind and Body Connection

By Bina Benisch, Ms, Rn

March 16th, 2012 at 10:28 pm

 At Long Island IVF, we understand the emotional aspect that accompanies infertility, and we believe it is equally important to support our patients emotionally as well as physically. It is important to understand fertility holistically. In addition to treating the various physical etiologies of infertility, we must take into account the effects of stress and anxiety. Your mind and body work together, not separately. Therefore your thoughts have a direct effect on your physiology.

When you are experiencing stress, your brain releases stress hormones. These stress hormones function in many ways. One of the stress hormones, cortisol, has been documented to interfere with the release of the reproductive hormones, GnRH (gonadatropin releasing hormone), LH (luteinizing hormone), FSH (follicle stimulating hormone), estrogen, and progesterone.

In fact, severe enough stress can completely inhibit the reproductive system. Cortisol levels have also been linked to very early pregnancy loss. For this reason, it has been found extremely helpful when treating infertility, to include mind/body methods and strategies which help to alleviate the stress response that sets off a cascade of hormonal responses which may inhibit fertility.

The mind/body work we teach here at Long Island IVF includes methods that allow the body to return to a calm and relaxed state, thereby turning off the biochemical stress response and allowing our hormonal physiology to function optimally.  Feelings of anxiety, depression, isolation, and anger are common themes in infertility.  Often, anger masks the feelings of loss experienced month after month of trying to conceive without success. Infertility impacts on one’s marriage, self-esteem, sexual relationship, family, friends, job, and financial security.

One study showed that women going through infertility experience as much depression as women who have been diagnosed with life-threatening illnesses such as metastatic cancer, heart disease, or HIV. When women face these other illnesses, they are likely to seek out the support of their friends and family.

The sad aspect of infertility is that although these women are as depressed as those facing life-threatening illnesses, they are far less likely to seek out support from friends and family. Often, thoughts of not living up to the expectation to become pregnant, thoughts such as “why is this happening to me?!”, and the intense emotions of loss related to the thought that one may never have a child, lead to feelings of isolation, anger, and depression.

Although there is a correlation between stress and infertility, the relationship remains complex. However, the research does in fact suggest that psychosocial factors such as depression and anxiety correlate with lower pregnancy rates following IVF. In addition, of the women who participated in Alice Domar’s Mind/Body program at the Mind/Body institute inBoston, 55% conceived pregnancies that resulted in the birth of a full term baby compared with 20% of the control group.

~ Mind/Body Support Group at Long Island IVF ~

In our Mind/Body support group, patients experience the opportunity to share information, feelings, or their own personal stories. You may be surprised to see how your support can help others or you may be relieved to hear others experiencing the same type of thoughts and feelings as you experience. Often, the supportive nature of this group, and the connection that develops between members, fosters a healing process.
Feelings of isolation, anger, and stress are slowly relieved.

Our Mind/Body program focuses on symptom reduction and developing a sense of control over one’s life by utilizing Mind/Body strategies and interventions which elicit the relaxation response. The relaxation response is actually a physical state that counteracts the stress response. You can think of it as the physiological opposite of the body’s stress response. We cannot be stressed and relaxed at the same time.

Therefore when a person elicits the relaxation response, the body’s stress response is halted, stress hormones diminish. Stress responses such as heart rate, metabolic rate, blood pressure, and shallow breathing decrease. Breathing becomes slower and deeper, so we have more oxygen being delivered to all the cells in the body. The way in which you are taught to elicit the relaxation response is through methods such as: breath focus, guided visual imagery, muscle relaxation and learned mindfulness, and meditation.

In Mind/Body work, we also work with “cognitive restructuring” which is examining our negative thoughts, seeing where there is distortion, and reframing our thoughts positively and realistically. Often, we have held on to certain negative thoughts and feelings we may have developed years ago. The thought pattern becomes so ingrained in us, that we take it for truth, when in fact, it is a distortion.

Cognitive restructuring will help you examine your thoughts and see which are distorted, causing you needless worry, anxiety, or depression. Once you understand how a thought is distorted, you can change those thoughts and alleviate the anxiety attached to them.

Awareness of the mind/body connection allows us to use our minds to make changes in our physiology. This holistic treatment – combining bio-medical science with mind/body medicine deals with the treatment of the whole individual rather than looking only at the physical aspect.  The fact is, body and mind work together.

We invite you to take advantage of this unique area of support provided at Long Island IVF and join our Mind/Body group.

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Photo credit: http://www.publicdomainpictures.net/view-image.php?image=12572&picture=meditation-by-the-lake

 

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What Will YOUR Baby Look Like?

By Tracey Minella

March 15th, 2012 at 9:20 pm

Ever wonder what your child is going to look like or be like? I bet you used to wonder.

Sometimes you get so caught up in the quest for the baby that you stop imagining what kind of child you’re going to have. Not just boy or girl, or what it’ll look like, but what personality will that child have…what interests will he or she pursue. Will he play soccer or piano? Will she be a Girl Scout or a goalie?

Then sometimes along the journey…especially if it takes longer and gets harder than you ever thought it would at the start… you stop imagining that baby. The vision starts to blur. And sometimes your heart gets so heavy that, although you still go through the motions of your treatment plan, part of you starts to doubt that it will work. You may not admit or even realize it, but doubt creeps in.

Sometimes, the quest itself can steal your dream.

Don’t you let it.

We all have limits as to what we can handle physically, emotionally, and financially. But we all can handle more than we thought we could.

If someone told me at the start that my own journey would take me through six fresh IVF cycles, after a series of IUIs, and all the setbacks and losses along the six year span to finally have my daughter, I’d have said they were crazy. In fact, when I used to sit in the waiting room as a rookie and listen to veterans talk of their 4th and 5th IVFs, I secretly pitied them. Then I became them.

It is important not to lose sight of the baby you envision. In a Field of Dreams analogy, I believe that if you envision it, it will come. True, the exact baby you end up with may differ from the dream. Or the time and manner in which the baby enters your life may be different. Or the dream may change over time. But you must make the effort to keep that dream in sight while you are still pursuing a baby.

This is National Girl Scouts Week. I never dreamed that I…one who hot glues her fingers together, despises camping, irrationally fears nursing homes, and is tone deaf…would have a Girl Scout who can sing like an angel. But I do. And she’s perfect. (The athletic tomboy ballerina I envisioned went to someone else.)

Hold on to your vision with the knowledge that it’s that dream that will get you through the journey. But what awaits you at the end may be even more wonderful than you could ever have dreamed.

Long Island IVF has many wonderful social workers, counselors, and psychologists if you need help along the way. Our blogs and forums are here for you to ask questions and vent. You will find support from others who have walked…or are now walking…in your shoes.

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So how do you picture YOUR dream baby? It’s a good exercise to focus on the goal! Try it.

Photo Credit: http://www.publicdomainpictures.net/view-image.php?image=17082&picture=baby-looking

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Can Sunshine Boost Your Fertility?

By David Kreiner MD

March 13th, 2012 at 10:55 pm

Vitamin D is a fat soluble vitamin that is present in a variety of forms but has recently been recognized as playing a critical role in reproduction.  It is essential in the production of sex hormones in the body.  It is thought that a deficiency of Vitamin D may lead among other things to ovulation disorders.

It has been demonstrated that Vitamin D deficient rats had a 75% reduced fertility and a 50% smaller litter size that was corrected with Vitamin D treatment.  In addition, sperm motility in males was reduced in the presence of a Vitamin D deficiency.

A recent study at the Yale University School of Medicine revealed that only 7% of 67 infertile women studied had normal Vitamin D levels and not a single woman with an ovulatory disorder had normal levels.  Nearly 40% of women with ovulatory dysfunction had a clinical deficiency of Vitamin D.

At the American Society of Reproductive Medicine conference last year, a study presented by Dr. Briana Rudick from USC showed that a deficiency of Vitamin D can also have a detrimental effect on pregnancy rates after IVF, possibly through an effect on the endometrial lining of the uterus.  

In her study only 42% of the infertile women going through IVF had normal Vitamin D levels.  Vitamin D levels did not impact the number of ampules of gonadotropin utilized nor the number of eggs stimulated, embryos created or embro quality.  However, Vitamin D levels did significantly affect pregnancy rates even when controlled for number of embryos transferred and embryo quality.  In this study the pregnancy rate dropped from 51% in Caucasian women undergoing IVF who had normal Vitamin D levels to 44% in those with insufficient levels and 19% in those that were deficient.

Vitamin D deficiency has also been associated with poor pregnancy outcomes including preeclampsia and gestational diabetes

Vitamin D can be obtained for free by sitting out in the sun and getting sun exposure on the arms and legs for 15-20 minutes per day during peak sunlight hours.  The sunlight helps the skin to create Vitamin D3 that is then transformed into the active form of Vitamin D by the kidneys and liver.   An oral supplement is available also in the form of Vitamin D3, with a minimum recommended amount of 1000 IU a day for women planning on becoming pregnant.  For those with clinical insufficiencies a higher dose may be administered by injection.

Our study and many others suggest that the effect is endometrial, but we don’t know for sure.

 

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Does this information cause you to reconsider how much time you’ll spend in the sun this spring and summer and how you’ll use sunscreen or other sun protection?

Photo credit: http://www.publicdomainpictures.net/view-image.php?image=5983&picture=beauty-and-the-beach

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Women’s History Month, Eve, and Infertility

By Tracey Minella

March 9th, 2012 at 6:25 pm

March is National Women’s Month and National Women’s History Month.

So it got me thinking about, well, women in history. And I read several articles about women who’ve made great contributions to society. Some in the fields of medical research and embryology. I’ll share a couple of those stories over the next few weeks.

But interestingly, if you go back as far as Catholic teachings on women’s history would allow you’ll end up with Eve in the Garden of Eden. And as most people know from the story, she defied God’s order not to eat the fruit from a certain tree. I think she was on my mind because I’d recently seen the clips of the musical “Children of Eden”.

I’d never really thought of Eve when thinking about infertility before. After all, she had her sons (unlike several other Biblical women who did suffer infertility). But what just struck me about Eve was that she defied God and was banished from paradise because of it.

As a woman suffering from infertility, I’d often question “Why me?” As the years wore on it was often hard to keep the faith. I felt like God was punishing me by not answering my prayers for a child. I was angry. I admit it.

But for the first time tonight, I considered… “Hey, maybe this is all Eve’s fault”!

Do you think life’s sufferings, like infertility, go back to Eve’s defiance? Are we all still paying a price? Or is infertility just random bad luck? Or the result of specific medical diseases, conditions, and circumstances that have nothing to do with God or any religion?

Imagine if all womanhood was damned from the very beginning of history. One apple. Seems harsh, no?

Just something to ponder as we celebrate Women’s History Month.

Photo credit: http://www.wpclipart.com/religion_mythology/bible/creation/Adam_Eve_happy.png.html

 

 

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IVF 101: Infertility Terms Defined

By David Kreiner MD, and Tracey Minella

March 8th, 2012 at 11:07 pm

Don’t be a deer in the headlights when it comes to infertility diagnoses and treatments. Yes, there’s a lot to learn. Yes, it can be overwhelming, leaving you a bit glassy-eyed. But the good news is that you can go to the head of the class by the time you finish reading this post.

Dr. David Kreiner of Long Island IVF gives you the low-down and the lingo. It’s everything you need to know, from A to… well… P. And what better letter to stop at? “P” is for pregnant:

“Why me? My wife never had any infections, surgery or any other problem? I have no difficulty ejaculating and there’s plenty to work with so why can my friends and neighbors and coworkers get pregnant and we can’t?”

I hear these questions daily and understand the frustrations, anger and stress felt by my patients expressing these feelings through such questions. There are many reasons why couples do not conceive. An infertility workup will identify some of these. A semen analysis will pick up a male factor in 50-60% of cases. A hysterosalpingogram will locate tubal disease in about 20% of cases. Another 20-25% of women do not ovulate or ovulate dysfunctionally. A post coital test may identify that the problem is that the sperm is not reaching the egg. It may not be able to swim up the cervical canal into the womb and up the tubes where it should normally find an egg to fertilize. When these tests are normal a laparoscopy may be performed to identify the 20-25% of infertile women with endometriosis. However, even when this is normal and there is no test that logically explains the lack of success in achieving a pregnancy; an IVF procedure may both identify the cause and treat it successfully.

What is IVF?

In Vitro Fertilization, IVF, is the process of fertilizing a woman’s eggs outside the body in a Petri dish. Typically, a woman’s ovaries are stimulated to superovulate multiple eggs with gonadotropin hormones, the same hormones that normally make a woman ovulate every month. Injections of these hormones are usually performed by either the husband or wife subcutaneously in the skin of the lower belly with a very tiny needle. It takes 9-14 days for the eggs to mature. She will then take an HCG injection which triggers the final stage of maturation 35-36 hours prior to the egg retrieval. This is performed in an operating room, usually with some anesthetic. The eggs are inseminated in the lab and 3-5 days later, embryos are transferred into the uterus with a catheter placed transvaginally through the cervix into the womb.

What is ICSI?

Some times even in the presence of a normal semen analysis, and normal results on all the infertility tests, fertilization may not occur without microsurgically injecting the sperm directly into the egg. This procedure is called Intracytoplasmic Sperm Injection or ICSI and may achieve fertilization in almost all circumstances where there is otherwise a sperm cause for lack of fertilization.

If it looks like a sperm and swims like a sperm, why doesn’t it work like a sperm?

A South African gynecologist, Thinus Kruger, discovered that small differences in the appearance of sperm affected the sperm’s ability to fertilize an egg. In 1987, Thinus demonstrated that when we used the very strict Kruger criteria for identifying a normal sperm, we were able to identify most men who had normal semen analyses and were yet unable to fertilize their wife’s eggs. Most of these couples suffered from unexplained infertility except now utilizing the Kruger criteria for sperm morphology we were able to identify the problem. Today, these couples are successfully treated with the ICSI procedure.

Old eggs?

As women age, the percentage of genetically abnormal eggs increases. These older eggs are less likely to fertilize, divide normally into healthy embryos or result in a pregnancy. When older women do conceive they are more likely to miscarry then when they were younger. Aging of eggs begins in the 20’s but accelerates after age 35. This is why a woman’s fertility drops as she gets older. The age at which it becomes significant for a woman varies. Some women in their 30’s have significant aging of their egg. Others less so and may have a good number of healthy eggs into their 40’s.

ABC’s of IVF

Assisted Hatching is when the embryologist makes a hole in the shell around the embryo called the zona pellucidum. This is performed minutes prior to embryo transfer and may be performed chemically with acid tyrodes, mechanically with a micropipette or with a laser. It is commonly believed that older eggs may lead to embryos with a thicker or harder shell that may prevent the natural hatching of an embryo that must occur prior to the embryo implanting into a woman’s lining of her womb.

Blastocyt embryo transfers occur on day 5 or 6 after the egg retrieval. This is the embryonic stage when an embryo normally implants into the womb. These embryos have been selected to be healthier by virtue of the fact that they have made it to this stage. Some believe that a woman’s uterus may be more receptive to an embryo implanted at this stage. Statistically, the pregnancy rates for women who have had blastocysts transferred is higher than when the same number is transferred on day 3 using “cleaved” embryos of 4-10 cells. As the advantage of the blastocyst transfer may be only a matter of selection, it is thought that there may be no advantage if the embryologist is able to select just as well the best embryos to transfer on day 3.

Bravelle – Brand of FSH, follicle stimulating hormone which is a gonadotropin used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle.

Cetrotide – Brand of Gonadotropin Releasing Hormone Antagonist that prevents a woman’s pituitary gland from producing LH, luteinizing hormone. LH increases can trigger premature ovulation and stimulate testosterone and progesterone production which can be harmful to a woman’s egg production and prematurely mature the lining of womb potentially affecting implantation.

Co-culture of a woman’s endometrial cells from the uterine lining or granulosa cells from aspirated ovarian follicles along with the embryos in the same culture dish is thought to provide growth factors for the embryos which may improve the health and growth of the embryos.

Cleavage Stage Embryos are 2-10 cell embryos transferred on day 2 or 3. They are often graded by their lack of fragmentation and granularity of the inside of the cell cytoplasm; A to D or 1to 5 with A or 1 being the best grade.

Embryo Glue is a protein supplement to the transfer media prepared minutes prior to transfer to make the embryo more likely to stick to the lining of the womb. It is believed that some embryos may not implant since they are not adhering to the lining and do not get an opportunity to burrow into the endometrium.

Estradiol is produced by the granulosa cells of the follicle which surround the egg in the ovary. As follicles are stimulated and grow they produce more estradiol. We measure estradiol to monitor development of the follicles. It also helps to prepare the lining of the womb for implantation.

Follistim – Brand of FSH, follicle stimulating hormone which is a gonadotropin used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle.

Ganirelix – Brand of Gonadotropin Releasing Hormone Antagonist that prevents a woman’s pituitary gland from producing LH, luteinizing hormone. LH increases can trigger premature ovulation and stimulate testosterone and progesterone production which can be harmful to a woman’s egg production and prematurely mature the lining of womb potentially affecting implantation

Gonal F – Brand of FSH, follicle stimulating hormone which is a gonadotropin used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle.

Gonadotropins – FSH, follicle stimulating hormone and LH, luteinizing hormone stimulate the follicles in the ovary to mature and produce ovarian hormones, estradiol, testosterone and progesterone. It also is used to stimulate a woman’s ovaries to superovulate and make multiple eggs mature during the IVF cycle. We adjust the ratio of FSH and LH to achieve goals of optimal follicular development and maturation while trying to minimize the risk of hyperstimulation. Typically we administer the gonadotropins to the woman for 8-14 days before giving her HCG 35-36 hours prior to the egg retrieval

HCG is human chorionic gonadotropin, the pregnancy hormone we measure to see if your wife is pregnant. We follow the numbers to monitor the growth and health of the pregnancy. HCG has the same biological effect as LH and therefore can be used to mature the egg in the same way as if it were getting ready to ovulate. We therefore administer HCG to women 35-36 hours prior to the egg retrieval. Brand names for HCG include Pregnyl and Ovidrel.

HMG – Human Menopausal Gonadotropins are purified from the urine of menopausal women since they have high levels of FSH and LH. Menopur and Repronex are brands of HMG used in IVF stimulations containing a 1:1 ratio of FSH to LH. We adjust the ratio of FSH and LH to achieve goals of optimal follicular development and maturation while trying to minimize the risk of hyperstimulation. Adding pure FSH, i.e. Bravelle, Follistim or Gonal F will increase the ratio of FSH to LH which may be desirable especially early in a stimulation. Some patients may not need any supplemental LH and are stimulated with FSH only. LH is sometimes added towards the end of a stimulation to minimize the risk of hyperstimulation syndrome.

Hyperstimulation syndrome is a condition which occurs approximately 3% of the time as a result of superovulation of a woman’s ovaries with gonadotropins. A woman’s ovaries become enlarged and cystic, fluid accumulates in her belly, and occasionally around her lungs. When it becomes excessive, it may make it uncomfortable to breathe. We remove this excess fluid with a needle. Women can also become dehydrated and put them at risk of developing blood clots. We therefore recommend fluids high is salt content like V 8 and Campbell’s chicken soup. We give patients baby aspirin to prevent clot formation. It may also be recommended to freeze all the embryos and postpone the transfer to a later cycle as pregnancy can significantly exacerbate Hyperstimulation syndrome.

ICSI – Some times even in the presence of a normal semen analysis, and normal results on all the infertility tests, fertilization may not occur without microsurgically injecting the sperm directly into the egg. This procedure is called Intracytoplasmic Sperm Injection or ICSI and may achieve fertilization in almost all circumstances where there is otherwise a sperm cause for lack of fertilization

Lupron is a Gonadotropin Releasing Hormone Agonist that must be administered after a woman ovulates or concurrent with progesterone or oral contraceptive pills to effectively suppress gonadotropins. Lupron prevents a woman’s pituitary gland from producing LH, luteinizing hormone. LH increases can trigger premature ovulation and stimulate testosterone and progesterone production which can be harmful to a woman’s egg production and prematurely mature the lining of womb potentially affecting implantation

Monitoring of a woman’s stimulation with gonadotropins is performed by transvaginal ultrasound examination of her ovarian follicles and blood hormone levels. The gonadotropin doses can be adjusted according to the results of the monitoring. The timing of the HCG and subsequent egg retrieval are likewise based on the monitoring. Typically, a woman need not be monitored more frequent than every 3 days initially but may need daily monitoring as she approaches follicular maturation to determine timing of the HCG injection and retrieval.

Morula is the stage between the cleavage stage embryo and blastocyst. It is when the embryo is a ball of cells.

Oral contraceptive pills are often given prior to the stimulation to help time stimulation starts and bring a woman’s reproductive system to a baseline state from which the stimulation may be initiated.

Progesterone is an ovarian hormone that prepares the lining of the womb for implantation. We measure it during stimulation to check if the lining is getting prematurely stimulated. We add it to the woman after the retrieval to better prepare the lining and continue it as needed to help sustain the implanted embryo until the placenta takes over production of its own progesterone.

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