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Archive for the ‘Infertility Study’ Category

Sunshine, Vitamin D, and Your Fertility

By Dr. David Kreiner and Brianna Rudick, MD

May 27th, 2014 at 3:02 pm

 

 

image courtesy of victor Habbick/freedigitalphotos.net

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 an American Society of Reproductive Medicine conference, 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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Did you know that Vitamin D deficiency can affect your fertility? Do you know if you are deficient?  

*****Note that if you’re thinking of sitting outside without sunscreen now that the sun is scorching hot, please check with your doctor first for guidelines on how much time, if any, he or she recommends you spending outside with minimal or no sunscreen. It is not for everyone. And you can burn even when it’s cloudy.

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Long Island IVF Now Recruiting Patients for Exciting Research Study

By admin

November 14th, 2013 at 11:01 pm

 

 

The MultiCenter Registry with Eeva (MERGE) Research Study is currently recruiting patients at Long Island IVF.

Eeva: The Early Embryo Viability Assessment Test is a test to be used by IVF laboratories to analyze early embryo development and to aid in the selection of the best embryo for transfer. At the heart of Eeva is software that was designed to assess critical difference in early embryo growth and determine an embryo’s viability and the potential for further development.

The Eeva Test was developed based on landmark research conducted at Stanford University[1] which discovered that early embryo growth events can predict embryo development and reflect the underlying health of the embryo.

Auxogyn Inc. recently completed a multi-center clinical trial using Eeva with 54 patients and 758 embryos. The results from the trial supported that when embryologists used Eeva in conjunction with their traditional techniques they were able to correctly identify non-viable embryos 86% of the time vs. only 58% of the time without using Eeva[2].

The goal of the MERGE study is to record and evaluate the use of traditional embryo grading techniques combined with Eeva in the treatment of in vitro fertilization.

If you are interested in participating in this research, please contact Long Island IVF at 631-752-0606 or info@longislandivf.com and ask for the Auxogyn study coordinator for more information.

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1. Wong et al. in Nature Biotechnology, 2010.

2 Conaghan et al. Fertility & Sterility, May 2013.

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Is Your Reproductive Endocrinologist or Fertility Practice On Top of Their Game?

By Tracey Minella

October 10th, 2013 at 7:22 pm

 

photo credit: jscreationzs/freedigitlaphotos.net

Did you research your reproductive endocrinologist’s background before your initial appointment or did you just trust the recommendation of a friend who had success with him? Has your investigation gone no further than a quick glance at those diplomas on the office wall?

Does it matter that your doctor graduated first in his class at Harvard Medical School in 1980 if he hasn’t kept abreast of the rapidly changing advances in the assisted reproductive technology (ART) field, or hasn’t surrounded himself with a team of top-rate embryologists? Or hasn’t conducted any research studies?

Certainly, education matters. But so does something else…continuing education.

Is your doctor on top of his or her game? Is he involved in ground-breaking research? Is she recognized as a leader in the field?

The biggest annual conference on Assisted Reproductive Technology is the Conjoint Meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine…more simply referred to as the ASRM… and it kicks off in Boston this Saturday. Fertility doctors, embryologists, IVF nurses, and others working in the field come from all over the world to attend the 5 day conference to learn the latest, cutting edge developments in reproductive technology.

The information to be presented at the ASRM each year is chosen by the committee based on research studies and abstracts submitted by fertility professionals across the globe. Having an abstract chosen for presentation at the ASRM is a great honor to a fertility practice.

Although Long Island IVF always sends several doctors and key support staff, this year is extra special… 

This year, not only one… but two… abstracts from Long Island IVF have been accepted for presentation at the ASRM.

The first abstract is titled: “Minimal Stimulation (Micro-IVF) Achieves Similar Clinical Outcomes in Patients Under 35 years of age compared to those undergoing conventional controlled ovarian hyperstimulation.” For more information about the Long Island IVF Micro-IVF Program see http://bit.ly/12ZjvaD or speak to your Long Island IVF doctor.

The second abstract is titled:  “eSET vs DET: Its Clinical Effectiveness in the Real World”. This abstract compared the effectiveness of Single Embryo Transfers (SET) against that of Double Embryo Transfers (DET). For more information about the Long Island IVF Single Embryo Transfer Program, including the financial incentives offered to SET program patients, see http://bit.ly/WpzCvv or speak to your Long Island IVF doctor.

Through these two ground-breaking studies, Long Island IVF has addressed two important issues for today’s infertility patients… lowering the costs of treatment and minimizing the chance of potentially risky multiple pregnancies…all while maintaining competitive pregnancy success rates.

If you have any questions, including whether you might be a candidate for either of these well-established Long Island IVF programs, please contact your Long Island IVF doctor.

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Have you participated in (or would you consider) the SET or Micro-IVF program? What would your primary reason be for doing so, or not doing so?

 

Photos credit: jscreationzs/ http://www.freedigitalphotos.net/images/agree-terms.php?id=10018651

 

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Micro-IVF vs. Full Stimulation IVF Study Shows Similar Clinical Outcomes

By Dr. David Kreiner and Tracey Minella

August 21st, 2013 at 7:48 pm

 

photo credit: stockbyte/freedigitalphotos.net

Long Island IVF is excited to offer a glimpse into its fifteen (15) month study of clinical outcomes comparing minimal stimulation IVF (Micro-IVF) and traditional full stimulation IVF.

The two IVF options differ by their stimulation protocols, costs and risks. The fee for basic Micro-IVF is $3900 without anesthesia and not including the medication. In Micro-IVF, patients typically take 100 mg. of Clomid for 5 days, followed by 75 IU of gonadotropin injections for 2-4 days, depending on follicle size as monitored by ultrasound. In full stimulation IVF, patients typically take a GnRH antagonist with doses from 150-600 IU of gonadotropin daily for several days, depending on follicle size as monitored by ultrasound. The amount of medication used, and consequently the number of eggs retrieved, is much greater with the full stimulation IVF.  As a result, generally success rates would be higher with the more aggressive stimulation.

In a retrospective data analysis of patients (<35 years of age) undergoing IVF between October 2011 and December 2012, this study by the physicians and embryologists of Long Island IVF sought to evaluate the effects of minimal stimulation IVF (Micro-IVF) on clinical outcomes. This data was presented at the American Society for Reproductive Medicine (ASRM), held in Boston, Massachusetts on October 17, 2013.

Average Number of Oocytes (Eggs)

Average Number of Embryos Transferred

Fetal Hearts per Embryo Transfer/ (Implantation Rate)

Clinical Pregnancy Rate per Embryo Transfer

Micro-IVF

3.5

1.7

28%

13/28=46%

Full Stim IVF

14.5

1.8

38%

117/215=54%

 

 

In the Micro-IVF cycles, the average number of oocytes (eggs) retrieved was far less than for the full stimulation IVF cycles and therefore there were far fewer embryos to select from for transfer.  As a result, there were most likely fewer high quality pregnancy potential embryos transferred from the Micro-IVF cycles and consequently that implanted (implantation rate).  This did not result in a considerably lower clinical pregnancy rate but there were far fewer twins relative to the group undergoing full stimulation IVF.

Aside from the lower cost, Micro-IVF offers a significantly lower incidence of ovarian hyperstimulation syndrome albeit for most without the advantage of additional cryopreserved embryos.   Even so, with a clinical pregnancy rate of 46% per embryo transfer, the study confirmed that Micro-IVF is often appropriate for younger patients. It can achieve a similar pregnancy rate using fresh embryos, is more cost-effective, and can reduce the risk of hyperstimulation.

 

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Do the results of this study make you more likely to consider Micro-IVF?

If you are interested in Micro-IVF, is it primarily because of the pregnancy rate, the lower risk of ovarian hyperstimulation syndrome, less medication, lower cost, or another reason?

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Dude Looks Like a Baby

By Tracey Minella

July 18th, 2013 at 4:49 pm

 

image courtesy of fotographic 1980/free digital photos.net

Music and In Vitro Fertilization (“IVF”) rates are in the news.

Whether you’re into Aerosmith or Beyonce, Rascal Flatts or Metallica, a new study found that playing music in the presence of eggs increased fertilization rates in patients undergoing IVF.

In the study*, conducted at Barcelona’s Marques Institute fertility clinic, 1,000 eggs were “injected with sperm”. Half were then placed in incubators where various genres of music…including Nirvana, Madonna, Michael Jackson, Mozart and Bach… were playing on iPods. The other half of the eggs was not exposed to music.

 The fertilization rates were five percent (5%) higher in the eggs exposed to music.

Study leaders speculated that the vibrations from the iPods… not the music itself… was likely responsible for the difference in the fertilization rates.

Oxford Fertility expert, Dr. Dagan Wells, offers this theory: In natural fertilization, egg and sperm meet in the Fallopian tube and, if fertilization occurs, the resulting embryo gently “rocks and rolls” its way down the tube and into the uterus where it hopefully implants and results in a pregnancy. But with in vitro fertilization, the egg and sperm just sit largely stagnant in the culture media of the petri dish and “stew in its own juice.” Specifically, the addition of music may provide good vibrations for increased fertilization by helping nutrients pass into the egg and by speeding up the removal of toxic waste.**

Study leaders also found that the style or type of music was not a clear factor… so anything from Sinatra to show tunes may suffice. However, there was some speculation that pounding, rhythmic “techno music” with bass may provide the most vibration.

Music is almost always playing in the Long Island IVF O.R. and embryology lab.

What kind?  I’m told it usually ranges from soft pop to classical. Does that make our doctors and embryologists “rock stars” in their field?

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Was there music playing during your retrieval or transfer? Do you remember the song?

* http://www.institutomarques.com/pdf/music-enhances-in-vitro-fertilisation.pdf

** http://dailym.ai/17oCorm

Photo credit: fotographic 1980 and http://www.freedigitalphotos.net/images/agree-terms.php?id=100138806

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The Powerful Impact of PGD in Infertility Treatment

By Tracey Minella

June 13th, 2013 at 11:37 am

credit: Dream designs/freedigitalphotos.net

Preimplantation genetic diagnosis (or screening)…a/k/a PGD or PGS… is a process by which embryos created through in-vitro fertilization (IVF) are screened for various reasons prior to transferring them back into a woman’s uterus in the hope of implantation.
Why would a couple do this?
Well, most people think of infertility as being unable to get pregnant. While that is true, it is only one half of the definition. When you can conceive on your own but can’t maintain the pregnancy, as in the case of recurrent miscarriages, you are also considered clinically infertile.
PGD/PGS can help infertile couples in many ways:
• Improve IVF success rates by selecting for “chromosomally normal” embryos;
• Reduce the incidence of miscarriage;
• Reduce the risk of a live born child with a chromosome or genetic abnormality;
• Reduce cycle numbers to a live birth.

 

Simply put, screening embryos before transfer increases the chance of transferring embryos that are the most likely to implant. Screening may reduce miscarriage or a pregnancy at risk of a baby with a genetic condition.
PGD/PGS can be used to screen embryos for hereditary genetic diseases or conditions and gives couples the choice of transferring back only embryos that do not appear to carry the disease. For example, Spinal Muscular Atrophy (SMA) is a devastating, often fatal disease and is the leading genetic cause of death in infants. The carrier rate for someone to have the gene for SMA is only 1 in 50. Unfortunately, testing for such diseases is not performed prenatally so parents only learn they are carriers after they have a child affected. Other more commonly-known diseases that can be screened by PGD/PGS include Cystic Fibrosis, Tay Sachs, Muscular Dystrophy, and Huntington’s disease. In fact, there are literally hundreds of diseases we can test for with this technology.
PGD/PGS can also screen embryos for chromosomal abnormalities which may be the cause of recurrent miscarriages, enabling the couple to transfer back only viable, chromosomally-accurate embryos. It also can help in cases of repeated implantation failure.
In addition, PGD/PGS can be used for gender selection…choosing the sex of your baby. There are genetic diseases that run through offspring of only one sex, so by selecting to transfer only embryos of the opposite sex, couples can increase the odds of avoiding that disease in their children. However, gender selection can also be used for “family-balancing”, a sometimes controversial topic. Critics cite religious and moral objections to using PGD/PGS for the sole purpose of balancing out your family by choosing embryos of the sex opposite the child(ren) you already have.

 

It may be upsetting to infertile people who need IVF… and would be happy to have it produce a child of any sex… to hear that PGD/PGS can be used for gender selection by those who do not need IVF otherwise. However, others argue that anyone who undergoes the inconvenience and expense of IVF should be entitled to access any and all of the diagnostic tools available through today’s rapidly-developing assisted reproductive technology, including PGD/PGS for any purpose.
It is interesting to note that, although PGD/PGS is an additional out-of-pocket cost over and above traditional IVF, PGD/PGS may lower the overall total cost of IVF for those who produce an excess number of embryos. Since PGD/PGS seeks to select “chromosomally normal” embryos, patients can potentially avoid wasting money on thaw cycles for embryos that would likely not have the potential to develop into viable babies.
Long Island IVF is one of only five infertility practices in the country selected to participate in a recent PGD/PGS study by Reprogenetics. For more information on the study, including whether additional participants can be accommodated, please ask your Long Island IVF doctor, or contact Eva Schenkman, Senior Embryologist at evas@longislandivf.com
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How do you feel about PGD/PGS? Is it acceptable in any case, certain cases, or not at all?

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Exciting Long Island IVF Study Seeks to Prove that PGD/PGS Improves Pregnancy Rates in Older Women

By Eva Schenkman, M.S., C.L.T., T.S.

November 26th, 2012 at 12:49 pm

credit: Dream designs/freedigitalphotos.net

With advancing maternal age more embryos have chromosome abnormalities, from 60% in women younger than 35 to 80% in women 40 and older. This results in embryos failing to implant, pregnancy loss (miscarriage), or affected babies (i.e. Down’s syndrome). Because of that, more than one embryo is usually transferred during IVF. However, if two or more normal embryos implant, twins or triplets may result, which may result in a higher risk of congenital abnormalities, premature birth, and developmental problems.

A technique called PGD/PGS (preimplantation genetic diagnosis/screening) can detect if embryos are normal for chromosomes and may prevent the above problems.

In order to take advantage of this cutting edge technology, a woman must undergo in vitro fertilization (IVF), so her embryos may be examined. Embryos produced after IVF can be tested for the correct number of chromosomes through PGD/PGS.  During this process, a biopsy is performed on embryos on day 3, 5 or 6 of development, by inserting a small needle and withdrawing a few cells. Preliminary studies have shown that the biopsy does not harm the subsequent development of the embryo.

The biopsied cells are sent to a genetics laboratory, Reprogenetics, for rapid PGD/PGS testing using array CGH, a technique that allows for the analysis of all chromosomes, while the embryos remain in the IVF laboratory. PGD results are available in less than 24 hours, and an embryo classified by PGD/PGS as normal, can be transferred back to the woman’s uterus the next day. Extra embryos can be cryopreserved for future attempts at pregnancy.

Most studies performed to date have shown an improvement in pregnancy outcome when PGD/PGS is performed using array CGH.  Yet, so far, only one study (Yang et al. 2012*) has been performed with the utmost scientific rigor, that is, by blindly assigning patients at random to either a control group (no PGD) or to a PGD group.

This study was performed in young patients and showed that PGD significantly improved pregnancy rates even though only one embryo was transferred per woman. However, the same study has not yet been done for older patients (35 and older). In theory, older patients should benefit equally or more than younger ones since they produce more abnormal embryos.

We are excited to report that Long Island IVF has partnered with Reprogenetics and is currently recruiting patients for a study that will determine if this PGD approach is also beneficial for women 35 and older.  

If you are eligible you will be randomly assigned to either a control group (regular IVF and no PGD) or to a PGD group. The cost for PGD will be free. If you are assigned to the control group, have a transfer as a study participant, and do not become pregnant you will be offered PGD for free in your next IVF cycle. Eligibility depends on several factors which are determined at various stages of the IVF process, including the age of the woman (35 or older), having normal ovarian reserve, and producing 3 or more blastocyst embryos by day 5 of development. The PGD group will have only one normal embryo transferred while the control group will have up to two untested embryos transferred.

For more information, including the study’s complete eligibility guidelines and medically-qualifying criteria, contact: Eva Schenkman, MS, CLT, TS Senior Embryologist at Long Island IVF at 631-881-5337 or email at Evas@longislandivf.com  

*[Yang et al, Molecular Cytogenetics. 2012, 5:24] 

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Does the potential of PDG to significantly improve pregnancy rates in older women make this technology something you’d consider using?

Photo Credit: http://www.freedigitalphotos.net/images/Human_body_g281-Dna_p111802.html

 

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Figuring out YOUR Odds of a Live Birth With IVF

By David Kreiner MD, and Tracey Minella

July 2nd, 2012 at 8:35 am

 

 

Statistics can be confusing. And when you’re on fertility meds and your hormones are raging, it can be hard to think clearly. So grab a cup of coffee and your thinking cap because you’re going to be interested in this post from Dr. Kreiner.

It’s about a recent study published in the New England Journal of Medicine that finally sheds light on a woman’s odds of having a live birth from IVF. The study examined data from SART (Society for Assisted Reproductive Technology), the primary organization that collects data, sets the guidelines, and helps maintain the standards for the practice of assisted reproductive technologies.

Dr. Kreiner reports:

NEJM Study Uses SART Data to Determine Cumulative Birth Rates for Individual Patients with In Vitro Fertilization

A new study published in the New England Journal of Medicine links data from the SART Clinic Outcome Reporting System to individual women who underwent cycles from 2004 to 2009.  In this way a cumulative live birth rate over the course of all their cycles could be determined.

The researchers reviewed data from 246,740 women, with 471,208 cycles and 140,859 live births, found that live-birth rates declined with increasing maternal age and increasing cycle number when patients’ own oocytes were used, but live-birth rates remained high in donor egg cycles. See Luke et al, Cumulative Birth Rates with Linked Assisted Reproductive Technology Cycles, N Engl J Med 2012; 366:2483-2491 June 28, 2012. http://www.nejm.org/doi/full/10.1056/NEJMoa1110238

By the third cycle, the conservative (patients who underwent fewer than three cycles were assumed not to get pregnant) and optimal estimates of live-birth rates (patients with fewer than three cycles were assumed to have a live birth) with autologous oocytes had declined from 63.3% and 74.6%, respectively, for women younger than 31 years of age to 18.6% and 27.8% for those 41 or 42 years of age and to 6.6% and 11.3% for those 43 years of age or older. When donor oocytes were used, the rates were higher than 60% and 80%, respectively, for all ages. Rates were higher with blastocyst embryos (day of transfer, 5 or 6) than with cleavage embryos (day of transfer, 2 or 3).

At the third cycle, the conservative and optimal estimates of cumulative live-birth rates were, respectively, 42.7% and 65.3% for transfer of cleavage embryos and 52.4% and 80.7% for transfer of blastocyst embryos when fresh autologous oocytes were used.

The study looks for the first time at a “cumulative live birth rate” for each patient going through three embryo transfers. They provide a range based on those patients who did not proceed with subsequent cycles assuming no pregnancy for lower end and live birth in upper end. They do not go into number of embryos transferred or multiple pregnancies.  This provides the best data we have available to answer the question of what the odds are that a patient will experience a successful live birth with IVF.  Understanding that the data is now a little dated and represents a national average, my expectation is that on the average we should see even somewhat better success.

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What did you think of the study? Any questions? Ask Dr. Kreiner right here.

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