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Archive for the ‘ASRM 2013’ tag

ASRM Retrospective 30 Years Later

By David Kreiner MD

October 17th, 2013 at 1:48 pm

image courtesy of renjith krishnan/freedigital photos.net

 

Flying into Boston this week it occurred to me that this was the 30 year anniversary of the first ASRM meeting I ever attended.  In 1983, the American Fertility Society “AFS” meeting (as it was called then) was held in San Francisco and I attended as a third year ob-gyn resident. I was in awe attending this huge conference of about 3-5,000 held at the Hyatt Hotel as I recall.


Though I was required to man the Ovcon 35 birth control pill exhibit (since Ovcon’s manufacturer was paying my way), I was drawn to the microsurgery and in vitro fertilization exhibits and presentations.  

In the ballroom, the presenters presided over a few thousand of us eager to hear about the most recent successes in IVF.  Already, Norfolk had achieved dozens of births through this new scientific process which brought gynecological surgeons (laparoscopists) together with embryo biologists, endocrinologists, andrologists and numerous nurses, technicians and office staff.  For me, hearing Dr. Howard Jones, American IVF pioneer, and others speak about their experiences with this life creating technique was exhilarating.

Years later, as a Jones Institute reproductive endocrinology fellow, I would hear Dr. Howard proclaim that a chain is only as strong as its weakest link.  IVF required every link to maintain its integrity for the process to work.

In 1985, I presented my own paper at the AFS meeting in Phoenix, Arizona.  My wife and two sons joined me.  My presentation on endometrial immunofluorescence in front of hundreds of experts and specialists in the field remains one of the strongest memories in my life.

Today, the ASRM must be held in mega convention centers like the one in Boston where it could accommodate tens of thousands of attendees.  One presentation estimated the number of IVF births worldwide at over five million. Interestingly, per capita, the US performs one fifth the number of IVFs as Europe–where IVF is much more accessible and typically covered by government insurance.

Today, success in the US is better than fifty per cent for most people, thereby making single embryo transfer (“SET”) for good prognosis patients a viable option to avoid the risk of multiple pregnancy. Minimal stimulation IVF (“Micro-IVF”) is a viable alternative for many patients, offering a lower cost and lower risk option.  Egg freezing offers a means of fertility preservation, especially valuable to women anticipating cancer therapy.  Pre-embryo genetic screening (“PGS”) is an option that allows patients to screen for and eliminate genetically undesirable embryos that may otherwise lead to miscarriage or termination.

Looking back at the past thirty years, I am amazed at the progress and achievements made by my colleagues in IVF and happy that I was able to participate in this most rewarding field that has brought so much joy to millions of people.

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photo credit: renjith krishnan http://www.freedigitalphotos.net/images/agree-terms.php?id=10058384

 

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Plastics, Infertility, Paleo and the ASRM 2013

By David Kreiner, MD

October 15th, 2013 at 4:01 pm

 

credit: stuart miles/freedigitalphotos.net

It’s a beautiful day in Boston today.  I am here not because of the Red Sox playoffs or Sunday’s Patriots game but rather to attend our annual ASRM national fertility meeting. 

I was delighted upon greeting some former colleagues of mine from my old stomping grounds, the Jones Institute, to hear compliments about how good I looked.  (Well, if you lose 55 lbs. of “baby fat” people tend to notice.)  I explained that my son, Dan, convinced me to try the Paleo Diet, modeled after the diet of Paleolithic man.

I am intrigued that so much is known about how man from the Paleolithic age ate.  I guess he left menus and recipes on the walls of his man caves.  Anyway, the focus… aside from elimination of dairy and gluten from his diet… is avoiding processed foods and chemical additives such as artificial sweeteners.

It was while eating my veggies and bun-less burger that I came upon one of the lead stories at the ASRM in the Wall Street Journal.  The chemical BPA, or Bisphenol A, found in plastic is tied to the risk of miscarriage.  BPAs can leach into the food that is heated on it such as in a microwave or in water stored in plastic and left out in the sun.  Additionally, it was recommended to limit the use of canned foods and avoid handling cash register receipts, which often are coated with resins that contains BPA.

I’m not sure “Paleo” man extended his life, avoided disease or lived any healthier with his “natural only” diet but we have some evidence of some benefits by doing so today.  Oh, and did I mention I can fit into those jeans from my college days?

For more information on the effects of BPAs on fertility as being discussed at the ASRM, see http://bit.ly/19Q28Bt

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Did you know that plastics and other items made from BPAs may be harmful to your fertility or contribute to miscarriage? Do you use these products and if so, will you consider stopping now?

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=10054792/ Stuart Miles

 

 

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Three Reasons to Keep an Infertility Journal

By Tracey Minella

October 13th, 2013 at 12:39 pm

 

credit: Simon Howden/freedigitalphotos.net

The ASRM …the biggest annual medical conference of infertility professionals…is happening right now in beautiful Boston, Massachusetts. History is being made and discoveries shared in one of the country’s most historic towns.

Imagine the ASRM of bygone days. When decades ago, procedures which are routine today… like embryo cryopreservation and ICSI…were first being studied and proposed. How exciting that the brightest minds in assisted reproductive technology are gathering as we speak and crafting another chapter in the history of IVF.

Which begs the question: What chapter are you on in your personal infertility journey and have you been keeping your own historical journal?

The deafening sound of your collective “no” isn’t surprising. I know why most of you don’t keep the journal. I missed out on the very beginning of my own story for the same reason… because you wish, hope, believe, or pray…that it won’t really become “a journey”. You assume it’ll be resolved fast… that next month will be the lucky one… and you will just get on with your life. That infertility will be just a little speed bump… instead of a potentially long and bumpy road. So you don’t write about it.

Here are 3 reasons to keep and infertility journal:

1. Memory Fades: Even though you have committed every little detail about your failed cycles and the numbers and grades of frozen embryos to memory, those memories are going to fade.  Especially if the journey lingers on… and the details about cycle 2 and 4 start to blend. Trust me on that one. You should have a one place to look back on it all someday. And you will want to look back. Trust me on that, too. While you are living it, you can’t appreciate how strong you are. That only comes from hindsight.

2. It is Therapeutic: It’s another place to vent, and for those who hold it all in, it may be the only place to vent. And venting helps reduce stress. Reducing stress may help you conceive. It’s a good cycle.

3. It is Part of History: Your infertility journey, however long it is or may be, is taking place alongside history itself. Keeping a journal forces you to connect with today’s important news and events, when everything else about battling infertility could otherwise send you into self-imposed isolation. I’ll explain:

My own infertility journal chronicles what is arguably the most important day in U.S. history during my adult lifetime…September 11, 2011. I was newly-pregnant with my son, barely pregnant actually, after IVF cycle #7. And I was working as a medical assistant at Long Island IVF. I wrote about how we frantically tried to reach our patients that worked in NYC, how we inseminated a tearful woman who went on to conceive twins on that day, and how I worried about the world I was bring this baby into. I love that I have that story to share with my kids.

Maybe your story would be woven into events like the election of President Obama, the Boston Marathon bombing, or other historical events, good and bad, yet to unfold. Those events that people look back on and ask: “Where were you when…..happened?”

I know it’s hard to write it down. It’s hard enough to just live it. But do it. The babies you’re working on having will consider it a gift someday.

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Do you keep a journal? Do you have any stories to share about what you were doing…infertility-wise…on historically significant dates?

 

Photo credit: Simon Howden / http://www.freedigitalphotos.net/images/agree-terms.php?id=1005754

 

 

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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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