Archive for the ‘ASRM’ tag
By Dr. David Kreiner and Brianna Rudick, MD
May 27th, 2014 at 3:02 pm
Tagged with ASRM, David Kreiner MD, Dr. Brianna Rudick, Infertility, infertility information, Infertility Treatment, Long Island IVF, Trying to Conceive, viamin D and pregnancy, Vitamin D and fertility, vitamin D and gestational diabetes, vitamin D and IVF, vitamin D and ovulatory dysfunction, vitamin D deficiency
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.
By David Kreiner, MD
June 24th, 2013 at 9:34 pm
Tagged with ASRM, co-culture and implantation rates, co-culture and pregnancy rates, co-culture of embryos, cumulus cells, David Kreiner MD, embryo co-culture, Embryology, endometrial cells, Fertility, Infertility, Infertility Treatment, IVF, LI-IVF, Long Island IVF, Trying to Conceive
Welcome to the Journey to the Crib Podcast. We will have a blog discussion each week with each chapter. This podcast covers Chapter twenty: Co-culture of Embryos. You, the listener, are invited to ask questions and make comments. You can access the podcast here: http://podcast.longislandivf.com/?p=114
Co-Culture of Embryos
Co-Culture is a procedure whereby “helper” cells are grown along with the developing embryo. The most popular cell lines include endometrial cells (from the endometrium or uterine lining) and cumulus cells from a woman’s ovaries. Both cell lines are derived from patients. Endometrial cells are more difficult to obtain and process, while cumulus cells are routinely removed along with the oocytes during the IVF retrieval.
Cumulus cells play an important role on the maturation and development of oocytes. They produce hyaluronan which is normally involved in cell adhesion, growth and development in the body and is found in the uterus during implantation.
Co-culture of cumulus cells provides an opportunity to detoxify the embryo’s culture medium that the embryos are grown in and produce growth factors important for cell development.
Performing co-culture of embryos has improved implantation and pregnancy rates as presented by us at the national meeting of the American Society of Reproductive Medicine in 2007.
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Infertility Podcast Series: Journey to the Crib: Chapter 21: Things You Should Know About Your Embryo Transfer
By David Kreiner MD
August 9th, 2012 at 4:57 pm
Tagged with ASRM, blastocyst embryos, cervix suture, David Kreiner MD, embryo transfer, embryo transfer explained, embryo transfer information, embryologist role, free cryopreservation, Free Micro IVF Contest, Infertility, Infertility Treatment, Long Island IVF, pregnancy rates per transfered embryo, SET, Single Embryo Transfer, transvaginal follicular aspiration, Trying to Conceive, two-step embryo transfer
Welcome to the Journey to the Crib Podcast. We will have a blog discussion each week with each chapter. This podcast covers Chapter Twenty-One: Things You Should Know About Your Embryo Transfer. You, the listener, are invited to ask questions and make comments. You can access the podcast here: http://podcast.eastcoastfertility.com/?p=116
Things You Should Know About Your Embryo Transfer
As many embryos as you transfer may implant. There is also about a one per cent chance an embryo can spontaneously split resulting in identical twins. For young patients with high quality embryos, the implantation rate is high enough that transfer of one embryo offers a 50% pregnancy rate or better and transfers of two a slightly higher pregnancy rate but a twin rate of 40%. For this reason it is recommended that patients under 35 with a high quality embryo transfer one embryo to minimize their chance of having a higher risk multiple pregnancy.
At Long Island IVF, we offer the Single Embryo Transfer (SET) Program to minimize the cost implications of freezing the excess embryos by eliminating the fee to cryopreserve and store these embryos for up to a year. We also offer for SET participating patients, three frozen embryo transfers for the price of one.
Embryos are typically transferred three to five days after retrieval. The longer duration allows the embryos to develop further giving embryologists an opportunity to judge better which embryos have the best pregnancy potential. Otherwise, a day five transfer does not improve an embryo’s chance to implant. Many embryos fail to develop further after the third day and therefore are not ideal for transfer on day five. The embryologist will decide whether delaying transfer improves a woman’s pregnancy potential based on the number and grade of the embryos, the woman’s age, and her history.
The embryo transfer procedure, which we studied in the late 1990′s and presented at the ASRM in 2000 includes first passing a thin very pliable tube (trial catheter) through the cervix under ultrasound guidance. Occasionally, a suture has been placed in the cervix during retrieval so as to not cause any uterine contractions at the time of transfer. This suture can then be used to manipulate the cervix to straighten the cervical canal for easier atraumatic passage of the trial catheter. The inner part of the trial catheter is removed leaving the trial open at its distal end. The embryologist loads the embryo/s in the transfer catheter which is fed through the trial catheter noting on ultrasound when the transfer catheter has reached the center of the uterine cavity. The embryos contained in a microdroplet are then gently expressed with visualization of an air bubble usually adjacent to the microdroplet noted on the ultrasound. The catheter is then examined by the embryologist to insure that the embryo/s did not stick to the wall of the catheter. If it does we repeat the procedure.
Results of our study of this transfer procedure, I called the two-step transfer method, showed shockingly higher implantation rates compared to transfers with different catheters, with a one-step approach, without ultrasound, and with a tenaculum at the time of transfer instead of the suture.
In the 27 years I am performing IVF, this advance in the embryo transfer stands out as one of the top three most significant advances in IVF along with the radical improvement in media preparation and the ultrasound-guided transvaginal follicular aspiration.
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Are you aware that Long Island IVF is giving away a free basic Micro-IVF cycle, valued at $3,900.00? Check out the contest here: http://bit.ly/LHbmQR
Please share your thoughts about this podcast here. And ask any questions.
By Dr. David Kreiner
November 10th, 2010 at 10:58 pm
It has been two weeks since my return from this year’s national fertility meeting, the ASRM (American Society for Reproductive Medicine) which was held in Denver this year. It is the time and place that breakthroughs in fertility care are announced, results of research studies are discussed, problems and issues of the day are hammered out.
A few national trends were evident throughout the meeting. Single embryo transfer is becoming common place and successful. In some studies, it was as reliable as double embryo transfer in obtaining a baby. Noteworthy, was a study out of the Cornell program which attempted to dispute the previously reported increase in pregnancy complications associated with IVF pregnancies. They showed in their study that when only one embryo was transferred there was no increase in preterm birth complications. They proposed that multiple embryo transfers perhaps with multiple implantations that spontaneously reduce to singletons are the cause for the reported increase in IVF pregnancy complications supposedly seen in singleton pregnancies. This was yet another argument in addition to reducing the risk to multiple pregnancies proposed for transferring a single embryo at a time.
Questions were raised as to how to motivate patients to transfer only one embryo at a time. In addition to education, the concept at East Coast Fertility that is to offer those who transfer one at time free cryopreservation, storage and frozen embryo transfers was being practiced currently by at least one other program. I believe we will be hearing next year that this became a nationwide practice.
There were several studies showing excellent success with minimal stimulation IVF. Program directors actively providing minimal stimulation IVF complained that no distinction was made in the SART reporting so that the lower pregnancy rates seen with minimal stimulation still hurt those programs’ pregnancy statistics. Hopefully, this much less expensive, less invasive, safer alternative will be evaluated separate from full stimulation IVF so programs that offer this service to patients are not discriminated against for doing so.
Perhaps the most exciting advance I heard about during the meeting was the improved pregnancy rates and diminished miscarriage rates seen with the 24 chromosome analysis preembryo genetic diagnosis. This was being offered at the Blastocyst stage to improve cost effectiveness and reduce error and injury to the embryo. If this holds up then the promise of improving pregnancy rates of a single embryo transfer known to be genetically normal will become the standard of care not just improving the efficiency of IVF but perhaps making it as safe as a naturally conceived pregnancy
By Amy Demma, Esq
November 1st, 2010 at 12:00 am
For the past several weeks, I have used this blogging opportunity to offer encouragement, to give a third-party perspective that utilizing donor eggs can work out beautifully.
This morning, having just returned from the 66th Annual American Society of Reproductive Medicine Conference, I am delighted to be writing to you about donor egg through the voices of both donors and of recipient parents ….and I am delighted to be bringing you good news!
At ASRM, a meeting of some 8,000 professionals who gather every year to discuss varied aspects of assisted family building, I attended as many donor related educational sessions as possible. It is with tremendous gratitude for the work of my colleague, Dr. Andrea Braverman, that I am thrilled to share with you the early results of a study she is conducting on donors and their retrospective thoughts on having donated…it is good news:
“Up until now we’ve known that donors are by and large very satisfied by their experience when it takes place,’ said study lead author Andrea M. Braverman, director of complementary and alternative medicine at Reproductive Medicine Associates of New Jersey in Morristown. “And now we see that for the vast majority the positive experience persists.”
A year after donation, the women said they seldom worried about either the health or emotional well-being of the children they helped to spawn. They said they only think about the donation occasionally and rarely discuss it.
The donors also reported that financial compensation was not the number-one motive for facilitating another woman’s pregnancy. Rather, a desire to help others achieve their dreams was pegged as the driving force, followed by money and feeling good.
Women who said the donation process made them feel worthwhile tended to be open to the notion of meeting their offspring when they reach adulthood. And most donors were receptive to the idea of meeting the egg recipients and participating in a donor registry.” (As reported by Alan Mozes, a Healthday reporter: http://health.usnews.com/health-news)
As further encouragement, I culled some testimonials from a “parenting after egg donation on-line forum” to also bring to you a parental perspective on raising a donor conceived child…it is even more good news:
“My husband and I feel blessed that (our son) is in our lives and lucky to have had all the medical procedures to help us. Lucky and Blessed.”
“The child who came into my life is the most beautiful, spirited child in the world–he is the child I was meant to have and fills me with love every minute of the day.”
“….I wouldn’t do anything differently, including having biological children. These are the kids who were meant to be ours and we are lucky to have them.”
And so, once again, I offer to you my most sincere wishes that you should find a sense of peace about collaborative reproduction, that you should know that family building through donor egg can be wonderful and that this is not only the professional perspective but also that of the folks for whom donor egg is a very personal matter…it is, it seems, all good!!!
Amy Demma, Esq
DR. GREGORY ZAPANTIS OF EAST COAST FERTILITY PRESENTS RESEARCH AT ANNUAL MEETING OF LEADING FERTILITY ORGANIZATION
By Gregory Zapantis, Md
October 27th, 2010 at 7:17 am
Tagged with ASRM, East Coast Fertility, embryo implantation markers, Ferring Pharmaceuticals Inc., Gregory Zapantis, Infertility, IVF, March of Dimes Foundation, MD, oocyte donors, ovarian hyperstimulation, Vaginal progesterone
Today, Gregory Zapantis, MD, a reproductive endocrinologist and infertility specialist at East Coast Fertility (ECF) in Plainview, NY, presented the results of his new research study—which aims to advance treatments for infertile women undergoing assisted reproductive technology (ART) such as in vitro fertilization (IVF)—to an international audience at the Annual Meeting of the American Society for Reproductive Medicine (ASRM), an organization renowned worldwide as the leader in reproductive medicine. The 66th annual meeting was held in Denver, October 23-27. The study was supported by Ferring Pharmaceuticals Inc. and the March of Dimes Foundation.
“This research was inspired in large part by the many hopeful patients who arrive at our busy infertility practice yearning for a child. My colleagues and I are determined to offer the latest treatment advances to our patients. While we strive to provide individualized care and emotional support, we also know the importance of conducting research to optimize our patients’ outcomes,” said Dr. Zapantis. “We hope our results will lead eventually to more successful pregnancies, not only for our patients but for all women undergoing IVF treatment.” Dr. Zapantis joined East Coast Fertility in 2005 after completing his fellowship at Albert Einstein College of Medicine, where he is currently Assistant Clinical Professor of Obstetrics and Gynecology.
The new study continues Dr. Zapantis’ investigation of embryo implantation markers in the endometrium as part of an ART treatment. The study evaluated the transient appearance of nucleolar channel systems (NCSs) in the endometrium before and after ovarian hyperstimulation, with and without vaginal progesterone (Endometrin®*). Vaginal progesterone supports the implantation of the embryo and early pregnancy in ART. The results showed that in healthy oocyte donors, NCSs appear earlier than expected following ovarian hyperstimulation, which might be responsible for a reduced implantation on cycle day 21 following embryo transfer in IVF. This may indicate when the endometrium is receptive to the implantation of a fertilized egg, which could lead to a higher rate of successful pregnancy.
About East Coast Fertility
East Coast Fertility is one of the premier centers for infertility care on Long Island. Established in 2002 by Dr. David Kreiner, the program at ECF is designed to utilize the most recent developments in reproductive technology while minimizing risks to the patient. The Single Embryo Transfer program, which helps minimize multiple births, is evidence of ECF’s
commitment to reducing risks to the patient. The team at ECF is known for delivering high quality care with a personal touch. This combined with the most competitive pregnancy success rates in the country, and programs available to make fertility care affordable, help distinguish ECF as a center of excellence. ECF has offices conveniently located throughout Long Island and New York City. For more information about East Coast Fertility, visit eastcoastfertility.com.
*Endometrin® (progesterone) Vaginal Insert is manufactured by Ferring Pharmaceuticals Inc.
By Pamela Madsen
August 11th, 2010 at 10:16 am
Admittedly, this may not seem like a very sexy subject – but if you are a patient seeking treatment for infertility in the United States – or a reporter – or a policy maker – perhaps it is time to do a little primer on what we have in the United States in the way of oversight for reproductive medicine. You see – there are many folks out there who believe that there have been too many cases of impropriety in the conduct of assisted reproductive technologies (ART) for the field to remain without some form of external oversight.
Did you know that the breast implant industry receives more oversight than reproductive medicine? That is because the breast implant business is overseen by The FDA, not The CDC the way reproductive medicine is handled. And perhaps that was done intentionally, because the field didn’t want government oversight. Did you know that with the hundreds of IVF clinics around the country – that the CDC only has the man power and or budget to make about 15 spot inspections a year? Did you know that there is a little loop hole in the powers of the CDC – and if an IVF Center does not want to let the CDC in to do an inspection – they don’t have to? Shh….don’t’ tell the clinics!
Now how did all of this happen in the first place? In 1992, Congress passed the Fertility Clinic Success Rate and Certificate Act which was authored by Representative Ron Wyden a Democrat from Oregon. This Act was written with the consultation and endorsement of the medical trade organization for reproductive endocrinologists known as The American Society for Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technologies (SART). What the Act requires is for fertility clinics to collect and make public the results of ART treatments. Although national data for all clinics clinics are compiled and published, including clinic specific data, this process is voluntary and not enforced, and in the eyes of many patient advocates, reporters and policy makers – not adequate or fully enforceable. Nor by the way are the "guidelines" for treatment put forth by ASRM or SART – they are also voluntary.
Currently in the United States – due to the Fertility Clinic Success Rate and Certification Act is overseen by The CDC which is a non regulatory body. Now I wonder about that – why did "they" choose the CDC and not the FDA?
Consumers use this data to compare clinic A’s success rate to clinic’s B’s success rate – often not understanding that meaningful comparisons between the clinics using this data is not really possible as it has been explained to me by statisticians. It has something to do with inherent problems of dealing with heterogeneous data , and the large confidence limits around all calculated success rates. I must admit I don’t understand any of it – except to know that using the report in this way – is meaningless -and that is mostly what patients do with this report.
So, here we land with an Act that was designed to inform and protect fertility patients that was given to a non regulatory agency of the Federal Government, The Centers for Disease Control (CDC) which does not have the funding, has a tiny staff, and little power to intervene with IVF centers.
Several people have speculated to me that if the CDC was funded properly that they could do a more complete job of implementing the Wyden Bill. And perhaps even expand their role in reproductive medicine as they have so successfully done in other arena such as HIV. Would guidelines created and put out by the CDC be more effective, and carry more weight to fertility doctors than guidelines put out by ASRM?
The CDC has been very successful with their HIV Guidelines. But alas – they are not funded to do this yet. Perhaps we should call our representatives – and start to make a little noise. If in fact – the CDC is the government agency that is over seeing ART – no matter how tied their hands – perhaps we should be looking at how we as patient advocates should be supporting them so that they have enough budget to see more than 15 clinics a year – and are able to use the powers of their office to put out more educational materials such as guidelines for embryo transfers.
While it is true that there are multiple agencies in the US concerned with what the appropriate behavior is for ART Centers, I wonder what the environment would be like if the Wyden Bill was funded properly and fully implemented. I wonder if Senator Wyden has even checked in with the CDC or patient organizations to see how his hard won act is doing? When was the last time he sat down with the CDC I wonder or talked to a patient advocate?
I understand that we live in a time when health care costs are seen as more important than health care outcomes. And it is unlikely that more oversight will ever get rid of all unethical behavior – just yesterday I was told of a patient who had five embryos transferred into her uterus!
But at the very least we need to understand who is guarding the hen house – and what tools do they have to protect the chickens. In the field of reproductive medicine – we still are in a land of voluntary oversight and guidelines. The CDC is under-funded, under staffed – and could be used to do more in regard to putting out education for both patients and providers.
What we need are voices – patient voices – strong patient organizations with leadership that is able to speak out on capitol hill with passion in their hearts - independently from ASRM and SART – and the fertility industry as a whole.
The issues of our community are not so different from any other enmeshed society. We are all lying to close together in bed – we need more space between the organizations – more autonomy – and more funding. Until then – patients are stuck using tools that they don’t completely understand – and that in the end don’t truly serve them. And it is only a matter of time until the next horror story hits the news.
By Dr. David Kreiner
July 13th, 2010 at 12:00 am
What everyone wants to know when they decide to look into invitro ferilization (IVF) as a treatment option is "what is my chance for success?" It’s a complicated question and the answer varies from patient to patient. But let me try to break down a little bit for you.
In 2002 about 28% of cycles in the United States in which women underwent IVF and embryo transfer with their own eggs resulted in the live birth of at least one infant. This rate has been improving slowly but steadily over the years. Patients should be aware, however, that some clinics define "success" as any positive pregnancy test or any pregnancy, even if miscarried or ectopic. These "successes" are irrelevant to patients desiring a baby. To put these figures into perspective, studies have shown that the rate of pregnancy in couples with proven fertility in the past is only about 20% per cycle. Therefore, although a figure of 28% may sound low, it is greater than the chance that a fertile couple will conceive in any given cycle.
Success varies with many factors. The age of the woman is the most important factor, when women are using their own eggs. Success rates decline as women age, and success rates drop off even more dramatically after about age 37. Part of this decline is due to a lower chance of getting pregnant from ART, and part is due to a higher risk of miscarriage with increasing age, especially over age 40. There is, however, no evidence that the risk of birth defects or chromosome abnormalities (such as Down’s syndrome) is any different with ART than with natural conception.
Success rates vary with the number of embryos transferred. However, transferring more embryos at one time not only increases the chance of success with that transfer, but will also increase the risk of a multiple pregnancy, which are much more complicated than a singleton pregnancy. The impact of the number of embryos that are transferred on success rates also varies with the age of the woman.
Pregnancy complications, such as premature birth and low birth weight, tend to be higher with ART pregnancies, primarily because of the much higher rate of multiple pregnancies. Nationally, in 2002-2003 about 30% of ART deliveries were twin deliveries, versus 1-2% of spontaneous pregnancies. The risk of pregnancy containing triplets or more was 6% in 2003.
As women get older, the likelihood of a successful response to ovarian stimulation and progression to egg retrieval decreases. These cycles in older women that have progressed to egg retrieval are also slightly less likely to reach transfer. The percentage of cycles that progress from transfer to pregnancy significantly decreases as women get older. As women get older, cycles that have progressed to pregnancy are less likely to result in a live birth because the risk for miscarriage is greater. This age related decrease in success accelerates after age 35 and even more so after age 40. Overall, 37% of cycles started in 2003 among women younger than 35 resulted in live births. This percentage decreased to 30% among women 35–37 years of age, 20% among women 38–40, 11% among women 41–42, and 4% among women older than 42. The proportion of cycles that resulted in singleton live births is even lower for each age group.
The success rates vary in different programs in part because of quality, skill and experience but also based on the above factors of age, number of embryos transferred and patient population. Patients may also differ by diagnosis and intrinsic fertility which may relate to the number of eggs a patient may be able to stimulate reflected by baseline FSH and antral follicle count as well as the genetics of their gametes. These differences make it impossible to compare programs.
Another factor often overlooked when considering one’s odds of conceiving and having a healthy baby from an IVF procedure is the success with cryopreserved embryos.
Thus, a program which may have a lower success rate with a fresh transfer but much higher success with a frozen embryo transfer will result in a better chance of conceiving with only a single IVF stimulation and retrieval. Success with frozen embryos transferred in a subsequent cycle also allows the program to transfer fewer embryos in the fresh cycle minimizing the risk of a riskier multiple pregnancy. It may be more revealing to examine a program’s success with a combination of the fresh embryo transfer and frozen embryo transfers resulting from a single IVF stimulation and transfer. For example, at East Coast Fertility, the combined number of fresh and frozen embryo transfers that resulted in pregnancies for women under 35.from January 1, 2002 to December 2008 was 396. The number of retrievals during that time was 821. The success rate combining the fresh and frozen pregnancies divided by the number of retrievals was 61%. The high frozen embryo transfer pregnancy rate allowed us to transfer fewer embryos so that there were 0 triplets from fresh transfers during this time.
What can I do to increase my odds?
Patients often ask if there are any additional procedures we can do in the lab that may improve the odds of conception. Assisted hatching is the oldest and most commonly added procedure aimed at improving an embryo’s ability to implant. Embryos must break out or hatch from their shell that has enclosed them since fertilization prior to implanting into the uterine lining. This can be performed mechanically, chemically and most recently by utilizing a laser microscopically aimed at the zona pellucidum, the shell surrounding the embryo. Assisted hatching appears to benefit patients who are older than 38 years of age and those with thick zonae.
Recently a protein additive called “Embryo glue” was shown to improve implantation rates in some patients whose embryos were transferred in media containing “Embryo glue”. Time will tell if the adhesive effect of this supplement is truly increasing success rates and warrants wide scale use in IVF programs.
Embryo co culture is the growth of developing embryos is the same Petri dish as another cell line. Programs utilize either the woman’s endometrial cells obtained from a previous endometrial biopsy or granulosa cells obtained at the time of the egg retrieval from the same follicles aspirated as the eggs. Growth factors produced by these endometrial and granulosa cell lines diffuse to the developing embryo and are thought to aid in the growth and development of the embryo. It appears to help patients who have had previous IVF failures and poor embryo development.
By Pamela Madsen
July 6th, 2010 at 5:56 am
The Fertility Do’s:
1. If You Are Under The Age of of 34 and Not Planning on Getting Pregnant Right Now: Do Get a Fertility Evaluation.
2. If you are sexually active and you are not in a monogamous relationship or only "fluid bonded" to one person – Do use condoms. Sexual Transmitted Diseases (STD’s) is a leading cause of infertility.
3. Do see a Fertility Specialist if you are 35 years old and have been trying for six months or longer. Too many women waste precious years sitting in their gynecologist’s office cycle after cycle.
4. Do make friends with your body. Your relationship to your body does count. Get in touch with yourself. What is your body trying to tell you through physical symptoms? Read "Women’s Bodies, Women’s Wisdom: Creating Physical and Emotional Health and Healing" by Christiane Northrup, MD. Learn about how the effects of nutrition, stress reduction, complimentary medicine, sex and lifestyle can impact on your fertility.
5. If you find yourself going through infertility, Do build yourself a "Fertility Support Team". A Fertility Support team could consist of your everyday friends and family. For some people that is the best – and for others the idea of talking about infertility with close family and friends is really edgy. But there can be lot of components to a "Fertility Support Team". For peer support there are lots of great on line opportunities for connection. Check out Face of Fertility, or Fertility-Ties for a great on line 24/7 community of peer support and professional answers. If you prefer meeting face to face check out the in person support groups that are offered by RESOLVE and The American Fertility Association.
6. Do think about hiring a "Fertility Consultant" if you are able to afford one (and some of them are not too pricey at all). It is wonderful to have your own personal guide through the world of reproductive medicine. Your Fertility Consultant acts as a kind of "Conception Life Coach" You don’t need to live in the same town or even state as your consultant. Most of the work is usually done on the telephone. A short resource list would include - "My Fertility Plan", and "Lotus Blossom Consulting".
7. Do get a second opinion if you are working with a doctor and have not achieved a pregnancy in six months to one year. A great way to get a second opinion is to take advantage of>free consultations. To learn more about free consultations and second opinions read this blog entry.
8. Do read fertility blogs like The Fertility Advocate! There are all kinds of fertility blogs on line and they are wonderful and different. It is a great way to feel like you are not alone – get daily support and information – and learn about the reproductive medicine community. There are doctor blogs, like Dr. Kreiner’s Fertility Doc, reproductive attorney blogs, patient blogs, and "Tell it like I see it blogs"!
Fertility Authority has a great blog community – but there are lots of independent fertility bloggers out there, (I only linked to a few here) with so many unique stories and points of views. Go investigate community sites like Blogher, and Empowher. You will find just what you are looking for…..
9. Do explore the websites of the fertility industry’s professional organizations such as The American Society of Reproductive Medicine and The Association of Reproductive Health Professionals. These professional organization often have good patient information on them – and you can get familiar with fertility practice guidelines there. Also the medical information may be more updated then the fact sheets that are on the patient organization’s websites. I was just checking some of those out – and I was shocked to see some fact sheets that were older than ten years old on some of these sites. Check for dates! Don’t just assume that fact sheets are current just because they are there (uh-oh slipped in here!).
10. Investigate your clinic’s success rates by jacking into The SART Report. And remember when you are reviewing success rates that small differences mean nothing.
By Marna Gatlin
May 13th, 2010 at 5:41 am
I was quoted the other day in the New York Times about my feelings about regulation regarding egg donation. I am not shy about how I feel on the subject. I think less is more where the government is concerned.
The issue being that we are supposed to be a self-regulating community regarding egg donation and Third-Party reproduction and we aren’t. The Nadya Suleman’s of the world have put the “freak show” back into Advanced Reproductive Technology (ART), which frankly irritates me to no end because we as a community have worked so hard to educate the public about ART, and specifically egg donation. Moreover, while we want to put a face on those who create their families via egg donation many of us are afraid to be “outed “because of public reaction to something “different.”
The NYT article as well as the ABC News Article focused on the cost of eggs and those agencies who don’t abide by ASRM guidelines because after all they are just guidelines. ABC also focused on donor compensation, and what characteristics recipients felt were important in making their donor selection.
This got me to thinking about egg donation as a whole. How I get from point “A” to point “B” meaning how I made my own donor choices and my journey along the way. For me when I received my diagnosis that to create my family and become a mother I would need to rely on an egg donor I was initially relieved. Finally, a doctor could name what was wrong with me instead shrugging and saying “I don’t know.”
After 16 years of failure I was sick of “I don’t know.”
Then I began to ruminate – about my future child, about the fact I would not be seeing myself in the eyes of my child, or for that matter having a child that would have no genetic connection to me or my side of the family. I won’t fool you – that was a tough pill to swallow. Nevertheless, I swallowed it. I gnashed my teeth in the beginning because I didn’t know any better. I cried bitterly and shook my fist at my creator. “Nine times I lost babies and now you are telling me I can have a child maybe but I have to give up my genetics? Have you lost your mind!?”
So what did I do? I took the blue pill and jumped through the looking glass with both feet. I have never looked back. I have only gone forward. For instance, I decided I hated the fact that I am a shrimp. Being short has been the bane of my existence. I feel strongly that tall people have it easier in life. Therefore, I decided I wanted a tall donor – an Amazon if I could find one. A tall donor coupled with my husband’s 6’3 stature would create a very tall child. I have some cardiac issues on my side of the family as well as Diabetes. I wanted to make sure my egg donor had a clean health history. I also was sick of my stick straight dark hair that never did anything. I have paid a lot of money over the years to have curly hair – so I selected an egg donor with thick curly hair. Is that being vain? Probably. However, my mindset was if I have to trade in my own genetics I might as well find someone not only had the characteristics I found appealing, but also someone that I could connect with, and fit into our family.
Was I scared? You bet I was. The insecurity I felt was overwhelming. However, I realized through the process it wasn’t just about losing my genetic link it was about finally becoming a mom. 1. Would I be a good mother? 2. Would I be as good of a mother as my own mother who inspires me every day? 3. Would I screw up my kid? 4. Would I be able to love this child even though this child and I shared no DNA?
Finally, when I was able to answer those questions:
2. Yes, my own mom taught me the most important thing about being a parent was to love your children unconditionally and to accept your children period – warts and all.
3. Yes, not only would I screw up my kid, I was going to do it on a regular basis. I was going to do it so much that I decided I would provide my kid with a “therapy bucket”. Every time I screwed him up, I’d give him a buck to toss in the therapy bucket to pay for the therapy he’d need later in his life.
4. Yes! Yes! Yes! I have to say this was probably the easiest part for me – was to love him unconditionally. And this is coming from someone who started out in a rocky place. I didn’t feel worthy of this piece of perfection, and when I finally got it together and came to realize I was deserving of this being who loved me unconditionally my shields and defenses came down I began to love and haven’t stopped since.
When I hear the media use the term designer babies, or read the snarky comments from those who do not agree with how intended parents select their egg donors I am left with the question – “How did you go about selecting your mate or life partner?” There were certainly characteristics you found attractive or appealing were there not? It is the same for us – except we do not get to use our own genetics to have our children we rely on a third party for that purpose – and with that being said, I see no reason for us not to be able to be comfortable with our egg donor selection.
So let us fast forward to 2010 – almost 10 years have passed since the birth of my son. The whole egg donor – selection process is hazy. In fact, even though I am the founder of PVED I often forget about the donor aspect because he is simply my son. He is an amazing, beautiful, well-adjusted, blue eyed, very tall nine year old who could care less about the manner in which he was conceived. Moreover, we don’t care how he was conceived. We are just glad he is here, that he is part of our family, and I am thankful every day for the privilege to love him.
I am not sure even why I feel the need to defend my choices. In the end, what others think is not important. I am my son’s mom they aren’t.