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Archive for the ‘co-culture of embryos’ tag

Infertility Podcast Series: Journey to the Crib: Chapter 20: Co-Culture of Embryos

By David Kreiner, MD

June 24th, 2013 at 9:34 pm

 

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 3: What Are My Odds?

By David Kreiner MD

February 26th, 2013 at 4:59 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Three: What Are My Odds? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=24

 

What are my odds?

 

This chapter is dedicated to informing patients regarding the potential for success with fertility therapy.  Success, in particular with IVF has been increasing significantly over the years as physicians and embryologists became more experienced.   The tools we use are more accurate and effective today and the protocols, media and laboratory conditions are all far superior to that which was standard not so many years ago.

 

This improved efficiency of the process has allowed physicians to transfer fewer embryos thereby avoiding the higher risk multiple pregnancies that IVF was known for in the 1990’s.  Still pressure exists to transfer multiple embryos to minimize expenses for the patient and maximize success rates for the IVF programs.  I have instituted a single embryo transfer incentive (SET) program at Long Island IVF eliminating the cost of cryopreservation and storage for a year for patients transferring a single embryo.  These patients are also offered three frozen embryo transfers within a year of their retrieval for the cost of one in an effort to eliminate the financial motivation some patients express to put “all their eggs in one basket”.  Experience tells us that the take home baby rate for patients transferring a single embryo at the fresh transfer is equal to that for patients transferring multiple embryos when including the frozen embryo transfers. For information on the SET program, go to: http://bit.ly/WpzCvv

 

Since the merger of East Coast Fertility and Long Island IVF, we have seen clinical IVF pregnancy rates at 66% (35/53) for women <35, 60% (18/30) for women 35-37, 54.1% (20/37) for women 38-40 and 8/28 (28.6%) for women 41-42 from Oct 1- Dec 31, 2011.  MicroIVF has been running better than 40% for women <35.

 

Different factors are discussed that can affect pregnancy rates at different programs.  The use of Embryo Glue and co-culture at Long Island IVF are discussed as laboratory adjunctive treatments that appear to improve our success rates.

 

For the most recent success rates, speak to your Long Island IVF physician or visit our website at http://bit.ly/XYZrSC

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TTC? Try Separating and Washing Your Sheets

By Tracey Minella and David Kreiner MD

March 18th, 2011 at 12:00 am

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

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

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

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

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

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

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

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

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

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

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

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

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

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Finding the Best Fertility Clinic

By Tracey Minella

March 11th, 2011 at 12:15 am


Your mission…if you choose to accept it…is to locate the best infertility specialist. And since you really have no choice but to accept this unfair and lousy assignment, you’d better narrow down the suspects.

First, you need the right mindset. Do not assume that just any reproductive endocrinologist will get you pregnant. If you do that, and choose poorly, you may waste all your money and precious time before you realize your mistake…and it may cost you your dream of having a baby.

The field of assisted reproductive technology is ever-changing and growing, not unlike web technology and social media. Many patients use search engines to find a doctor. That may be fine as a starting point, but a far better indicator would be recommendations from a patient or staff member of a practice, or from your gynecologist. Sometimes crappy doctors have flashy websites.

Check out the doctor’s credentials and ask some questions. If that makes you nervous, write them down in advance. How long has he been practicing? Is he a member of the premier organization for reproductive endocrinologists: SART (Society for Assisted Reproductive Technology) and thereby held to the highest standards and guidelines? Is the chemistry right between you? Meet the nurses. Talk to or eavesdrop on patients in the waiting room. Is the atmosphere generally positive?

What are the success rates for IVF and how have they been calculated? You may find that a clinic’s rates are slightly lower than another’s due to their practice recommending  single embryo transfers to reduce the risk of complicated multiple births, or because, even though it will potentially lower their practice’s overall success rates, they accept a larger number of older or obese patients rather than turn them away. Get the whole story behind the stats.

Do they offer refunds or guarantees, or grant programs to subsidize or offset costs? Do they participate in your insurance plan if you do have such coverage and do they have staff that will handle your insurance claims and grant applications and any other similar frustrating paperwork for you?

Are they up on the latest, cutting edge treatments and protocols? As of today, if they don’t offer services such as co-culture of embryos, or embryo glue, then they are lagging behind. [Run away as fast as you can! I repeat. Run!] Do they have a donor egg and sperm program? A micro-IVF program? A Single Embryo Transfer (SET) program? Do they have an andrology lab on site for the processing and testing of semen samples? Do they have an on site OR for IVF procedures or must you go to a local hospital? Are they welcoming to same sex couples or single patients?

Are they open minded and willing to treat the whole individual? Do they offer less traditional adjunct therapies such as acupuncture, herbal medicine, body and mind/reiki/yoga/massage to complement the Western medicine approach to treating infertility? Are there counseling and stress reduction services? Are there blogs and forums to offer you additional information and support?

Does the practice have a variety of doctors and nurses available to meet your needs? Men and women? Different religions and ethic backgrounds? Do they speak your language? Do they have convenient business hours and office locations? Do they have a nurse on call 24/7?

Whether you are looking for a fertility specialist now… or you chose the wrong practice initially and want to change… please use these questions as your guide to choosing the best practice for your fertility needs.

And listen to your gut. If it doesn’t feel right, it isn’t. Move on. Your dream is at stake.

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If you already have a fertility specialist, how did you find him/her? If you don’t have one yet, what are the three most important factors you’d consider when choosing one?

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