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Archive for the ‘Cryopreservation’ tag

The ABCs of IVF

By David Kreiner MD

May 9th, 2014 at 9:15 am

 

credit: digitalart/freedigitalphotos.net

If you’re not pregnant yet and you’re wondering what to do, this post may shed some light on infertility diagnoses and treatments. Yes, there’s a lot to learn. Yes, it can be overwhelming. But the good news is that you can go to the head of the class by the time you finish reading this post.

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

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

I hear these questions daily and understand the frustrations, anger and stress felt by my patients expressing these feelings through such questions. There are many reasons why couples do not conceive. An infertility workup will identify some of these. A semen analysis will pick up a male factor in 50-60% of cases. A hysterosalpingogram will locate tubal disease in about 20% of cases. Another 20-30% of women do not ovulate or ovulate dysfunctionally. A post coital test may identify that the problem is that the sperm is not reaching the egg. It may not be able to swim up the cervical canal into the womb and up the tubes where it should normally find an egg to fertilize. When these tests are normal a laparoscopy may be performed to identify the 20-25% of infertile women with endometriosis. However, even when this is normal and there is no test that logically explains the lack of success in achieving a pregnancy; an IVF procedure may both identify the cause and treat it successfully.

What is IVF?

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

What is ICSI?

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

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

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

Old eggs?

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

ABC’s of IVF

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

Blastocyt embryo transfers occur on day 5 or 6 after the egg retrieval. This is the embryonic stage when an embryo normally implants into the womb. These embryos have been selected to be healthier by virtue of the fact that they have made it to this stage. Statistically, the pregnancy rates for women who have had blastocysts transferred is higher than when the same number is transferred on day 3 using “cleaved” embryos of 4-10 cells. As the advantage of the blastocyst transfer may be only a matter of selection, it is thought that there may be no advantage if the embryologist is able to select just as well the best embryos to transfer on day 3 which is typically the case when there are not excess numbers of high quality embryos which will vary according to the patient and be dependent on the age of the patient.

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

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

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

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

Cryopreservation or freezing can be performed on individual eggs where it may serve as a way to preserve a woman’s fertility either due to aging or in preparation for surgery, chemotherapy or radiation which may affect future access to a woman’s eggs.  It may be performed on cleaved embryos or blastocyst embryos that are already fertilized either because they are in excess of the desired number of embryos to be transferred fresh or to bank for a future PGS/PGD or to improve implantation by delaying transfer to a subsequent unstimulated cycle.

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

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

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

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

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

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

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

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

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

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

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

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

Morula is the stage between the cleavage stage embryo and blastocyst. It is when the embryo is a ball of cells and is usually achieved by the 4th day after insemination.

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

PGD/PGS is preembryo genetic diagnosis and screening.  PGD refers to diagnosing the presence of a single gene disorder in the embryo.  Typically, patients with a prior history of producing a child with this disorder or where both partners are known carriers for a genetic disease are candidates for PGD.  Alternatively, patients could make the diagnosis in pregnancy by chorionic villus sampling or amnioscentesis.  PGS is screening for chromosomal abnormalities and has been used to improve success after embryo banking, to prevent chromosomally caused recurrent miscarriages, to improve success with older patients’ IVF cycles and for family balancing/gender selection.  Embryos are biopsied 3 days after retrieval in the cleaved state or 5 or 6 days after retrieval in the blastocyst state. 

Progesterone is an ovarian hormone that prepares the lining of the womb for implantation. We measure it during stimulation to check if the lining is getting prematurely stimulated. We add it to the woman after the retrieval to better prepare the lining and continue it as needed to help sustain the implanted embryo until the placenta takes over production of its own progesterone.  It may be administered as an intramuscular injection in which it is placed in various oil media to facilitate absorption.  It may also be administered as vaginal suppositories or tablets either as compounded micronized progesterone or in the commercially prepared brands; Endometrin and Crinone.

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Infertility Podcast Series: Journey to the Crib: Chapter 22: Cryopreservation of Embryos

By David Kreiner MD

July 8th, 2013 at 8:58 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-Two: Cryopreservation of Embryos. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=119

Cryopreservation of Embryos

In 1985, my mentors, Drs. Howard W. Jones Jr and his wife Georgeanna Seegar Jones, the two pioneers of In Vitro Fertilization (IVF) in the Western Hemisphere, proposed the potential benefits of cryopreserving embryos for future transfers.  They predicted that doing so would increase the overall success rate of IVF and make the procedure safer, more efficient and cost effective. 

 

One fresh IVF cycle might yield enough embryos so that in addition to performing a fresh embryo transfer in the same cycle as the stimulation and retrieval that additional embryos may be preserved for use in future cycles.  This helps to limit the exposure to certain risks confronted in a fresh cycle such as the use of injectable stimulation hormones, the egg retrieval and general anesthesia.  It also allows patients to minimize their risk for a multiple pregnancy since embryos can be divided for multiple transfers.

 

At Long Island IVF, we are realizing the Jones’ dream of safer, more efficient and cost- effective IVF, as well as increasing the overall success of IVF. 

 

Today, an estimated 25% of all assisted reproductive technology babies worldwide are now born after freezing.  Studies performed in Sweden revealed that babies born after being frozen had at least as good obstetric outcome and malformation rates as with fresh IVF.  Slow freezing of embryos has been utilized for 25 years and data concerning infant outcome appear reassuring relative to fresh IVF. 

 

I personally have pushed to promote the concept of removing the financial pressure to put all your eggs in one basket by eliminating the cost of cryopreservation and storage for those patients transferring a single embryo.  Furthermore, such a patient may go through three frozen embryo transfers to conceive for the price of one at our program.  We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

 

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Was this helpful in answering your questions about cryopreservation of embryos?

Please share your thoughts about this podcast here. And ask any questions, whih Dr. Kreiner will answer.

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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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Please share your thoughts about this podcast or ask any questions of Dr. Kreiner here.

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Cryopreservation: A Look into the IVF Freezer

By Tracey Minella and David Kreiner MD

May 22nd, 2012 at 5:00 pm

 

Remember the Good Humor man? You’d hear that sound from blocks away and bolt out the door barefoot, shrieking “STAAAPPP!” arms flailing, and being joined by the rest of the block like rats to the Pied Piper.

Remember the way the white square door with the chunky silver hinge on the back swung open and all that cold, smoky fog billowed out into the humid air?

Remember the frozen magic inside?

Well, Long Island IVF has a magic freezer, too. Full of dreams. Full of potential. Full of embryos that may one day turn out to be sweaty maniacs running after the ice cream man.

 In fact, Long Island IVF’s freezer once held the frozen embryo that turned out to be Long Island’s very first cryo baby! Let’s revisit an earlier post by Dr. Kreiner which lets us take a peek inside the freezer of Long Island’s first successful cryopreservation program:

In 1985, my mentors, Drs. Howard W. Jones Jr. and his wife Georgeanna Seegar Jones, the two pioneers of in-vitro fertilization in the USA and the entire western hemisphere, proposed the potential benefits of cryopreserving or freezing embryos following an IVF cycle. They predicted that cryopreserving embryos for future transfers would increase the overall success rate of IVF and make the procedure more efficient and cost effective. They also suggested that it would reduce the overall risks of IVF. For example, one fresh IVF cycle might yield many embryos which can be used in future frozen embryo transfer cycles, if necessary. This helps to limit the exposure to certain risks confronted only in a fresh IVF cycle such as the use of injectable stimulation hormones, the egg retrieval operation, and general anesthesia.

At East Coast Fertility [now merged with Long Island IVF], we are realizing the Joneses’ dream of safer, more efficient and cost effective IVF. By utilizing the ability to cryopreserve embryos in 2007, 61.5% (118/192) of patients under 35 were successful in having a live birth as a result of only one egg stimulation and retrieval cycle! In addition, because of our outstanding Embryology Laboratory, we are usually able to transfer as few as 1 or 2 high quality embryos per cycle and avoid risky triplet pregnancies. In fact, since 2002, the only triplet pregnancies we have experienced have resulted from the successful implantation of two embryos, one of which goes on to split into identical twins (this is rare!). By cryopreserving embryos in certain high-risk circumstances, we are able to vastly reduce the risk of ovarian hyperstimulation syndrome requiring hospitalization. At Long Island IVF, the safety of our patients comes first. Fortunately, our success with frozen embryo transfers is equivalent to that of fresh embryo transfers, so that pregnancy rates are not compromised in the name of safety, nor are the babies.

As recently reported in the Daily Science: “The results are good news as an increasing number of children, estimated to be 25% of assisted reproductive technology (ART) babies worldwide, are now born after freezing or vitrification” (a process similar to freezing that prevents the formation of ice crystals).

The study, led by Dr Ulla-Britt Wennerholm, an obstetrician at the Institute for Clinical Sciences,SahlgrenskaAcademy(Goteborg,Sweden), reviewed the evidence from 21 controlled studies that reported on prenatal or child outcomes after freezing or vitrification.

She found that embryos that had been frozen shortly after they started to divide (early stage cleavage embryos) had a better, or at least as good, obstetric outcome (measured as preterm birth and low birth weight) as children born from fresh cycles of IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection). There were comparable malformation rates between the fresh and frozen cycles. There were limited data available for freezing of blastocysts (embryos that have developed for about five days) and for vitrification of early cleavage stage embryos, blastocysts and eggs.

Slow freezing of embryos has been used for 25 years and data concerning infant outcome seems reassuring with even higher birthweights and lower rates of preterm and low birthweights than children born after fresh IVF/ICSI. For the newly introduced technique of vitrification of blastocysts and oocytes, very limited data have been reported on obstetric and neonatal outcomes. This emphasises the urgent need for properly controlled follow-up studies of neonatal outcomes and a careful assessment of evidence currently available before these techniques are added to daily routines. In addition, long-term follow-up studies are needed for all cryopreservation techniques,’ concluded Dr Wennerholm.

The use of frozen embryos has become a common standard of care in most IVF Programs. At Long Island IVF, we are able to keep multiple pregnancy rates down – by only transferring one or two embryos at a time – while allowing patients to hold on to the additional embryos that they may have created during the fresh cycle. It is like creating an insurance plan for patients. We developed a unique financial incentive program using the technology of cryopreservation to encourage patients to transfer only one healthy embryo at a time.

In order to ensure the best outcome for mother and child – these special pricing plans take the burden off the patient to pay for the additional transfers and the cryopreservation process. We have eliminated the cost of cryopreservation, storage and embryo transfer for patients in the single embryo transfer program. Thus, patients no longer have that financial pressure to put all their eggs in one basket! We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

* * * * * * * * * * * * * *

Did you know before today that Long Island IVF is the home of Long Island’s first cryo baby? Or that Dr. Kreiner and Dr. Kenigsberg co-founded Long Island IVF  way back in 1988–back when most of you reading this were very little kids or teens?

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Can Twins Be Born Years Apart?

By Tracey Minella

January 19th, 2012 at 2:14 pm


Unless you’re the Octomom, chances are that if you’ve done IVF, you may have frozen…or cryopreserved… a number of embryos above and beyond the number you elected to transfer back on your fresh IVF cycle. If you were lucky enough to have an excess, that is. (Alas, my first few IVFs back in the dark ages, never produced enough for cryo. But later cycles did.)

So, let’s assume you had a baby from that fresh cycle. You breathe a sigh of relief at your motherhood dream coming true and proceed to enjoy a few years of normalcy with your little miracle. So you’re out there doing the play date thing, having great birthday parties, doing Disney. Not to mention suffering–happily–  through Yo Gabba Gabba  as you catch yourself singing things like “Don’t bite your friends”…

All the while in the back of your brain there’s some security  knowing you’ve got “potential” children…literally frozen in time from when your eggs were younger than they are today. No guarantee, but some level of security nonetheless. They do cross your mind at times.

So the time comes to revisit the clinic with the hope of a successful cryo transfer. Imagine it works again.

The question: Are your two children “twins”?

Well, they were conceived at the same time, as fraternal twins would be. But one has been out living its life for a few years. A big head start. The other was tossed in the freezer. (Oh, I’m just kidding…) But the reality is that one… merely through the judgment call of an embryologist … was ever so carefully placed in a frozen state of existence. It’s potential for life on hold. For years.

So are they “twins”?

Is it defined at conception? Is it occupying the same uterus at the same time?

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What do you think?

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Cryopreservation: A Look into the IVF Freezer

By Tracey Minella and David Kreiner MD

December 13th, 2011 at 2:41 pm

Remember the Good Humor man? You’d hear that sound from blocks away and bolt out the door barefoot, shrieking “STAAAPPP!” arms flailing, and being joined by the rest of the block like rats to the Pied Piper.

Remember the way the white square door with the chunky silver hinge on the back swung open and all that cold, smoky fog billowed out into the humid air?

Remember the frozen magic inside?

Well, Long Island IVF and East Coast Fertility have magic freezers, too. Full of dreams. Full of potential. Full of embryos that may one day turn out to be rugrats running after the ice cream man.

In fact, Long Island IVF’s freezer once held the frozen embryo that turned out to be Long Island’s first cryo baby! Let’s revisit an earlier post by Dr. Kreiner which lets us take a peek inside the freezer of Long Island’s first successful cryopreservation program:

In 1985, my mentors, Drs. Howard W. Jones Jr. and his wife Georgeanna Seegar Jones, the two pioneers of in-vitro fertilization in the USA and the entire western hemisphere, proposed the potential benefits of cryopreserving or freezing embryos following an IVF cycle. They predicted that cryopreserving embryos for future transfers would increase the overall success rate of IVF and make the procedure more efficient and cost effective. They also suggested that it would reduce the overall risks of IVF. For example, one fresh IVF cycle might yield many embryos which can be used in future frozen embryo transfer cycles, if necessary. This helps to limit the exposure to certain risks confronted only in a fresh IVF cycle such as the use of injectable stimulation hormones, the egg retrieval operation, and general anesthesia.

At East Coast Fertility, we are realizing the Jones’ dream of safer, more efficient and cost effective IVF. By utilizing the ability to cryopreserve embryos in 2007, 61.5% (118/192) of patients under 35 were successful in having a live birth as a result of only one egg stimulation and retrieval cycle! In addition, because of our outstanding Embryology Laboratory, we are usually able to transfer as few as 1 or 2 high quality embryos per cycle and avoid risky triplet pregnancies. In fact, since 2002, the only triplet pregnancies we have experienced have resulted from the successful implantation of two embryos, one of which goes on to split into identical twins (this is rare!). By cryopreserving embryos in certain high-risk circumstances, we are able to vastly reduce the risk of ovarian hyperstimulation syndrome requiring hospitalization. At East Coast Fertility, safety of our patients comes first. Fortunately, our success with frozen embryo transfers is equivalent to that of fresh embryo transfers, so that pregnancy rates are not compromised in the name of safety, nor are the babies.

Today, as reported in the Daily Science: “The results are good news as an increasing number of children, estimated to be 25% of assisted reproductive technology (ART) babies worldwide, are now born after freezing or vitrification” (a process similar to freezing that prevents the formation of ice crystals).

The study, led by Dr Ulla-Britt Wennerholm, an obstetrician at the Institute for Clinical Sciences, Sahlgrenska Academy (Goteborg, Sweden), reviewed the evidence from 21 controlled studies that reported on prenatal or child outcomes after freezing or vitrification.

She found that embryos that had been frozen shortly after they started to divide (early stage cleavage embryos) had a better, or at least as good, obstetric outcome (measured as preterm birth and low birth weight) as children born from fresh cycles of IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection). There were comparable malformation rates between the fresh and frozen cycles. There were limited data available for freezing of blastocysts (embryos that have developed for about five days) and for vitrification of early cleavage stage embryos, blastocysts and eggs.

Slow freezing of embryos has been used for 25 years and data concerning infant outcome seems reassuring with even higher birthweights and lower rates of preterm and low birthweights than children born after fresh IVF/ICSI. For the newly introduced technique of vitrification of blastocysts and oocytes, very limited data have been reported on obstetric and neonatal outcomes. This emphasises the urgent need for properly controlled follow-up studies of neonatal outcomes and a careful assessment of evidence currently available before these techniques are added to daily routines. In addition, long-term follow-up studies are needed for all cryopreservation techniques,’ concluded Dr Wennerholm.

The use of frozen embryos has become a common standard of care in most IVF Programs. At East Coast Fertility, [now merging with Long Island IVF], we are able to keep multiple pregnancy rates down – by only transferring one or two embryos at a time – while allowing patients to hold on to the additional embryos that they may have created during the fresh cycle. It is like creating an insurance plan for patients. We developed a unique financial incentive program using the technology of cryopreservation to encourage patients to transfer only one healthy embryo at a time.

In order to ensure the best outcome for mother and child – these special pricing plans take the burden off the patient to pay for the additional transfers and the cryopreservation process. We have eliminated the cost of cryopreservation, storage and embryo transfer for patients in the single embryo transfer program. Thus, patients no longer have that financial pressure to put all their eggs in one basket! We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

* * * * * * * * * * * * * *

Did you know before today that Long Island IVF is the home of Long Island’s first cryo baby?

Or that East Coast Fertility’s Director, Dr. Kreiner, and Long Island IVF’s Co-Directors, Drs. Kenigsberg and Brenner were running the show together at Long Island IVF way back then when cryo first came to Long Island…back when most of you reading this were very little kids?

Stay tuned as we bring you more interesting history about these IVF pioneers now that they’re all together again.

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What is an Embryo Transfer? Five Things to Know

By Tracey Minella and David Kreiner MD

April 14th, 2011 at 12:00 am


One is the loneliest number. Eight makes you an Octomom. But there’s more to Embryo Transfers than just those extremes.

And the standards regarding how many embryos to transfer back to a woman’s uterus have changed as the assisted reproductive technology improves and IVF success rates continue to rise.

Two decades ago, it was standard to transfer up to four embryos per fresh IVF cycle. Even more if you were older or had prior failed IVF cycles. Today, cutting edge clinics like East Coast Fertility have success rates so high that Single Embryo Transfers (SETs) are often highly encouraged. And transferring more than two embryos is generally discouraged in most cases.

So, nowadays, one is no longer the loneliest number…it’s often the luckiest number!

Below, Dr. Kreiner of East Coast Fertility shares five facts about embryo transfers that curious patients need to know:

  • After a few days of development, the best appearing embryos are selected for transfer
  • The number chosen influences the pregnancy rate and the multiple pregnancy rate
  • A woman’s age and the appearance of the developing embryo have the greatest influences on pregnancy outcome
  • Embryos are placed in the uterine cavity with a thin tube
  • Excess embryos of sufficient quality that are not transferred can be frozen

After a few days of development, one or more embryos are selected for transfer to the uterine cavity.  Embryos are placed in the uterine cavity with a thin tube (catheter).  Ultrasound guidance may be used to help guide the catheter or confirm placement through the cervix and into the uterine cavity. Although the possibility of a complication from the embryo transfer is very rare, risks include infection and loss of, or damage to the embryos. 

The number of embryos transferred influences the pregnancy rate and the multiple pregnancy rate. The age of the woman and the appearance of the developing embryo have the greatest influence on pregnancy outcome and the chance for multiple pregnancy.  While it is possible, it is unusual to develop more fetuses than the number of embryos transferred. It is critical to discuss with your doctor the number to be transferred before the transfer is done.

In an effort to help curtail the problem of multiple pregnancies (see multiple pregnancies), national guidelines published in 2006 recommend limits on the number of embryos to transfer (see Tables below). These limits should not be viewed as a recommendation on the number of embryos to transfer. These limits differ depending on the developmental stage of the embryos and the quality of the embryos and take into account the patient’s personal history.  

Recommended limits on number of 2-3 day old embryos to transfer

Embryos

age <35

age 35-37

age 38-40

age >40

favorable

1 or 2

2

3

5

unfavorable

2

3

4

5

Recommended limits on number of 5-6 day old embryos to transfer

Embryo Prognosis

age <35

age 35-37

age 38-40

age >40

favorable

1

2

2

3

unfavorable

2

2

3

3

In some cases, there will be additional embryos remaining in the lab after the transfer is completed.  Depending on their pregnancy potential, it may be possible to freeze them for possible use in a subsequent cycle. 

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Cryopreservation: Peeking in the IVF Freezer

By Tracey Minella and David Kreiner MD

April 8th, 2011 at 12:00 am

Remember the Good Humor man? You’d hear that sound from blocks away and bolt out the door barefoot, shrieking “STAAAPPP!”, arms flailing like you were trying to get the bathroom pass from the teacher, and being joined by the rest of the block like rats to the Pied Piper. Remember the way the white square door with the chunky silver hinge on the back swung open and all that cold, smoky fog billowed out into the humid air?

Remember the frozen magic inside?

Well, East Coast Fertility has a magic freezer, too. Full of dreams. Full of potential. Full of embryos that may one day turn out to be rugrats running after the ice cream man. Below, Dr. Kreiner lets us take a peek inside ECF’s cryopreservation program:

In 1985, my mentors, Drs. Howard W. Jones Jr. and his wife Georgeanna Seegar Jones, the two pioneers of in-vitro fertilization in the USA and the entire western hemisphere, proposed the potential benefits of cryopreserving or freezing embryos following an IVF cycle. They predicted that cryopreserving embryos for future transfers would increase the overall success rate of IVF and make the procedure more efficient and cost effective. They also suggested that it would reduce the overall risks of IVF. For example, one fresh IVF cycle might yield many embryos which can be used in future frozen embryo transfer cycles, if necessary. This helps to limit the exposure to certain risks confronted only in a fresh IVF cycle such as the use of injectable stimulation hormones, the egg retrieval operation, and general anesthesia.

At East Coast Fertility, we are realizing the Jones’ dream of safer, more efficient and cost effective IVF. By utilizing the ability to cryopreserve embryos in 2007, 61.5% (118/192) of patients under 35 were successful in having a live birth as a result of only one egg stimulation and retrieval cycle! In addition, because of our outstanding Embryology Laboratory, we are usually able to transfer as few as 1 or 2 high quality embryos per cycle and avoid risky triplet pregnancies. In fact, since 2002, the only triplet pregnancies we have experienced have resulted from the successful implantation of two embryos, one of which goes on to split into identical twins (this is rare!). By cryopreserving embryos in certain high-risk circumstances, we are able to vastly reduce the risk of ovarian hyperstimulation syndrome requiring hospitalization. At East Coast Fertility, safety of our patients comes first. Fortunately, our success with frozen embryo transfers is equivalent to that of fresh embryo transfers, so that pregnancy rates are not compromised in the name of safety, nor are the babies.

Today, as reported in the Daily Science: “The results are good news as an increasing number of children, estimated to be 25% of assisted reproductive technology (ART) babies worldwide, are now born after freezing or vitrification” (a process similar to freezing that prevents the formation of ice crystals).

The study, led by Dr Ulla-Britt Wennerholm, an obstetrician at the Institute for Clinical Sciences, Sahlgrenska Academy (Goteborg, Sweden), reviewed the evidence from 21 controlled studies that reported on prenatal or child outcomes after freezing or vitrification.

She found that embryos that had been frozen shortly after they started to divide (early stage cleavage embryos) had a better, or at least as good, obstetric outcome (measured as preterm birth and low birth weight) as children born from fresh cycles of IVF (in vitro fertilization) or ICSI (intracytoplasmic sperm injection). There were comparable malformation rates between the fresh and frozen cycles. There were limited data available for freezing of blastocysts (embryos that have developed for about five days) and for vitrification of early cleavage stage embryos, blastocysts and eggs.

‘Slow freezing of embryos has been used for 25 years and data concerning infant outcome seem reassuring with even higher birthweights and lower rates of preterm and low birthweights than children born after fresh IVF/ICSI. For the newly introduced technique of vitrification of blastocysts and oocytes, very limited data have been reported on obstetric and neonatal outcomes. This emphasises the urgent need for properly controlled follow-up studies of neonatal outcomes and a careful assessment of evidence currently available before these techniques are added to daily routines. In addition, long-term follow-up studies are needed for all cryopreservation techniques,’ concluded Dr Wennerholm.

The use of frozen embryos has become a common standard of care in most IVF Programs. At East Coast Fertility we are able to keep multiple pregnancy rates down – by only transferring one or two embryos at a time – while allowing patients to hold on to the additional embryos that they may have created during the fresh cycle. It is like creating an insurance plan for patients. We developed a unique financial incentive program using the technology of cryopreservation to encourage patients to transfer only one healthy embryo at a time. In order to ensure the best outcome for mother and child – these special pricing plans take the burden off the patient to pay for the additional transfers and the cryopreservation process. We have eliminated the cost of cryopreservation, storage and embryo transfer for patients in the single embryo transfer program. Thus, patients no longer have that financial pressure to put all their eggs in one basket! We truly believe we are practicing the most successful, safe and cost effective IVF utilizing cryopreservation.

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