Dr. Werlin's Fertility World

Happy (early) Mother’s Day! Today I was thinking about this special holiday, and I wanted to share a few fun Mother’s Day facts I uncovered:

· Did you know the first Mother’s Day was celebrated in 1907 and was established by Anna Marie Jarvis? Jarvis devoted her life to establishing Mother's Day as a national after her mother’s death in 1905.

· Did you know that Mother’s Day holidays are also observed in several other countries? "Mothering Sunday" is celebrated in the UK and Ireland on the fourth Sunday of Lent.

· Did you know in China most names begin with a character signifying mother which honors the maternal heritage? Every day is a day to celebrate your mother!

I would like to also extend my gratitude to mothers nationwide – especially those whom I have had the pleasure of working with. You all encompass a loving and caring nature. This holiday reminds my team and me of why we are in the business we love – to help others achieve the gift of motherhood.

Recently I received a wonderful email from former patient, Kasey Russell. She wanted to share her thanks to the team at Coastal Fertility. Kasey first came to me in 2002 and since then I have helped her family to grow – she is currently pregnant with her third child. It is always a pleasure to hear from my patients and I wanted to share what she wrote. I encourage any other former/current Coastal Fertility patients to comment or send me an email.

After a year of trying on my own I had a tube removed and was told to seek fertility treatments. I went to Dr. Werlin for help. I have been a patient of Dr. Werlin's twice. The first time was in 2002 and I became pregnant on our first round and gave birth to a beautiful healthy little girl, the second time was in 2005 and again gave birth to a beautiful healthy little girl in 2006. Since then we have had a tubal pregnancy in September of 2007 which Dr. Werlin was there for me. Low and behold, with only one tub and not a very good one at that I came up pregnant again in March (this year). My husband and I were nervous to get excited at first knowing my history, but I am now 11 weeks pregnant with baby #3 and everything looks good. Dr. Werlin is the best and I miss his special care that I received during my first two pregnancies. I definitely have two miracle babies, and now one on the way.

Never give up hope! Thanks Werl!!!

I recently attended the Pacific Coast Reproductive Society's (PCRS) annual conference in Palm Springs, Calif. There were two discussions that peaked my interest, both of which I would like to share with my readers.

First, it appears that acupuncture does play a role in improving In Vitro success. Over the years there have been studies exploring the connection between acupuncture and fertility, of which I have found very insightful. Stronger data now suggests that acupuncture has been beneficial in improving fertility. In my practice, when called for, we currently utilize acupuncturists in association with fertility treatments.

Secondly, on the PGD front, it appears that the technology is advancing to a point where we may be able to, in the near future, look at all 23(24) chromosomes in a single cell. As you know, the present technology for PGD allows us to safely look 12 chromosomes. However, these 12 chromosomes, either individually or in some combination, do make up 85% of all the chromosomal abnormalities that occur. If the technology allows us to evaluate 23(24) chromosomes, this technique will be even more beneficial.

All in all, it was a very successful meeting.

Newsweek just released an in-depth article about surrogates. The story follows several women who have helped other couples begin their own families. I wanted to share this with my readers, as the surrogates use IVF treatments in order to conceive.

Surrogacy is just another way fertility and IVF treatments can help families begin! Please enjoy.

The Curious Lives of Surrogates
Thousands of largely invisible American women have given birth to other people's babies. Many are married to men in the military.

Lorraine Ali and Raina Kelley

NEWSWEEK
Updated: 2:55 PM ET Mar 29, 2008

Jennifer Cantor, a 34-year-old surgical nurse from Huntsville, Ala., loves being pregnant. Not having children, necessarily—she has one, an 8-year-old daughter named Dahlia, and has no plans for another—but just the experience of growing a human being beneath her heart. She was fascinated with the idea of it when she was a child, spending an entire two-week vacation, at the age of 11, with a pillow stuffed under her shirt. She's built perfectly for it: six feet tall, fit and slender but broad-hipped. Which is why she found herself two weeks ago in a birthing room in a hospital in Huntsville, swollen with two six-pound boys she had been carrying for eight months. Also in the room was Kerry Smith and his wife, Lisa, running her hands over the little lumps beneath the taut skin of Cantor's belly. "That's an elbow," said Cantor, who knew how the babies were lying in her womb. "Here's a foot." Lisa smiled proudly at her husband. She is, after all, the twins' mother.

It is an act of love, but also a financial transaction, that brings people together like this. For Kerry and for Lisa—who had a hysterectomy at the age of 20 and could never bear her own children—the benefits are obvious: Ethan and Jonathan, healthy six-pound, 12-ounce boys born by C-section on March 20. But what about Cantor? She was paid, of course; the Smiths declined to discuss the exact amount, but typically, surrogacy agreements in the United States involve payments of $20,000 to $25,000 to the woman who bears the child. She enjoyed the somewhat naughty pleasure of telling strangers who asked about her pregnancy, "Oh, they aren't mine," which invariably invoked the question, "Did you have sex with the father?" (In case anyone is wondering, Lisa's eggs were fertilized in vitro with Kerry's sperm before they were implanted on about day five.)

To read the rest of the article follow this link, http://www.newsweek.com/id/129594

The Today Show recently aired a segment about the first set of twins born via IVF in the United States. Heather and Todd Tilton turned 25 this year and the show reflected on how IVF has evolved since their birth.

I too wanted to reflect on the changes of IVF both socially and medically. When the Tilton’s were conceived fertility treatments were still relatively new. The embryologist who performed the first procedure was condemned by the Vatican, calling the procedure “unnatural.” Today, the process is a one that many couples turn to when conception is not possible.

Medically, in 1982, the success rate was in single digits. Today, the procedure has a success rate of at least 30 percent per cycle. I am so glad to have been a part of the progress and to see first hand how IVF can help families.
Here is to another 25 successful years!

America's first ‘test tube’ twins turn 25
Siblings conceived in laboratory dish thankful to parents for never giving up
By Mike Celizic
TODAYShow.com contributor
updated 7:33 a.m. PT, Tues., April. 1, 2008
Heather Tilton and her brother, Todd Tilton II, are ordinary siblings with an extraordinary message. The first twins born in America through in vitro fertilization, they want people to know that their parents’ refusal to take “no” for an answer is as relevant today as it was when they were conceived in a laboratory 25 years ago this month.
“We’re here to extend the message that there is hope,” said Todd Tilton, who appeared with his sister on TODAY on Tuesday.
“Throughout our lives, the message of ‘Where there’s a will, there’s a way’ has resonated,” added Heather Tilton, who works for a New York financial firm.
With them was their mother, Nan Tilton, 56, who had been told that she and her husband, Todd Tilton, Sr., would never have children and should quit trying. She was 30 years old in 1982 and the couple had been married for eight years and been trying to conceive for six.
But her fallopian tubes were blocked and his sperm count was low, and even after five surgeries between the two of them, their chances of conceiving were still virtually zero.
“We tried every technique and were told we would never have a child,” she told TODAY’s Ann Curry. That news was, she said, “absolute heartbreak.”
A Quaker, Nan Tilton prayed for guidance and felt strongly that she should not surrender to medical opinion. “I felt very strongly that if we tried and never gave up, it would work,” she said.
There was one chance, and it was a slim one at the time. It was a new and controversial technology called in vitro fertilization that generated massive media coverage in 1978 when the first child, Louise Joy Brown, was born in England.
The embryologist who performed the procedure, Robert Edwards, was condemned by the Vatican, which called the procedure “unnatural,” a view shared by many commentators at the time.
But Nan Tilton thought it might be a way for her to have a child. Drs. Howard Jones and Georgeanna Seegar Jones, founders of the Jones Institute for Reproductive Medicine in Norfolk, Va., successfully performed the procedure for the first time in the United States in 1981, resulting in the birth of Elizabeth Jordan Carr.
Procedure common now
The Tiltons went to the clinic the following year, and on July 12, 1982, their twins were conceived in the Jones Institute. They would be the first twins born of the procedure in the United States and the third in the world after sets born in Australia and Canada.
Today, a week after the Tilton twins celebrated their 25th birthday, the procedure has a success rate of at least 30 percent per cycle, but, Nan Tilton told Curry, when she went to the clinic in 1982, the success rate was in single digits. Of all the women in the cycle she was in at the clinic, only she conceived.
There never was a test tube involved in the procedure; fertilization instead took place with medical assistance in a laboratory vessel called a Petri dish. But the offspring so conceived were dubbed “test tube babies” by the media and for years the name stuck.
Today, in vitro fertilization is just one of a number of procedures known collectively as assisted reproductive technology, or ART.
California leads the nation in such births, followed by New York.
In 1982, medical insurance did not cover in vitro fertilization and the Tiltons paid the $2,500 cost of the procedure from their own pockets. Today, one cycle of the procedure averages about $12,500, and a number of states require insurance carriers to cover the cost.
Today, in vitro births are so common they go without notice. But Todd and Heather were the focus of intense media coverage after their births and their parents even wrote a book about their experience.
Both twins said that their parents insulated them from the attention and the then-extraordinary means of their conception did not affect them while they were growing up.
Todd, a gifted, self-taught musician who is due to graduate from Fordham University in May with degrees in business and communications, said he and his sister aren’t special at all, but their parents are.
“I’m just thankful that my mother and my father both had the determination to go through everything they went through, being told no at every turn and still not relenting,” he said.

Years ago Paul C. Magarelli M.D. Ph.D., my co-medical director of Corona Institute for Reproductive Medicine & Fertility (CIRMF), realized the value of integrating the age-old technique and for the last few years he and his colleague, Diane Cridennda L.Ac., D.O.M. of East Winds Acupuncture Inc., have dedicated their research to the impact of acupuncture on in-vitro fertilization (IVF) outcomes.

Research demonstrates that women who receive acupuncture combined with high-tech fertility treatments may improve reproductive outcomes. Research published in The Fertility & Sterility Journal in 2005 showed an astonishing increase in pregnancies by 15 percent and a 23 percent climb in actual births in IVF patients treated with acupuncture.

How does acupuncture impact fertility? Dr. Magarelli notes: there are eight common attributes to acupuncture that relate to enhancing fertility and, in turn, conception. Acupuncture is gaining greater credibility for its ability to:

- Reduce stress hormones
- Increase blood flow to the ovaries and uterus
- Improve ovarian function
- Improve thickness of uterine wall
- Regulate menstrual cycles
- Lessen ectopic pregnancies miscarriage rates
- Lessen uterine contractions after embryo transfer in IVF patients
- Enhance the effectiveness of IVF medications and reduce side effects

Acupuncture also provides many women with a resemblance of control and an opportunity to be actively involved with their care at a time when they may feel especially helpless and vulnerable.

A similar study also recently appeared, for more read on:

http://www.msnbc.msn.com/id/23057790/from/ET/

A new study completed by a team at Kaiser Permanente in Oakland, Calif. has confirmed a direct correlation between caffeine and miscarriages. The study involved more than 1,000 women in San Francisco during the early stages of pregnancy. Of those women, the ones who consumed more than 200 milligrams of caffeine were twice as likely to miscarry.

Although doctors have been warning their patients for years to watch their caffeine consumption, this is the first study to confirm caffeine as the stand alone reason for a woman’s miscarriage.

To read the complete article, please see below.

Washington Post
Caffeine Increases Risk of Miscarriage, Study Finds

By Rob Stein
Washington Post Staff Writer
Monday, January 21, 2008; A02

Caffeine consumption by pregnant women can significantly increase the risk of miscarriage, according to new research.

The study, involving more than 1,000 pregnant California women, provides the most convincing evidence to date of such a link, the researchers said.

Research previously indicated an increased risk, but scientists were unsure whether those findings were affected by the fact that women having morning sickness might be less likely to drink caffeinated drinks, such as coffee, and less likely to have miscarriages.

"The relationship between caffeine intake and miscarriage was controversial," said De-Kun Li, a reproductive and perinatal epidemiologist at Kaiser Permanente in Oakland, Calif., who led the study. "The question has been whether this association is really due to caffeine itself or something else."

To answer that, Li and his colleagues studied 1,063 women in the San Francisco area early in their pregnancies. They questioned the women in detail about their beverage consumption and whether they were experiencing morning sickness.

Those women who consumed 200 milligrams of caffeine or more a day were about twice as likely to miscarry, the researchers report today on the Web site of the American Journal of Obstetrics and Gynecology. That's about the amount of caffeine in two five-ounce cups of coffee, five 12-ounce cans of soda or six five-ounce cups of tea, Li said.

The findings are consistent with those of earlier studies, which have found an increased risk of miscarriage from daily consumption of about 150 to 300 milligrams of caffeine, Li said.

"But we went one step further in determining whether it was the caffeine itself or it was women changing their drinking pattern," he said. "My hope is our study will remove that uncertainty. I think this should put the argument to rest."

Based on the findings, Li recommended that women who are pregnant or trying to get pregnant minimize caffeine intake.

"If they have to drink caffeine-containing beverages, they should reduce the amount to one cup a day at the most," he said.

Tracy Flanagan, director of women's health at Kaiser Permanente, agreed.

"Avoiding [caffeine] may be even better. Consider switching to decaffeinated coffee and other decaffeinated beverages during your pregnancy," she said. "Learn to perk up instead with natural energy boosts, like a brisk walk, yoga stretches, snacking on dried fruits and nuts."

I was recently asked to serve on RESOLVE's Advisory Committee for the department of Health and Human Services on the subject of embryo donation grant. I wanted to share this exciting news with my readers as well as to tell you a little bit more about RESOLVE.

The advisory committee will consist of 2 physicians, 2 attorneys, and 2 mental health professionals. As advisory committee members, we will assist in developing content for the conference modules and updating existing content. In addition, the advisory group is asked to participate in one of the RESOLVE conferences.

RESOLVE: The National Infertility Association is a non-profit organization with the only established, nationwide network of chapters mandated to promote reproductive health and to ensure equal access to all family building options for men and women experiencing infertility or other reproductive disorders. The mission of RESOLVE is to provide timely, compassionate support and information to people who are experiencing infertility and to increase awareness of infertility issues through public education and advocacy.

For more information about RESOLVE visit http://www.resolve.org/site/PageServer

Yahoo! News recently reported a story about a new technology for developing embryonic stem cells. The company, Advanced Cell Technology, is using preimplantation genetic diagnosis (PGD) techniques to test and grow the stem cells. This new process, as with PGD, does not harm any human embryos.

Through their testing, the company was able to grow five batches of cells. This is a huge step for stem cell research because it shows no damage to the human embryos.

I thought the article would be of interest to my readers. Although not everyone may agree with stem cell research, it is always important to stay abreast of the current medical research. Please enjoy.

Embryo-friendly technique produces stem cells

By Maggie Fox, Health and Science Editor Thu Jan 10, 12:30 PM ET

WASHINGTON (Reuters) - A company that devised a way to make embryonic stem cells using a technique it said does not harm human embryos reported on Thursday it has grown five batches of cells using this method and urged President George W. Bush to endorse it.

Massachusetts-based Advanced Cell Technology has been working with a method sometimes used to test embryos for severe genetic diseases. Called preimplantation genetic diagnosis, it involves taking a single cell from an embryo when it contains only eight or so cells.

The method usually does not harm the embryo, which is frozen for possible future implantation into the mother's womb. The ACT team also froze the embryos and used the single cell that was removed as a source of human embryonic stem cells.

Dr. Robert Lanza, ACT's scientific director, said it provides a way to create mass quantities of embryonic stem cells without harming a human embryo. Current stem cell technologies require the embryo's destruction.

"This is a working technology that exists here and now. It could be used to increase the number of stem cell lines available to federal researchers immediately," Lanza said by e-mail. "We could send these cells out to researchers tomorrow."

Embryonic stem cells are the body's master cells. They can give rise to every other cell type and are found in the earliest-stage embryos.

Researchers agree they could transform medicine. But some people including Bush object to methods that might destroy human embryos, and federal funding for such research is strictly limited.

CELLS FROM SKIN, EGGS

Companies such as ACT can do what they please, and other teams are looking for ways to make ordinary cells act like embryonic stem cells. Three teams of researchers reported progress last year in making what they call induced pluripotent stem cells -- transformed skin cells that look and possibly act like embryonic stem cells.

Another team generated similar cells using human egg cells only, a process called parthenogenesis.

But all the researchers also said scientists must continue to study true embryonic stem cells.

"If the White House approves this new methodology, researchers could effectively double or triple the number of stem cell lines available within a few months. Too many needless deaths continue to occur while this research is being held up," Lanza said.

"I hope the president will act now and approve these stem cell lines quickly."

In a letter to the journal Cell Stem Cell, Lanza and colleagues at the University of California, San Francisco, said they took single cells from five embryos, re-froze the embryos, and used the cells to grow batches of embryonic stem cells.

They thrived in lab dishes, as do true embryonic stem cells, and began to change into the various cell types, Lanza said.

"We discovered a new trick that allowed us to redirect the fate of the removed cell," he said.

"The stem cells we generated were completely normal and differentiated into all the cell types of the body, including insulin-producing cells, blood cells and even beating heart cells."

(Editing by Julie Steenhuysen and Xavier Briand)

Because 15 out of every 100 couples experience problems conceiving within a year of trying, more attention is being paid to fertility issues. By understanding the potential causes of infertility and also the available solutions, more couples can take control of their conception plans. I would like to offer my readers the top 8 fertility tips every woman must know in 2008.

■ The Count Counts – Fertility issues are usually thought of as having to do with female reproductive issues, but that is not always the case. Couples having a hard time conceiving should get both partners checked out for potential problems, including a low or otherwise abnormal sperm count.

■ Double-Check the Plumbing – The smallest tubal blockage can lead to major infertility problems. A thorough examination of the uterus and fallopian tubes may uncover a simple solution to fertility problems.

■ Prescriptions Aren’t Always Your Friend – There are certain medications which have been linked to infertility. Re-evaluating use of these medications and possibly decreasing the number of medications being taken may help improve the chances of conceiving.

■ Your Chances Don’t Improve With Age – Much has been said about older women conceiving. In fact, Hollywood is fraught with examples of women giving birth well into their 40’s and give the false impression that it is easy. But the fact remains that as women age, their chances of conceiving a healthy child drastically decreases.

■ Know Your Cycle – It is critical to know when your ovulation occurs. If you are having trouble tracking your own ovulation, speak with your doctor. Regular cycling can help increase a couple’s chances of conception. Those with irregular cycles can sometimes be helped by ovulation induction medications.

■ Find Ways to De-Stress – Don’t underestimate the impact of everyday stress – from work, finances and more – on your ability to conceive. Look for ways to de-stress such as acupuncture, medication, yoga, and more.

■ Learn More About Your Family History – Your doctor needs to know if you have a family history of diseases like hypothyroidism, infertility, and more. These conditions can affect hormone levels in your body, making it difficult to conceive.

■ Your Doctor is a Huge Resource – There are a myriad of tests that fertility specialists can do to help couples identify and isolate their fertility problems. Many times there is more than one factor at play for infertile couples. Four out of five couples experiencing fertility problems ultimately have their fertility problems diagnosed.

May you all have a happy holiday and a prosperous New Year!

Best wishes,

Dr. Werlin