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November 2006 Archives

November 17, 2006

New Guidelines Presented at the American Society of Reproductive Medicine Conference

I recently attended the American Society of Reproductive Medicine (ASRM) meeting in New Orleans, where the guidelines were again presented for patients undergoing assisted reproductive technologies. These guidelines state that in women under the age of 35 years old, no more than two embryos should be considered for transfer and it’s possible that perhaps only a single embryo may be considered for transfer. In women ages 35 to 37, no more than two blastocyst-stage embryos should be transferred or no more than two cleavage-stage or day three embryos should be transferred. Finally, for patients in the age group of 38 to 40, four cleavage-stage or day three or three blastocyst day five embryos are the recommended limits. For women over the age of 40, no more than five cleavage-stage embryos, which is day three, or three blastocyst day five embryos should be transferred.

In looking at these guidelines, clearly it appears that the major reason for this is to lower the multifetal gestation rate in women undergoing assisted reproductive technologies. At the ASRM meeting, we presented a randomized prospective study which looked at putting back only two embryos in women at the day five stage and utilizing preimplantation genetic diagnosis as a determinate to putting back the best embryos. In that study, the major goal was to limit the incidence of multifetal gestation.

This study, although preliminary, does in fact show that if you put back two day five embryos in these young women, the risk of a multifetal gestation is dramatically lowered. In fact, in the group that underwent PGD, in putting back only up to two normal embryos, there were no multifetal gestations. I think that this will have an impact on the reproductive community and will hopefully by following these guidelines encourage a lower multifetal pregnancy rate.

In Europe of course there are limits to numbers of embryos that are put back, and clearly their multifetal gestation rate is less than that in the United States. However, in the United States of course the driving power many times is for a patient to be successful, and clearly when a patient goes through IVF -- which is an expensive procedure, time consuming, emotionally consuming, and physically consuming -- a patient wants her best likelihood for success. Thus in certain instances, more embryos may be put back than would be followed by the guidelines. So I think that this will have an effect on the reproductive community; however, I do believe that most groups are now following these guidelines.

November 28, 2006

Common Misconception of PGD - Gender Selection

On November 17, a segment was aired on my local NBC station on couples paying big bucks to choose the sex of the baby in the United States. Primarily, this topic was a discussion about sex selection and utilizing the process of preimplantation genetic diagnosis, or PGD, for that purpose. Unfortunately, the primary point of this discussion was in fact sex selection whereas the primary purpose for preimplantation genetic diagnosis was not even discussed. PGD is a process that is utilized for a number of different scenarios.

PGD is primarily used for couples who have certain types of genetic defects that they do not wish to transfer on to their children. An example of this might be cystic fibrosis, Huntington’s disease, sickle cell disease, retinitis pigmentosa, any number of different hereditary diseases that could be prevented by using the process of PGD.

The second use for PGD is in fact to help to prevent certain chromosome abnormalities occurring in certain high risk patients: for example, women who have advanced maternal age, women who have recurrent pregnancy loss, couples in whom the male has severe male factor, which is less than a million motile sperm, couples who fail two or more IVF cycles which would be thought to be implantation failures, and couples who have previous histories of chromosomally abnormal embryos. All are at greater risk for having embryos that have aneuploidy. Aneuploidy is defined as an embryo that has either too many or not enough chromosomes. The most common example of aneuploidy that most people know of is in fact trisomy 21, or Down’s syndrome. These women in those high risk groups are at greater risk for having abnormal embryos, and thus PGD can be used to in fact rule that problem out by screening those embryos, looking for specific chromosome abnormalities.

So I think it is important that when looking at preimplantation genetic diagnosis, although sex selection can be done or family balancing can be done, the true primary effect or the primary use for preimplantation genetic diagnosis is to prevent certain hereditary diseases from being passed on and to rule out certain chromosome abnormalities. I think that is the primary benefit of using it and that is what should be looked at as well.

If you want to read more about this story click on this link, http://www.nbc4.tv/drhensel/10348703/detail.html

November 21, 2006

The 15th Annual Coastal Fertility Halloween Party held on October 29, 2006

The Halloween party was a dramatic success. It was absolutely wonderful seeing all the parents and all the children and it was a milestone for us in that it was our 15th annual party. Each year it just keeps getting bigger and bigger and bigger. This year we held it at a new venue which was Heritage Park in Irvine. In fact, this turned out to be quite a successful event. The children had many more options other than just the bouncy playhouse. They were now able to utilize various things that occur in the park. It was an absolutely beautiful day. The patients were happy, the children were happy, and it was an extremely happy day for all of us.

To me personally, it just reinforces everything that we do on a daily basis. It reinforces the fact that we do have the ability to help people and those people are extremely appreciative of all of our efforts. I would just like to emphasize the fact that this is an absolute team effort. Everybody in our office works to make this a very very successful event.

Our local community paper the Irvine World News attended the party and ran a wonderful story on the event. To read the story and view the pictures taken by the papers reporter click on the following link, http://epaper.ocregister.com/Default/Client.asp?enter=true&skin=OCW&Daily=OCWIrvineWorldNews The article is on page 3.

Also if you would like to view photos of some of the happy families click on the following link, http://www.coastalfertility.com/11052006_HR.htm

November 17, 2006

HealthDay News Article About Smoking and Fertility

While online I came across the following article and I wanted to share it with the readers of my blog. Although it's a well known fact that heavy smoking can hurt your chances of concieving, I believe that it never hurts to reiterate good information.

Smoking's Effects on Uterus Harm Fertility

11.09.06, 12:00 AM ET
THURSDAY, Nov. 9 (HealthDay News) -- If you thought all the risks of cigarette smoking were already known, think again.
New research finds that heavy smoking impairs women's fertility by reducing the odds that a fetus will implant in the uterus.
Previously, experts had thought that heavy smoking reduced fertility because of its effect on the ovaries. The new finding suggests tobacco deals women a double blow.
"Tobacco consumption reduces your pregnancy probability, not only due to the already known ovarian effects but also due to impaired uterine receptiveness," said Dr. Sergio R. Soares, lead author of the study and director of the IVI Clinic in Lisbon, Portugal.
"This is the first study that shows the clinical impact of cigarette smoking on uterine receptiveness," added Soares, whose study is published in the Nov. 9 online edition of Human Reproduction.
The take-home message remains the same: "A healthy pregnancy starts with a healthy mother," said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "Quit smoking before you become pregnant."
The effect of cigarette smoking on the ovaries has been known for a while, she said. "There's often ovulatory dysfunction in heavy smokers, and they tend to have menopause at an earlier stage," Wu noted.
The authors of the study looked retrospectively at 741 non-heavy smokers (under 10 cigarettes a day) and 44 heavy smokers (over 10 cigarettes a day). All of the women had received oocyte donations as part of in vitro fertilization (IVF) between January 2002 and June 2005.
None of the women's partners smoked and none of the oocyte donors were heavy smokers.
According to the study, the lighter smokers had a significantly higher pregnancy rate (52.2 percent) than the heavy smokers (34.1 percent).
The fact that the oocytes were donated means the problem lies with the uterus, not the ovaries, the researchers noted.
Previous research had also shown that light smoking had no significant effect on IVF cycles.
Oddly, heavy smokers had about double the rate of multiple pregnancies (60 percent) than non-heavy smokers (31 percent). Although this may be a glitch in the findings, it's also possible that different women respond differently to cigarette smoking, Soares said.
Soares and his team are now looking at the genetics behind the phenomenon.
"We are beginning a study of gene expression in the endometrium of heavy smoking oocyte recipients to see which might be the key molecules involved in the implantation process that are altered in these patients," he said.

About November 2006

This page contains all entries posted to Dr. Werlin's Fertility World in November 2006. They are listed from oldest to newest.

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