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May 2007 Archives

May 31, 2007

Calling All Proud Papas

Fertility is often considered a “female” issue, but any couple undergoing fertility treatment knows the female half doesn’t go it alone. Would-be dads play a crucial role in offering emotional support, guidance and assistance throughout the process— and sometimes undergo their own poking and prodding!

Whether you already have children or are aspiring to become a father in the near future, we would like to recognize you this Father’s Day, and hear your stories, surprising experiences, tips, challenges and triumphs.

From one proud papa to another, I’d like to invite you to participate in this forum and share your inspiring story with others.

Happy Father’s Day!

May 17, 2007

The Case for PGD

On April 23, 2007, Bruce Goldman authored a byline for The Los Angeles Times entitled, “Not-so Natural Selection,” in which he outlined to readers the results of a Belgian study published by Human Reproduction in 2004. This study indicated that, among other things, the advanced reproductive technology Preimplantation Genetic Diagnosis (PGD) – when utilized as a tool for aneuploidy screening in women of advanced maternal age – yielded fewer successful pregnancies when compared with a control group. Goldman uses this to build a foundational argument supporting the opinions of unidentified industry experts, citing deficient substantiation of claims that PGD positively contributes to the “take-home baby rate.”

While the results of the Belgian study are no doubt reliable and noteworthy to be sure, they beckon mention of the following point: that PGD’s proven benefits rest in aiding the detection of single gene defects like cystic fibrosis or Huntington’s disease. “When planning PGD for infertility, the number of cells to be biopsied must be considered carefully,” explains Dr. Santiago Munné, an award-winning and internationally recognized leader in reproductive medicine research, director of Preimplantation Genetic Diagnosis at Reprogenetics, LLC and the co-author of a noted study(*) on the subject.

This may account for the discrepancy between American and Belgian study results. Whereas European groups remove two cells for biopsy, American groups rely on the use of just one cell. Removal of up to one-third to one-half of embryonic tissue versus a single cell may be the defining difference in the embryo’s ability to continue to develop and divide appropriately.

As with any technology, patients must be advised of risks and benefits associated with the procedure. For women of advanced maternal age, as was cited in The Los Angeles Times – and who mainly comprise a high-risk group of patients for whom there is increased risk for chromosomal abnormality – PGD serves another function not addressed in the article. When observing embryos for high-risk groups, such as women of advanced maternal age, women with recurrent pregnancy loss, women with two or more failed in-vitro fertilization (IVF) cycles and couples where the male has severe male factor; 25 to 30 percent of these patient have all embryos abnormal. Thus, PGD allows patients within these high-risk groups an assessment on their likelihood of conceiving and consideration of alternative options.

In instances where aneuploidy is consistent, PGD can help women turn a corner from their painful position of, “If I just keep trying IVF, I will eventually get pregnant.” The technique provides answers that allow these women to search for other options such as traditional adoption, use of donor eggs or donor embryos. Of course, every patient’s case needs to be evaluated on an individual basis and no process is 100 percent accurate; however, PGD can be beneficial for a number of reasons – including its ability to answer patient queries as to why they haven’t conceived in the past or why repetitive results may indicate a need to look at other options.

Clearly, there need to be guidelines for how PGD is used. But through application of the technique, multifetal gestational rates can effectively be reduced – a point not mentioned by Goldman (LA Times, 2007). By transferring fewer healthier embryos, the likelihood of a pregnancy resulting in twins and triplets is dramatically reduced.

Perhaps Goldman’s closing thoughts on the impact that an embryo experiences from removal of its genetic material deserve greater attention. Attributing results of a Belgian study to the PGD pregnancy rates of American patients, becomes an apples-to-oranges comparison – one that acts as a disservice to the thousands of couples nationwide who aspire to build a family through advanced reproductive technologies.

(*) Cohen, J., Munné, S. & Wells, D. (2007). Removal of 2 cells from cleavage stage embryos is likely to reduce the efficacy of chromosomal tests that are used to enhance implantation rates. Fertility and Sterility (Vol. 87, No. 3), p.495-502.

Article excerpt below:

Not-so natural selection
A procedure called PGD is used to prevent inherited disorders, but can it improve in vitro pregnancy rates?
By Bruce Goldman
Special to The Times

April 23, 2007

BIOPSIES are a pain. When they're medically necessary we put up with them. When they're not, most of us would just as soon remain un-punctured.

When the patient is a 3-day-old embryo, it's especially fair to ask for some evidence of a clear medical benefit.

Pre-implantation genetic diagnosis, or PGD, is a procedure sometimes performed in conjunction with in vitro fertilization to improve the quality of the embryos selected. It entails the careful isolation of one of a 3-day-old embryo's eight or so cells, then analysis of that cell's genetic contents. Based on what is found, IVF patients and doctors can decide which embryos to transfer into the woman's uterus.

Use of PGD has risen exponentially since its inception 17 years ago. In the U.S., where PGD isn't formally tracked, about 3,000 procedures were performed in 2005, according to a recent report from the Genetics & Public Policy Center, which is affiliated with Johns Hopkins University. Experts estimate its frequency is rising annually by 15% to 30%.

To view the full LA Times article, see www.latimes.com (subscription required)

May 15, 2007

Talk to Me on the “Conceive On-Air” Radio Program

On May 23rd, at 11:00 a.m. (Pacific Time), I will be a guest on Conceive Magazine’s radio program.

For couples concerned with passing along genetic diseases, such as cystic fibrosis or Huntington’s Disease, host Kim Hahn and I will discuss the topic of PGD’s role in breaking the transference cycle.

Listeners are invited to call in with their questions to 866-475-5792 or tune into the show at http://www.voiceamerica.com/conceiveonair

Hope to hear from you!

May 10, 2007

A Mother's Day Wish

In honor of Mother’s Day, our team would like to send out the best wishes to our patients. Over the years, we have come to know and respect a phenomenal group of women – all sharing the same resolve and uncompromising spirit. Mother’s Day is a particularly special time of the year. It reminds us of why we are in the business we love – to help others achieve the gift of motherhood.

Best wishes!

May 9, 2007

National Attention on the Issue of Recurrent Pregnancy Loss

This week, NBC’s Today Show is airing an important piece on miscarriage and recurrent pregnancy loss (RPL). This is one of the toughest, most emotional experiences for a couple.

In speaking to our patients and based on the viewer comments from the Today Show’s own blog – one of the biggest questions is, “Why did this happen? Everything appeared normal.”

There is no one definitive answer. However, in August 2003, the findings of a Genesis Network for Reproductive Health study were published in the medical journal Fertility and Sterility. In three high-risk groups – Recurrent Pregnancy Loss (RPL), Advanced Maternal Age (AMA), and Repeated Failed Cycles – the procedure Preimplantation Genetic Diagnosis (PGD) was shown to be beneficial, since there is a tendency toward higher pregnancy and implantation rates with its use. The study also confirmed aneuploidy as a common cause of RPL. Aneuploidy is the medical term for when there are too many or too few chromosomes present in the embryo. When observing embryos for high-risk groups, 25 to 30 percent of these patients have all embryos abnormal – shedding light on their fertility challenges to carry successfully.

Also, in view of the large numbers of abnormal embryos in each of these groups, PGD enables couples to consider alternative options, such as donor eggs, donor embryos, and/or adoption, sooner.

There are many reasons to pursue PGD as a diagnostic and therapeutic fertility tool when trying to start a family. Some of the PGD-warranted situations in which infertility patients can benefit from PGD include:
• when fertility is complicated by the threat of hereditary diseases such as Cystic Fibrosis and Huntington’s Disease;
• when the health of embryos has lead to miscarriages due to the refusal of embryos to implant; aneuploidy – a condition whereby an embryo has too many, or not enough chromosomes – is a common cause; and
• when a woman is in a high-risk group due to recurrent miscarriage, advanced maternal age or repeated failed cycles

About May 2007

This page contains all entries posted to Dr. Werlin's Fertility World in May 2007. They are listed from oldest to newest.

April 2007 is the previous archive.

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Many more can be found on the main index page or by looking through the archives.

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