Posts Tagged ‘IVF’

Freezing Embryos May Result in Healthier IVF Babies

More evidence that using frozen embryos may result in healthier IVF babies than using fresh embryos comes from a new British study.

The researchers found that babies born following IVF using frozen embryos may be born later and weigh more than babies born from fresh embryos, according to a presentation at the British Fertility Society last week.

They looked at nearly 400 babies born after fresh embryo transfer and just more than 100 born after frozen embryo transfer.

On average, babies born from frozen embryos weighed 253g more and were born 4 to 5 days later than babies born from fresh embryos.

“This is important because prematurity and low birth weight are both risk factors for poorer health later in life and are linked to higher rates of behavioral and learning difficulties,” said Suzanne Cawood, who led the study at the Centre for Reproductive and Genetic Health in London.

“This means that resulting babies may potentially be healthier if frozen embryos are transferred rather than fresh embryos.”

She hypothesizes that the difference may be in the uterine environment between fresh cycles when embryos are transferred soon after the eggs have been collected compared to frozen cycles when the uterus has not been stimulated in the days before transfer.

This hypothesis needs to be tested further, she said.

Previously, Danish scientists had found that babies from frozen embryos were heavier and suggested this could be due to only top quality embryos surviving the freezing procedure.

Early-stage Thawed Frozen Embryos Lead to Fewer Miscarriages

Most IVF clinics have embraced freezing embryos as a way to enhance a couple’s chances of achieving a pregnancy.

Better ovulation induction protocols now allow the harvesting of 10 or more mature eggs from a woman from one cycle of hormonal stimulation.

Freezing embryos allows couples to have several IVF treatment cycles from the same egg collection, reducing the number of times that the ovaries are stimulated and, therefore, reducing the costs.

The most costly part of an IVF cycle is the ovulation induction, egg retrieval, and fertilization stages.

Frozen embryos can also be used during a natural cycle IVF without any hormonal stimulation.

Natural cycle replacement is an easier procedure, and is usually recommended for a woman who ovulates regularly and normally.

Thawed Embryo Transfer

The thawed embryos are placed into the uterus three to five days after ovulation in exactly the same way as fresh embryos.

The transfer is timed to the stage of development of the embryo.

Embryos frozen at the 8-cell stage are transferred earlier than those frozen at the blastocyst stage.

For a natural cycle, the fertility team will thaw earlier embryos one day after ovulation (two days after the LH peak) and make the transfer on the day of the thaw.

Blastocysts are thawed five days after the LH peak and transferred on the day of the thaw.

About 75% of frozen embryos survive the thawing at Weill Cornell in New York, says Zev Rosenwaks, MD, director and physician-in-chief of the Center for Reproductive Medicine at the Weill Cornell Medical Center.

“Our pregnancy rates are slightly higher – more than 50% – when blastocysts are thawed and transferred compared to earlier stage embryos.”

A new study in the December issue of Reproductive BioMedicine Online (www.rbmonline.com) states that miscarriage is less likely to occur after the transfer of fresh embryos compared with frozen-thawed embryos, but also that the age of the embryos at the time of freezing could influence the miscarriage rate.

The retrospective analysis of more than 52,000 clinical pregnancies recorded on the Australian and New Zealand Assisted Reproduction Database between 2004 and 2008 showed that a woman’s age and obstetric history are closely related to the risk of miscarriage, but that the transfer of fresh embryos is associated with fewer miscarriages than transfer of frozen–thawed embryos.

Transferring thawed embryos at an earlier stage of development than the blastocyst stage reduced the likelihood of miscarriage, leading the authors to suggest that transferring fresh blastocysts and freezing of cleavage-stage embryos might reduce miscarriage rates.

However, a retrospective analysis of large national databases is mainly useful to identify trends and generate hypothesis.

“It is interesting that miscarriage rates of frozen blastocysts were higher in the Australian study, particularly since it is well known that blastocysts have a lower frequency of chromosomal anomalies than cleaved embryos,” said Dr. Jacques Cohen, senior editor of Reproductive BioMedicine Online, of the study.

“Blastocyst culture is still a relatively new approach and culture-related factors such as selection for freezing at blastocyst stage may have affected early learning experiences in some clinics.

It is therefore important to repeat a similar analysis of Australian clinic data during subsequent years.”

Frozen Embryos Healthier

Initially, there were some concerns about the health of children born to women who had frozen embryos transfers, but now we know these children are just as normal as those conceived with fresh embryos.

There’s even some evidence that frozen embryos are healthier than fresh embryos.

A Danish study found that women implanted with frozen embryos had babies who weighed slightly more than those implanted with fresh embryos, and they also had fewer multiple births.

The reason for the differences is probably that only top-quality embryos survive the freezing and thawing process, allowing the selection of healthier embryos.

Celine Dion Would Love to Have Another Baby

Three-time mom Celine Dion says she would love to do it again – have another baby, that is.

The superstar singer has conceived twice through in vitro fertilization (IVF) with the help of Zev Rosenwaks, MD, director of the Center for Reproductive Medicine at the Weill Cornell Medical Center in New York City.

Her first son, Rene Charles, is now 10 years old, and her twin boys, Eddie and Nelson, will turn 1 this October.

In A Baby at Last!, written by Dr. Rosenwaks and Marc Goldstein, MD, director of the Center for Male Reproductive Medicine and Microsurgery at Weill Cornell, Dion wrote:

“When I think about my association with Dr. Zev Rosenwaks, I think about the extraordinary talent and intelligence that allows him to combine nature and genius, to create new life.

I am forever in awe of this, and I’m forever grateful for his wonderful talent.”

On “Good Morning America” on September 20, when asked if she would like to add to her family, Dion said:

“We’d love to.”

”It’s the biggest gift that you can offer yourself.”

She added: “Is it gonna be possible?

“Is it gonna happen?”

“I don’t know.”

Dion’s wish for more children will be part of the 90-minute documentary, “Celine: 3 Boys and a New Show,” airing October 1 on OWN, the Oprah Winfrey Network.

Dion told GMA “Now I’m in my 40s and I think I’m blessed with my family and husband (Rene Angelil).

I’m very privileged to have them.

It’s what I’m the most proud of, my family, my kids.”

In her book, Celine Dion: My Story, My Dream, published just after Rene Charles’ birth, Dion wrote about the meaning of family.

“The one thing that we have been working on so hard all these years is this family.

To us, this great family is more important than anything else, and no other accomplishment makes us so proud.”

She also discussed plans back then to give birth again.

“The idea of having another baby is already in the back of my mind.

One of my eggs that been inseminated with Rene’s sperm is kept at the fertility clinic.

It will be possible to place it back in my uterus.

If everything goes well and, and it’s God’s will, my belly will once again be home to a child from the man I love.”

And now shes thinking of the possibility of a third IVF procedure.

“I think the best is yet to come,” she said.

Top Quality Embryos Go With The Flow

Ever since the first so-called “test-tube” babies were born, fertility experts have been searching for the best way to culture fertilized eggs outside a woman’s womb.

A new device that mimics the movements inside the womb may help produce better quality embryos.

Normally, nutrient-rich fluid washes over the embryo through muscle contractions within the fallopian tubes.

To copy that in the laboratory, University of Michigan researchers created a culture system that moves pins up and down to send pulses of medium washing over an embryo.

The researchers tested the new system versus standard, static embryo culturing using 315 embryos from 25 women undergoing in vitro fertilization (IVF).

They found the new system slightly boosted the number of embryos graded as top-quality and greatly improved the chances of embryos becoming good quality, reported Michigan’s Gary Smith, Ph.D, Professor, of Obstetrics and Gynecology, at the European Society of Human Reproduction and Embryology annual meeting in Stockholm, Sweden, this month.

He expects the new system to translate into better pregnancy rates, and is tracking that now.

Another important approach to improve the success rate of IVF is to optimize the laboratory conditions for early embryos.

At Weill-Cornell, Zev Rosenwaks, MD and colleagues have developed a method to co-culture embryos with certain helper cells to enhance the development of fertilized eggs and improve embryo quality.

“Endometrial co-culture is a laboratory method that utilizes the mother’s own uterine lining cells to enhance embryo quality,” says Dr. Rosenwaks.

Simply stated, in a separate menstrual cycle 1 to 2 months before undergoing an IVF procedure, the woman undergoes a biopsy of her endometrial lining 7 to 10 days after ovulation.

The cells are separated, grown in the laboratory, and frozen, later to be thawed during the subsequent IVF cycle.

After her eggs are fertilized through IVF, the embryos are grown on top of the mother’s extracted cells.

“This provides a better environment for the embryos, especially for couples who have exhibited poor embryo quality in previous IVF cycles,” he says.

Co-culture is usually reserved for use in “poor prognosis” patients, particularly when other cycles have failed because of slow growth of the embryo.

“This method is not a cure for age-related IVF failures, but in properly selected couples, it has significantly improved embryo quality,” says Dr. Rosenwaks.

Buying Fertility Treatments in Bulk

The mounting cost of getting pregnant has led some fertility clinics and doctors to join forces and offer bulk discounts on in vitro fertilization (IVF) treatments.

The Attain IVF network includes 40 fertility clinics and 190 fertility doctors across the country.

The network offers a program that provides you with multiple IVF cycles for a single, discounted fee that costs about 30-40% less than the same exact treatment plan if you were to pay for it on a cycle-by-cycle basis.

The idea is paying upfront for a few cycles offers peace of mind and takes the stress out of subsequent tries.

With a good fertility work-up, most couples take home a baby after 1 or 2 cycles, but some couples need 3 or more cycles of IVF.

Attain IVF may be particularly appealing to couples who recognize they may have trouble getting pregnant.

This includes couples where the woman is over age 35, when her egg quality is in decline.

This may also include women with polycystic ovarian syndrome, who usually require higher doses of drugs to stimulate egg production and often have their IVF cycles canceled because of overstimulation of the ovaries.

And, of course, this concept may work for couples who can not afford to continue to pay for more than 1 IVF cycle.

On the other hand, younger couples with a single, known fertility problem probably don’t need to enroll in Attain IVF.

A 28-year-old woman who has endometriosis with a partner who has no male factor infertility has a good chance of becoming pregnant with a single IVF cycle.

No one size fits all medical treatments, including IVF.

It comes down to a question of how risk aversive you are, and your particular fertility problem.

Infertile Couples Can Cope with Family Gatherings

The media treat Mother’s Day as a news peg to publish articles about happy families celebrating having children.

Headlines recount tales of how couples celebrate Mother’s Day after in vitro fertilization (IVF) treatments for endometriosis and blocked fallopian tubes or to overcome production of too few eggs.

Other articles tell of dozens of IVF moms gathering at a fertility clinic to form their own support group.

But infertility may cause a tremendous amount of strain on relationships with family and friends, particularly on Mother’s Day.

Family gatherings may be particularly painful as you deal with loss and grief.

Some families and friends are supportive, while others just add to your stress.

This may make you angry or cause you to isolate yourselves from them.

You may feel jealous of friends and relatives who have babies.

Friends and relatives may aggravate the situation by repeatedly asking you when you plan to have a baby, or by unwittingly talking endlessly about their own children.

Some family members may want to help, but don’t know what to do or say, while others may prefer to avoid the topic completely.

Many people feel uncomfortable discussing infertility because it relates to having sex.

The older generation may be ignorant of modern technology and new methods of conception.

Siblings and friends may flaunt their own fertility, intentionally or unintentionally.

If you feel a lack of understanding, you may not want to go home for the holidays or may decide to avoid anything having to do with children.

But you don’t want to sacrifice your social networks just when you need them the most, say Weill Cornell fertility experts Drs. Zev Rosenwaks and Marc Goldstein, the co-authors of A Baby at Last!.

If you put a temporary limit on contact with insensitive family members and friends, seek out help from other more supportive friends and family members, therapists, or online or in-person infertility support groups, they write.

Also, a family gathering may be the right time to share your experiences with family members.

The doctors suggest you might speak to one or two family members ahead of time and let them spread the word, or simply answer probing questions honestly.

Be aware of who is capable of being understanding and supportive, and increase your time with those people.

Reduce your time with those who cannot provide the support you need.

Also, take heart that more and more fertility treatment are now available to couples.

Half of all women under age 35 going through one IVF cycle at Weill Cornell take home a baby.

Welcome!

NY Resident magazine book review

Welcome to my new blog. My current news is the positive responses I’ve been getting regarding my latest book, A Baby At Last!

A very favorable review ran in this month’s issue of the Resident magazine.

A Couples’ Guide to Getting Pregnant

“Everyone seems to know someone who has a fertility problem…”  That’s the start of  A Baby At Last!: The Couples’ Complete Guide to Getting Pregnant—from Cutting-Edge Treatments to Common Sense Wisdom by Mark L. Fuerst, Zev Rosenwaks, M.D., and Marc Goldstein, M.D.

This book is for every couple seeking a solution to fertility problems. It conveys the knowledge that you are not alone and much can be done. You’ll learn when to seek help, how to find doctors and ask the right questions, what tests are worth having and why. The book covers up-to-date therapies and provides support for the emotional rollercoaster of fertility treatments.

Céline Dion’s many failed attempts at in-vitro fertilization were heartbreaking but in October 2010 the 42-year-old singer gave birth to twin boys. She said, “When I think about Dr. Rosenwaks and the extraordinary talent and intelligence that allows him to combine nature and genius to create new life, I am in awe and forever grateful for his talent.”

“Sugar” Ray Leonard, six-time world boxing champion, said, “One of my toughest fights was to father children with my loving wife, Bernadette. After two failed surgeries, I found Dr. Goldstein. My greatest victories are my Olympic gold medal, my world titles, and my family, the last one with thanks due to Dr. Goldstein.”

Mark L. Fuerst’s writing talents shine. Publishers Weekly said, “The text is reader-friendly and accentuated with informative ‘Take Home Messages’ that will help couples expand their knowledge and foster fertility success.”

About the Authors

Mark L. Fuerst is a health and medical writer and coauthor of ten books including The Couple’s Guide to Fertility. His many articles on fertility have appeared in major magazines.

Zev Rosenwaks, M.D. and Marc Goldstein, M.D. are fertility experts at the NewYork-Presbyterian/Weill Cornell Medical Center, a leading pioneer in treating infertility.

By Dorri Olds