Posts Tagged ‘Zev Rosenwaks’

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.

Polycystic Ovaries Linked to Pregnancy Problems and Heart Disease

Polycystic ovary syndrome (PCOS) is one of the most common causes of women not ovulating and can lead to fertility problems.

PCOS has also been linked to pregnancy problems and heart disease.

Women with the condition typically have small cysts around the edge of their ovaries.

Symptoms include irregular periods, problems with ovulation, weight gain, and excessive hair growth.

Women with PCOS are also more likely to have fertility treatment.

A new Swedish study just reported online in the British Medical Journal indicates that women with PCOS are at increased risk of pregnancy complications, regardless of whether they are undergoing fertility treatment.

The nationwide study on 3,787 births among women with PCOS found these women were 45% more likely to experience pre-eclampsia (pregnancy–induced high blood pressure) and were more than twice as likely to give birth prematurely or to develop diabetes while pregnant.

Fertility is not the only health consequence these women face, however.

PCOS has been associated with an increased risk for cardiovascular disease (CVD), the leading killer of women and men alike.

PCOS has been associated with increases in artery-clogging triglycerides (fats) and insulin resistance, which boosts the chances for diabetes, a risk factor for heart disease.

“Some women need intervention based on existing guidelines, either to control their blood sugar to head off diabetes, or reduce their cholesterol to moderate the risk of premature heart disease.

For the rest, it’s a matter of treating each woman based on their individual needs,” said Sarah Berga, MD, former Chair of the Department of Gynecology and Obstetrics at the Emory University School of Medicine, at the “The Physiology of Cardiovascular Disease: Gender Disparities” conference held earlier this week at the University of Mississippi in Jackson.

“We know that PCOS puts these women at risk for CVD-related disease, but we do not yet understand the extent to which it does so.”

Experts recommend that women with PCOS be periodically screened for diabetes and treated for it if they meet certain formal criteria.

However, drug treatment to forestall diabetes has not been endorsed and it has not been established that giving women with PCOS metformin will delay or prevent diabetes.

Metformin is an oral drug used to manage diabetes, either alone or in combination with sulfonylureas or other agents.

Fertility experts often prescribe metformin to treat PCOS.

To identify whether an infertile woman who has PCOS will benefit from metformin, simple tests are performed to see whether she has insulin resistance, says Zev Rosenwaks, MD, director and physician-in-chief of the Center for Reproductive Medicine at the Weill Cornell Medical College in New York.

“If she does, then I prescribe metformin,” says Dr. Rosenwaks.

“Over 2 to 3 weeks, she slowly builds up to the usual dose of 500 milligrams of metformin 3 times daily or 850 milligrams twice daily with meals.”

If the woman does not start ovulating regularly over the next 6 to 8 weeks, then he initiates treatment with the ovulation-stimulating drug clomiphene.

About three-quarters of women with PCOS who are not ovulating will ovulate on clomiphene at some dosing level, and about half will become pregnant.

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.

Some Surprising Causes of Male Infertility

A number of lifestyle factors play a role in a man’s fertility.

About 25% of the time, a man could have avoided infertility by being more aware of lifestyle choices that can harm sperm, says male fertility expert Marc Goldstein, MD, in a new article in the Wall Street Journal about the surprising causes of male infertility.

The article highlights certain lifestyle factors, specifically an adolescent groin injury, cigarette smoking, heavy drinking, intense cycling, and even using a laptop directly on the lap.

In A Baby at Last!, Dr. Goldstein and co-author Zev Rosenwaks, MD, fertility experts at New York Presbyterian/Weill Cornell Medical College, provide a list of lifestyle factors that can impair a man’s fertility.

These include:

–smoking cigarettes

–heavy drinking

–stress

–excessive weight

–exposure to heat

–recreational drug use

–sexually transmitted diseases

–genital infections that lead to sperm busters called antisperm antibodies

–drugs to improve sexual performance

–health kicks such as too-strenuous exercise

On Dr. Goldstein’s Cornell Institute for Reproductive Medicine website, he describes “10 Tips to a Fertile Lifestyle” that provide guidelines on how a man can maintain his fertility.

In their book, the two fertility doctors suggest what a man and a woman can do to “upgrade” their fertility.

Their take-home messages for men are:

• To optimize your chances of producing viable sperm, live a fertile lifestyle: don’t smoke, limit your drinking, minimize stress, be physically active, maintain a healthy weight, eat lots of fresh fruits and leafy, green vegetables, take fertility-enhancing vitamins, and avoid recreational drugs.

• Protect yourself from damage from sexually transmitted diseases.

• If you take prescription medications regularly or you need cancer therapy, talk with your doctor about strategies to preserve your sperm.

• Reduce your exposure to environmental hazards.

• If you are a man, avoid activities that raise the temperature of your testicles, ask your doctor for help with erectile problems, and don’t take hair-growth pills.

Adopting these healthy lifestyle habits, and avoiding negative habits, will help preserve your fertility and increase your chances of fathering a child.

Hormone Levels May Predict a Woman’s Future Fertility

A combination of a woman’s age and the blood levels of a specific hormone may be able to predict her future fertility.

“Women often postpone having children until their career has been well established.

However they may find that it is difficult to get pregnant at this time.

It could therefore be very useful for women to know beforehand up to which age they remain fertile,” write Dutch researchers in a study published online May 26 in the Journal of Clinical Endocrinology & Metabolism.

In general, a woman’s fertility ends about 10 years before she goes into menopause.

Now Dutch researchers say they can use a woman’s age and her blood levels of anti-muellerian hormone (AMH) to predict the end of her fertility.

AMH is a hormone produced by the follicles in the ovary.

A higher AMH level indicates a higher number of follicles and eggs in the ovaries.

As a woman gets older and the number of eggs in her ovaries decreases, the AMH levels also start to decrease.

So AMH levels can be used to help predict a woman’s ovarian reserve, that is, the number of eggs she still has available to become fertilized.

Researchers at the University Medical Center Utrecht, The Netherlands, followed 257 healthy woman, ages 21 to 46, for 11 years.

The Dutch researchers were able to link AMH levels to the point when 48 of the women entered menopause.

Based on this information, they built a model using age and AMH levels to predict when an individual woman would enter menopause.

They are working on standardizing an assay so this can be translated into clinical practice.

For example, if a woman receives a prediction that she will become infertile at an early age, she may choose to have her eggs harvested and frozen.

This would give her a good chance of having children later on if it turns out that she has a reduced egg count.

The AMH test is still considered experimental because the cutoff values have not been standardized in many countries, notes Zev Rosenwaks, MD, director of Reproductive Medicine and Infertility at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York.

The Weill Cornell fertility center has been using the AMH test for several years.

AMH levels can also be used to predict a woman’s response to ovarian stimulation in in vitro fertilization (IVF) cycles, he says.

Dr. Rosenwaks determines which woman will have a higher or lower response by measuring her AMH levels at any time during her menstrual cycle.

This allows him to choose a high or low follicle-stimulating hormone (FSH) dosage even before the woman begins her treatment.

“FSH levels along with AMH concentrations can help a couple decide on whether to proceed with IVF, particularly if their previous IVF cycles have failed,” says Dr. Rosenwaks.

However, no hormonal marker of ovarian reserve is an absolute determinant of success or failure with IVF, he points out.

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.

Cancer Survivors Can Father Children

Men who have a zero sperm count from cancer treatments may still have a chance to father a child.

“We can usually retrieve sperm from the testicles of 30-50% of men who had chemotherapy even 15 or more years ago. Using ICSI, about 20% take home a baby,” write Weill Cornell Drs. Zev Rosenwaks and Marc Goldstein in A Baby at Last!

Sperm can be extracted using a procedure called microdissection testicular sperm extraction (TESE), a procedure that was developed by Weill Cornell researchers.

The procedure enables doctors to identify small areas in the testicles where sperm are made and then carefully extract these healthy sperm cells, even in men whose testicles have been severely damaged by chemotherapy. These sperm are then directly injected into a woman’s egg using an advanced in vitro fertilization (IVF) procedure called ICSI, which stands for intracytoplasmic sperm injection.

In a new study published online in the Journal of Clinical Oncology on March 14, Weill Cornell researchers report on more than 1,000 TESE procedures on nearly 900 men, including 73 cancer patients.

The researchers retrieved sperm in 27 (37%) of the cancer survivors, which led to the birth of 20 children using IVF techniques.

If you have cancer, the type of cancer and type of chemotherapy you receive affects your chances of successful sperm retrieval. For men with testicular cancer who received platinum drugs, the sperm retrieval rate was 85%. Men with lymphoma treated with an alkylating agent such as cyclophosphamide had lower retrieval rates, ranging from 26-36%. Sarcoma patients had the lowest retrieval rate, only 14%.

“When we started this study, we thought sperm retrieval rates would be close to zero among the group of cancer survivors, but we were surprised to discover that in many cases small areas of testicular tissue survived and resumed sperm production over a period of several years,” said lead author Peter Schlegel, MD, chairman of the Department of Urology at Weill Cornell Medical College, in a press release about the study.

“This study gives men a new way to achieve fertility and the potential of parenthood. Survivors of childhood cancer should be made aware of options besides using banked sperm, adoption or donors if they want to be fathers,” noted Lisa Diller, MD, Associate Professor of Pediatrics, Harvard Medical School, in the release.

Because the numbers of sperm retrieved from the testicles of cancer survivors are low, TESE is best performed at the time of egg retrieval so that fresh sperm can be immediately injected into the egg using ICSI. Any extra sperm can be frozen and preserved for future use.

Adding Acupuncture to IVF

More and more infertile couples are turning to holistic techniques to increase their odds of conception and to cope with the stresses of trying to conceive.

There is increasing evidence of the effectiveness of alternative medical approaches. Some fertility clinics recommend that couples introduce yoga, relaxation, and nutrition into their fertility treatment plans, or, in difficult cases, to try acupuncture in addition to assisted reproductive technologies, such as in vitro fertilization (IVF).

As a fertility treatment, acupuncture is said to increase blood flow to the uterus, relax the cervix, and help stabilize the nervous system to allow the body to handle stress better.

The effects of acupuncture may also be based on brain chemistry. Acupuncture may help to improve a woman’s chances of conceiving by balancing the hormones released by the brain. In 2002, Weill Cornell researchers, including Dr. Zev Rosenwaks, searched the medical literature and found a clear link between acupuncture treatments and increased production of endorphins, the body’s natural pain-killing brain chemical.

The studies they reviewed suggested that certain effects of acupuncture are mediated through endorphins, and the endorphins influence secretions of reproductive hormones. So it’s logical to hypothesize that acupuncture may influence ovulation and fertility.

This new blog post says prominent acupuncturist Jin Jin Hua asserts acupuncture can be used in conjunction with IVF to further enhance your fertility chances to a “surprising success rate of 60% among infertile women.”

Since IVF pregnancy rates are at about 50%, adding acupuncture might boost a woman’s chance of having a baby by about 10%.

But the jury is still out as to whether acupuncture can help increase your chances of getting pregnant with IVF, based on very mixed results of clinical trials.

While there are still some unresolved issues about acupuncture and IVF, it’s unlikely that acupuncture does any harm, and probably does reduce the stress associated with fertility treatment.

If you do decide to try acupuncture, always check on the training and qualifications of the acupuncturist. The National Certification Commission for Acupuncture and Oriental Medicine can help you locate a board-certified, licensed acupuncturist in your area.

What’s your experience in using acupuncture along with IVF?

No Need to Stress Out Over Fertility

Does stress affect fertility?

A body of evidence continues to build about the effects of chronic stress on a woman’s ovulation and a man’s sperm production. Stress may lead to a cascade of hormonal events that led to inhibition of the body’s central reproductive hormone signal, and subsequently disturb ovulation or sperm production and sexual activity, write Weill Cornell fertility doctors Drs. Zev Rosenwaks and Marc Goldstein in A Baby at Last!

Humans are designed to endure acute stress. That’s a part of life. But the significant amount of stress couples endure, cycle after cycle, as they attempt to conceive may disrupt reproductive function. Normal fitness and diet routines may fall by the wayside, leading to a more frazzled, stressed lifestyle. Putting this into Eastern philosophic terms, if you are not in harmony with yourself and your culture, you are stressed.

However in studies attempting to make a direct connection between stress and lower in vitro fertilization success rates, the results are mixed.

A new meta-analysis of 14 studies and more than 3,500 infertile women undergoing assisted reproductive treatment found emotional distress did not affect their chances of becoming pregnant. In the Feb. 24, 2011 online edition of the British Medical Journal, Cardiff University psychologists conclude: “The findings of this meta-analysis should reassure women and doctors that emotional distress caused by fertility problems or other life events co-occurring with treatment will not compromise the chance of becoming pregnant.”

We still need more information to determine the exact relationship between stress and its effects. It may be helpful for couples to know that anxiety and depression won’t necessarily ruin their chances of having a baby.