You may be surprised to find out that in many cases, the first step in the IVF process is to take birth control pills. Though this seems to be counter-productive to your goal of getting pregnant, there are several reasons why they are used.
One of the hardest parts of being an embryologist is having to tell a patient that, after all their hard work getting their eggs ready for retrieval, there is nothing good to report the next morning when we check the eggs for fertilization. Hopefully this never happens to you.
But there are times when we have to make that unfortunate call to patients waiting to hear about fertilization. While we expect, statistically speaking, about 75% of mature eggs to fertilize, sometimes it happens where none fertilize, despite all of our best efforts in the lab. Why does this happen? And more importantly, is there anything that can be done after the fact?
Good eggs and a healthy embryo aren't enough to assure pregnancy during IVF. A receptive uterine lining (endometrium) is also critical for successful implantation after embryo transfer. A commonly used parameter for assessing the endometrium is to measure its thickness (endometrial thickness, EMT).
During the stimulation phase of IVF, EMT usually increases in response to estrogen released by the ovaries. EMT is now routinely measured using transvaginal ultrasound during in vitro fertilization (IVF).
When undergoing an IVF cycle you have a lot on your mind. If you are like most people, egg quality is typically not first on the list.
However, egg quality is one of the single most important aspects of a successful IVF cycle. With high egg quality, IVF is more likely to succeed. Good quality embryos come from good quality eggs.
The treatment of male factor infertility was revolutionized in 1992 when Palermo and co-workers introduced intracytoplasmic sperm injection (ICSI). With ICSI, embryologists use a micromanipulator to inject sperm directly into the egg (that has been retrieved as part of an IVF cycle). It was now possible for men with severe male factor infertility to father a child. ICSI can be used even in cases where the wife produces more eggs than the husband produces sperm!
Using high magnification, an oval-appearing motile sperm is selected for ICSI. When a sperm is motile-- moving and swimming-- it indicates that it is viable and therefore is capable of fertilizing the egg.
“My doctor said that my embryos looked picture-perfect, yet they failed to implant – why did this happen?”
This is the question in the minds of women who undergo IVF failure, and this becomes a particularly nagging doubt when they face multiple IVF failures. Many women naturally think that their uterus is defective or their body is not good enough to accept the embryo-- that their uterus is rejecting the transferred embryo, or their own body is killing it. After all, fertilization happened in the lab, the embryo grew well in vitro, and they even saw their embryo (remember, you must always see your embryos and ask for photos before embryo transfer!).
The embryologist assured them that they looked perfect, and they’ve read lots of IVF success stories of women who got pregnant with such good embryos. As a result, they naturally come to the conclusion that good embryos are meant to implant – and if they didn’t, this clearly means there’s a problem with their uterus or their body.
One of the commonest questions I get is from women with low AMH (anti mullerian hormone) levels who are having trouble getting pregnant. These women are often frantic and worried that they will never be able to get pregnant.
They often feel that having a low AMH level is the end of the world and it makes pregnancy impossible. Not necessarily true! Read on.
While all IVF patients understand that not every IVF cycle results in success, in their heart of hearts, every patient wants to get pregnant every cycle. After months or years of having trouble getting pregnant, the two weeks after the embryo transfer can seem like an eternity and can be very nerve-wracking.
Am I pregnant or not? Have the embryos implanted or not?
The suspense can be even worse than the pain of the IVF injections!
Polycystic ovary syndrome (PCOS)is the most common cause of infertility in women. PCOS is often associated with obesity. Obesity, however, is NOT a diagnostic criteria for PCOS, as it can also occur in normal weight women.
At InVia Fertility Specialists, we often encourage our patients who are overweight for their height to lose weight prior to proceeding with fertility treatment. The resultant delay in treatment can be frustrating for patients. However, does pre-treatment weight loss improve outcomes?
This very question was addressed by researchers working with Penn State University's College of Medicine in a large, multi-center trial ("Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS." Legro, et al; J Clin Endocrinol Metab 2016 Jul;101(7):2658-66).
Fertility drugs have been routinely used for ovulation induction for many years now. Many women do not ovulate or ovulate infrequently. In these women, fertility drugs are used to make them ovulate regularly. Another group of patients from whom fertility drugs are used are those with unexplained infertility, mild male factor or endometriosis. In these patients, fertility drugs are used to stimulate the ovaries to produce more than one egg, increasing the chance of conception.
There is an obesity epidemic in America today. More than four in ten women of reproductive age are overweight or obese. Obesity increases the risk of a number of health conditions: high blood pressure, diabetes, cholesterol problems, heart disease, breathing problems, joint problems, and cancer, and of dying early. (I have discussed the definition and grading of obesity in previous posts.)
The Practice Committee of the American Society for Reproductive Medicine (ASRM) recently published a report that included the effects of obesity on in vitro fertilization (IVF) success rates. Here is a brief summary of seven key findings.
Fertility drugs are used to stimulate the ovaries to produce multiple follicles. Their use is associated with multiple ovulations and often with high estrogen levels. It would therefore be reasonable to ask, “Do fertility drugs cause cancer?”
This is an important issue as there are approximately one million IVF cycles reported per year worldwide. In addition, there are an unknown number of ovulation induction cycles.
The technologies for successfully freezing embryos have now been available for more than twenty-five years.
With improved freezing techniques, the success rates with frozen embryo transfer (FET) are now equal to or even better than those achieved with the transfer of fresh embryos. The pregnancy outcomes with frozen embryos also seem to be better than their fresh counterparts.
A common question I get asked is “How many embryos should I transfer?” Most of my patients want to get pregnant as soon as possible, and a significant percentage actually want twins.
The logical answer, therefore, would be to transfer more than one embryo to achieve this outcome. However, this may not be the correct answer. Read on!
Letrozole (marketed as Femara in the U.S.) is a drug that is approved for the treatment of breast cancer after surgery. It is also used (“off label”) for ovulation induction. I have discussed its mechanism of action and success rates in a previous blog, as well as use of Letrozole versus Clomid for patients with PCOS. Despite its obvious advantages, Letrozole is used infrequently by fertility specialists in the U.S. A major reason for this is a controversy about the use of Letrozole and birth defects in the resultant children.
Anti-mullerian hormone (AMH) is a commonly used biomarker of ovarian reserve. AMH levels decrease with age and reach undetectable levels approximately 5 years before menopause. AMH levels are thought to have minimal within-menstrual cycle variation compared with inhibin-B or follicle stimulating hormone (FSH). Unlike FSH levels, which are drawn on cycle days 2, 3 or 4, AMH levels can be drawn on any day of the cycle. Is this really true?
I’m often asked by donors how many cycles they are allowed to do and the answer is always six. But where did that number come from? Did we make it up? Can they go somewhere else and do more?
As with smoking cigarettes, there's a connection between marijuana and fertility, and it's not a good one. Use of marijuana has a negative impact on trying to conceive, for both male and female users, for daily and occasional users alike.
While avoiding marijuana use is crucial if you're trying to get pregnant, you do not need to be using marijuana at the time you're trying to conceive in order for marijuana use to impact fertility. Using marijuana now can affect your ability to conceive in the future.
Early pregnancy bleeding is fairly common and occurs in 20 – 30% of pregnancies. Vaginal bleeding in early pregnancy can be worrying, so it's only natural that if it happens to you, you're concerned about your baby, especially if you've had trouble getting pregnant and maintaining a pregnancy. It doesn't always mean that there's a problem, however, it can be a warning sign of a miscarriage or recurrent pregnancy loss. Here are the top five facts you should know about early pregnancy bleeding:
Tubal pregnancy is possible regardless of how you get pregnant. But there are some unique aspects to tubal pregnancy that pertain to cases in which IVF is used. Here are ten interesting facts about IVF and tubal pregnancy:
1) A tubal pregnancy (also called an ectopic pregnancy) is a pregnancy that is implanted outside the uterus. During in vitro fertilization (IVF) embryo(s) are transferred into the uterus. However, subsequent uterine contractions can squeeze the embryo(s) into the tube where they can implant and result in a tubal pregnancy.
A recent study showed the majority of parents of egg donor conceived children intend to tell their children – but many put off that conversation.
If you've used an egg donor, there are many things to consider when deciding whether and how to tell your child how they were conceived. In this blog, I'll discuss the main pros and cons of telling your child, and some key considerations about when to tell them.
One major topic of discussion between a couple who is using an egg donor is whether or not they are going to disclose this information to their children later.
As the egg donor coordinator at InVia Fertility Specialists, I work regularly both with parents who plan to disclose and those who do not.
Topics: Egg donation
In a previous blog we discussed the expected ultrasound findings in a normal intrauterine pregnancy. Variations from the expected pattern of development are worrisome or, if major, definitive for early pregnancy failure or miscarriage. These were discussed in a recent review article by Doubilet et al. (N Engl J Med 2013;369:1443-51). Here is a summary:
Premature ovarian failure (POF) or premature ovarian insufficiency (POI) is defined by loss of ovarian activity before the age of 40 years. It is characterized by menstrual disturbance (absent or irregular menses) with increased follicle stimulating hormone (FSH) and low estradiol levels.
For more than a decade, we have been screening embryos for chromosomal number abnormalities (aneuploidy) at InVia Fertility Specialists. The technical term used for this process is preimplantation genetic screening (PGS) or pre-implantation genetic diagnosis (PGD). By screening out “abnormal” embryos we are now routinely able to achieve excellent pregnancy rates with transfer of single embryos and thus significantly reducing the incidence of multiple pregnancies. PGD or PGS, thus, is the smart thing to do so much that we have coined the term SMART IVF to describe them.
A uterine septum is a common anomoly of the uterus that is seen in 1 – 15 per 1,000 women (shown in the picture at right). In this condition, the cavity of the uterus is separated by a long piece of tissue, while the outside of the uterus has a normal shape.
According to several studies, treating a uterine septum is associated with an improvement in live-birth rates for women with prior pregnancy loss, recurrent pregnancy loss, multiple miscarriages, or infertility.
It is an established fact that risks associated with giving birth to babies conceived through IVF, are increased for both mothers and infants. Most of that increase in risk is related to the higher occurrence of multiple births. Currently, more than 30% of IVF pregnancies are twin or higher-order multiple gestations.
It is now more than 30 years since the first live birth after transfer of a frozen (cryopreserved) embryo (Zeilmaker et al., 1984). The ability to successfully freeze embryos had a profound impact on assisted reproductive technologies. It improved efficacy, encouraged the transfer of fewer embryos into the uterus and hence reduced complications arising from prematurity. Recent research indicated frozen embryo transfer babies do better than babies from fresh embryos.
When considering working with a fertility clinic, it is very important to review the clinic's IVF success rates. As a prospective patient, you need to know the clinic's success rates with fresh embryo transfer as well as, frozen embryo cycles, and donor egg cycles. 2014 was a very successful year for InVia's IVF program. The tables below represent IVF success rates in 2014 for all patients who had a non-donor egg, fresh and frozen embryo transfer at our clinic.
For those who have had trouble getting pregnant, once pregnancy is achieved it's important to do everything possible to improve embryo quality to maximize the chances of a successful outcome.
There are many choices to make in starting a family as a gay male couple. Let's say you've chosen a fertility clinic that has a track record of success serving same-sex couples, and you've secured an egg donor and surrogate. What’s next?
Topics: Egg donation
For same-sex male couples, planning a family starts with a lot of questions—about getting an egg donor, surrogacy, and other fertility treatment options. Some of these questions can be answered by you, while others require input from professionals.
Topics: Egg donation
Morning sickness in pregnancy is common. In fact, over half of women will vomit during pregnancy, and 80% will have some level of nausea. In most cases, these symptoms improve by the end of the first trimester. As any woman who has experienced morning sickness can tell you, even mild symptoms can have a real impact on a woman’s quality of life.
What is a varicocele?
A varicocele, or abnormally enlarged veins in the scrotum, are present in roughly 15% of the normal male population, jumping to 40% in men presenting with primary infertility, and 80% of men presenting with secondary male infertility (they have already fathered a child).
Embryo fragmentation is a fairly common occurance. It happens when there is an uneven division of the cells of the embryo.
It's as if you were breaking apart a piece of crusty bread. When you try to break the bread apart, crumbs or fragments are formed. These fragments are of no use to the embryo and are considered “junk” pieces of cytoplasm. The higher the degree of fragmentation, the lower the likelihood of pregnancy.
PCOS stands for polycystic ovary syndrome. It is a common condition related to an imbalance of hormones. It affects as many as 1 out of 15 women, and is a leading cause of infertility as well as other health problems. Getting pregnant with PCOS can be possible with the right diagnosis and treatment.
While many people understand why and how endometriosis causes infertility, fewer know whether endometriosis can cause cancer. This is one of the key questions addressed by a group of experts from The European Society of Human Reproduction and Embryology (ESHRE). The ESHRE Guideline Development Group recently published guidelines for management of endometriosis in patients, and this is what they conclude:
Anti-mullerian hormone (AMH) is a useful measure of the follicular supply in a woman. It is generally accepted that as a woman ages, the follicular supply decreases and AMH levels decrease. Blood (serum) AMH levels correlate to antral follicle count (AFC) and are more accurate than age and other routinely used blood tests (FSH, Estradiol, inhibin B) in predicting the ovarian response to fertility drugs.
ICSI is an acronym for intra-cytoplasmic sperm injection. In basic terms it means we are injecting a sperm into an egg. ICSI IVF differs from the conventional IVF process in that a single sperm is injected into an egg, instead of fertilization taking place in a dish where millions of sperm are placed near an egg.
You've been waiting for this for so long and at last your pregnancy test after IVF is positive. Now what happens? Well, in spite of the fact that you might want to shout the good news from a rooftop, it is probably best to be cautiously optimistic for now. A positive pregnancy test is just one step in the IVF process. You've cleared another hurdle, but there are still a few more to go.