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Huntington Reproductive Center - Blogs

The HRC Fertility Blog is a resource for patients and those seeking infertility related issues and articles. Check back often or subscribe to this blog as it is changed weekly by the HRC staff.

Human Oocyte Cryopreservation

Human Oocyte Cryopreservation
John G. Wilcox, MD, FACOG - Huntington Reproductive Center
By John G. Wilcox, MD, FACOG Board Certified, Reproductive Endocrinology and Infertility

Introduction

Human oocyte cryopreservation, or “egg freezing,” has long been an elusive goal of cryobiologists. Although sperm and embryos (fertilized eggs) have been successfully frozen and subsequently thawed to create healthy children for decades, egg freezing has only recently become a successful reality. The cryopreservation of human oocytes is highly beneficial for several reasons, most importantly to preserve a woman’s fertility. Oocyte storage allows: (i) women at risk of becoming sterile due to cancer to preserve their oocytes prior to radio- or chemotherapy or ovariectomy; (ii) the salvage of an in-vitro fertilization (IVF) cycle when no sperm is available; (iii) the alleviation of religious and ethical concerns of embryo storage; (iv) the elimination of donor-recipient synchronization problems; (v) a “quarantine period” on donated oocytes similar to that of donated semen; and (vi) women to delay reproduction until later in life, providing them with more reproductive choices.

Background Information

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Non-surgical Alternatives for Men Desiring Children Following a Vasectomy

Non-surgical Alternatives for Men Desiring Children Following a Vasectomy
Michael Feinman, MD, FACOG - Huntington Reproductive Center
By Michael Feinman, MD, FACOG Board Certified, Reproductive Endocrinology and Infertility

In the late 1980’s, Dr. Sherman Silber in St. Louis, proved that sperm obtained directly from the scrotum could be used to successfully fertilize eggs and achieve viable pregnancies. While this procedure was originally intended for men who are born with an obstruction in the genital tract (congenital absence of the vas deferens), it has become clear over the past decade that men with previous vasectomies can benefit from similar procedures as well.

The development and maturation of sperm occurs in the testes. The testes also produce most of the testosterone in men. The sperm begins its trip in the male through an enlarged portion of the ducts called the epididymis. This duct eventually becomes the vas deferens (vas). Along the route of the vas, the prostate and seminal vesicles add the fluid portion

of the ejaculated semen. When a vasectomy has been performed, the vas deferens is blocked before the area where the seminal vesicles add the fluid. That is why these men still produce semen, but no sperm. Dr. Silber microsurgically removed sperm from the epididymis and achieved viable pregnancies through assisted reproductive procedures, thus proving that sperm do not have to make the trip through the ducts to achieve fertilizing potential.

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Ovarian Aging and Infertility

Ovarian Aging and Infertility
Jane Frederick, MD, FACOG - Huntington Reproductive Center
Live Births Per Transfer
by Jane Frederick, MD, FACOG Board Certified, Reproductive Endocrinology and Infertility

The decrease in female fecundity beginning after the age of 30 and exaggerated after 40 is a well documented finding. This age-related decline in fertility is the result of several factors that contribute to overall reproductive failure. Women over 35 require a longer period to achieve conception than younger women, and a higher percentage of older women will never achieve pregnancy. In addition, the rate of early pregnancy wastage increases substantially during the 30's, and is over 50% after age 40.

With the aging of the baby boom generation and social trends to delay childbearing, the treatment of women =40 years of age who desire fertility has become a major challenge of today’s fertility specialists. For many women, the option to exercise other choices while deferring their reproduction has resulted in the need to use new reproductive technologies while treating their infertility. These technologies include controlled ovarian hyperstimulation (COH), intrauterine insemination (IUI), and assisted reproductive techniques (ART).

Literature Review

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Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS)

Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Screening (PGS)
By Barry Behr, PhD, HCLD

Introduction

Preimplantation genetic diagnosis (PGD) and screening (PGS) refer to the procedures involved in obtaining genetic makeup of the embryo(s) prior to their transfer into the uterus.

Genetic errors arise from deletions or insertions of genetic material, abnormal numbers of whole chromosomes or genes, and even from misplacement of a single base in the DNA sequence. Genetic abnormalities can range from relatively harmless to severe: from vitamin deficiencies and food allergies to cancer, birth defects and infant mortality. In recent years, significant advances in technology have enabled researchers to trace many disorders and diseases to their roots in the genetic code. Chromosome stretches, or even isolated genes, can now be used as markers to identify individuals at risk for certain illnesses. Additionally, the Human Genome Project, which aims to identify the chromosome location and DNA sequence of every human gene, is providing an ever-expanding catalogue of potential genetic markers along with the OMIM data base (Online Medelian Inheritance in Man). The ability to recognize these genetic warning signs is rapidly becoming the most effective tool for prevention, diagnosis and treatment of genetically based disorders.

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Preserving Reproductive Options in Oncology Patients

Preserving Reproductive Options in Oncology Patients
Bradford Kolb, MD, FACOG - Huntington Reproductive Center
By Bradford Kolb, MD, FACOG Board Certified, Reproductive Endocrinology and Infertility

Introduction

Over the last several decades we have witnessed a significant increase in survival rates for oncology patients. Due to the use of combination chemotherapy and radiotherapy many young patients are now living long, healthy, productive lives. While combination regimens have been designed to avoid acute toxic effects, many have resulted in unanticipated gonadal toxicity (harm to sperm or eggs). As such, an increasing number of cancer survivors are now facing difficulties in having families as well as hormonal deficiencies.

Preservation of Reproductive Options in Men

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The Contemporary Fertility Evaluation

The Contemporary Fertility Evaluation
Daniel Potter, MD, FACOG - Huntington Reproductive Center
By Daniel Potter, MD, FACOG Board Certified, Reproductive Endocrinology and Infertility

Introduction

Infertility is a complex medical, emotional and social condition that afflicts more than four million reproductive-age couples in the United States. Successful fertility treatment includes not only achieving pregnancy, but also achieving it in the most efficient and cost effective manner possible. The frequently ignored psychological toll of repeated treatment failures must also be considered. To achieve success, it is imperative that a timely and complete evaluation of both partners be performed. As our knowledge of reproductive physiology has expanded, the fertility workup has evolved as well. In this article, the contemporary fertility workup will be discussed. Attention will also be given to organizing the evaluation to prevent unnecessary testing.

Evaluation of the Male

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Third Party Parenting

Third Party Parenting
Michael Feinman, MD, FACOG - Huntington Reproductive Center
By Michael Feinman, MD, FACOG Board Certified, Reproductive Endocrinology and Infertility

Since the very first IVF procedure, the theoretical ability to perform egg donation or gestational surrogacy has existed. It took doctors and society a few years to realize this fact and embrace the concept. Considering the wide variation in the legal status of egg donation and surrogacy throughout the world, it is also clear that not all societies have fully accepted these alternatives. In the U.S., especially in California, these procedures are helping many couples have children when they may not have been able to in the past. In addition, their high success rates demonstrate the true potential of assisted reproduction when all factors have been optimized.

This article will review the medical indications for both egg donation and surrogacy. We will briefly consider how egg donors and surrogate mothers are chosen and screened.

Since the process for egg donation and gestational surrogacy are actually similar, we will discuss them together. Finally, a few thoughts about the legal and ethical aspects of third party parenting will be considered.

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Treatment Options for Those Who have Failed Assisted Reproductive Technologies

Treatment Options for Those Who have Failed Assisted Reproductive Technologies
Bradford Kolb MD, Huntington Reproductive Center
By Bradford Kolb, MD, FACOG Board Certified, Reproductive Endocrinology and Infertility

Reproductive medicine has expanded treatment options to many who would otherwise not be able to have children. Despite these advances, many still experience challenges and the emotional distress of unsuccessful treatment. While some continue treatment, others succumb to these stresses and give up pursuing treatment or seek unproven therapies.

First and foremost, it is important to stress that the lack of success is not the patient’s fault. Nor does it mean that a carefully thought-out treatment plan will always be successful. Often it is in a couple’s best interest to take a step back and take a break from treatment. Taking time to “reconnect” with your partner is vital to a healthy relationship. It is also vital that your physician take a second look at your case, reviewing your records and course of treatment to date. It may be necessary to pursue further testing or to update some tests. It may be necessary to change course in your treatment or it may be determined that you are on the right track. Much of fertility is about the numbers...in other words, with continued treatment, many will find success. Even under the very best of circumstances, there is no guarantee that a treatment will result in a successful pregnancy.

For the male, an in-depth evaluation of the sperm can yield useful information. Beyond the routine semen analysis, it may be necessary to evaluate the chromosomes for evidence of environmental stresses. Excessive exposure of the testis to heat or to environmental toxins can result in fragmentation of the chromosomes, thus compromising the opportunity for a successful conception. The Sperm Chromatin Structure Assay (SCSA) evaluates the chromosomal structures for any evidence of excess stress. When abnormal results are uncovered, it is important for the male to undergo a complete evaluation, looking for any abnormal blood flow patterns to the testis or environmental exposure to toxins. Exposure to smoking and excessive heat should be avoided. Dilated blood vessels to the testis may need to be removed. When these measures are unsuccessful, there is evidence that reveals the direct extraction of the sperm from the testis may improve treatment success. The extraction of sperm, Testicular Sperm Aspiration, is a painless office procedure that is performed under anesthesia, which allows for removal of newly produced sperm before it is adversely affected by negative factors.

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What to do with Frozen Embryos

What to do with Frozen Embryos
Jane L. Frederick MD, Huntington Reproductive Center
by Jane L. Frederick, MD, FACOG Board Certified, Reproductive Endocrinology and Infertility

Couples going through infertility have many decisions to make. For couples who have gone through in-vitro fertilization (IVF) and have extra frozen embryos which they no longer need, the decision of what to do with their frozen embryos is difficult. They can choose to have the IVF clinic thaw and discard the embryos, donate them to research, or donate them to another infertile couple (embryo donation). Not all infertility practices have active embryo donation programs. Currently, HRC Fertility is not participating in embryo donation, but referrals to National Embryo Adoption or Snowflakes Agency are available upon request.

Recently, a 2002 SART-RAND survey was generated by the IVF clinics in the United States documenting the number of embryos stored and their current disposition. Nearly 400,000 embryos are stored, the majority of which (88.2%) are targeted for patient use. Patients are holding these embryos in storage for future use in helping them get pregnant. Less than 3% of couples are willing to donate to research, and just over 2% are in storage for embryo donation.

In addition, there is a lot of debate about human embryos in the media today. Embryos have stem cells, almost magical cells that can become any tissue in the human body. Researchers say stem cells might one day be used to save adult lives, and many academic centers are boosting their efforts to become a major center in this hot branch of biomedical science. In 2004, California voters agreed to pay for stem cell research when they approved Proposition 71.

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Assisted Hatching

Assisted Hatching
Dr. Jeffrey Nelson, Huntington Reproductive Center
By Jeffrey Nelson, DO, FACOOG 

There are a multitude of factors contributing to a couple’s inability to conceive, including male factor, uterine factor, tubal factor, pelvic factor, and ovulatory dysfunction. The majority of these factors can be circumvented through the application of advanced reproductive treatments like in-vitro fertilization (IVF). The success of IVF depends on three primary components: good quality embryos, a technically uncomplicated embryo transfer, and a receptive intrauterine environment for embryo implantation. When we talk about “good quality embryos” the two most common criteria discussed are rate of embryo growth, and embryo grade. The rate of embryo growth is determined by the number of cells, or blastomeres, contained within the embryo on a specific day of development. For example, on the third day following egg collection and insemination, an appropriately developing embryo should consist of six to eight cells. It is believed that embryos growing at a slower rate havea less favorable chance of implantation. The grade of the embryo is determined by the appearance of the individual blastomeres. A high-grade embryo contains blastomeres that are symmetrical in size and shape, without evidence of intracellular fragmentation. Conversely, embryos made up of asymmetrical cells with a significant degree of fragmentation, are less likely to successfully initiate a pregnancy.

There is another critically important component of the embryo that does not get as much attention. This important structural component is the elastic outer shell, which surrounds the embryo, known as the zona pellucida (ZP). The ZP is formed from a matrix of various proteins that are secreted by the egg, and in photographs appears as a translucent halo enveloping the embryo. The ZP has several important functions. During the process of fertilization, it serves to prevent the access of more than one sperm to the egg. Following fertilization, the ZP keeps the cells of the embryo together during early development, until the embryo reaches the blastocyst stage. At the blastocyst stage, the embryo has enough structural integrity that it no longer needs the protection of the ZP. In fact, it is mandatory that the blastocyst break free of the ZP, once it is in the uterine cavity, in order to successfully implant within the uterine wall.This eventual escape from the ZP by the expanding blastocyst is calledembryo hatching.

Standard IVF protocols include culturing of embryos within the laboratory for three days, followed by transfer of cleavage stage embryos (6 to 8 cells), on Day 3, to the uterine cavity. Following transfer, the embryos must continue to progress to the blastocyst stage, shed the ZP, and embed into the uterine wall. In 1989 Cohen and his co-investigators observed a higher implantation rate in patients undergoing IVF, who had the ZP of their embryos mechanically opened. They therefore hypothesized that artificially creating a gap in the ZP might serve to facilitate embryo hatching and implantation. Microscopic manipulation of the ZP, in order to augment hatching and implantation, subsequently became known as “assisted hatching”. Prospective randomized clinical studies have been performed in order to evaluate the effectiveness of assisted hatching. Several studies report a significant increase in embryo implantation and clinical pregnancy rates, in select groups of patients whose embryos have undergone this procedure. These select patient groups include women greater than 38 years of age, those with elevated Day 3 FSH levels, couples with previous IVF failures, embryos with an abnormal appearing zona pellucida, and when using previously cryopreserved embryos. Some IVF programs will globally perform assisted hatching on all embryos prior to transfer, but the data on this are less clear.

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Alternatives For Ovulation Induction and Superovulation: SERMs and Aromatase Inhibitors

Alternatives For Ovulation Induction and Superovulation: SERMs and Aromatase Inhibitors
David E. Tourgeman, MD
By David E. Tourgeman MD, FACOG Board Certified, Reproductive Endocrinology and Infertility 

Introduction

Ovulatory dysfunction is one of the most common causes for reproductive difficulty in otherwise fertile couples. Once successful ovulation is achieved, fertility is often restored. For many years, the first line of pharmacologic ovulation induction has involved the use of selective estrogen receptor modulators (SERMs), of which clomiphene citrate (CC) has been most extensively studied. The first trial of CC resulted in successful ovulation induction in approximately 80% of women, and ultimately half were able to achieve pregnancy. (1) The use of CC for superovulation in patients with unexplained infertility (2)  has also been the mainstay when coupled with intrauterine insemination. Yet despite advances in ultrasonographic technology, hormone assays, and urinary leutinizing hormone kits, success with CC has not changed dramatically. Therefore, it is important that we evaluate our options for ovulation induction and superovulation.

SERMs

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HRC Fertility Baby Reunion Picnic 2012!

HRC Fertility Baby Reunion Picnic 2012!

HRC Fertility Physicians Dr. Jane L. Frederick, Dr. Daniel A. Potter, Dr. Mickey S. Coffler, and Dr. N. Edward Dourron and staff look forward to seeing you, the family and our littlest miracles for a family-friendly, fun filled day on October 14, 2012!

Click here for complete program information!

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Thank You for Attending the 2012 Miracle of Life Picnic!

Thank You for Attending the 2012 Miracle of Life Picnic!

HRC Fertility Encino thanks everyone who participated in this years Miracle of Life Picnic. Despite the heat we had so much fun and look forward to seeing everyone next year!

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Dr. Nelson hosted webinar about untangling the term "embryo quality" and the significant traits that impact to pregnancy success using donor embryos.

Dr. Nelson hosted webinar about untangling the term "embryo quality" and the significant traits that impact to pregnancy success using donor embryos.
Dr. Jeffrey Nelson

Dr. Jeffrey Nelson and Embryoadoption.org hosted a webinar 9/19 untangling the term "embryo quality" and the significant traits that impact to pregnancy success using donor embryos. More webinars to come. Registration is required.

Click here to view all upcoming webinars on Embryoadoption.org.

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Dr. Daniel A. Potter speaks on "Choosing the sex of your baby has become a multimillion-dollar industry" on Slate.com

Dr. Daniel A. Potter speaks on "Choosing the sex of your baby has become a multimillion-dollar industry" on Slate.com
Dr. Daniel Potter

Megan Simpson always expected that she would be a mother to a daughter.

She had grown up in a family of four sisters. She liked sewing, baking, and doing hair and makeup. She hoped one day to share these interests with a little girl whom she could dress in pink.

Simpson, a labor and delivery nurse at a hospital north of Toronto, was surprised when her first child, born in 2002, was a boy. That’s okay, she thought. The next one will be a girl.

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Fertility Treatment for Women over 40

Fertility Treatment for Women over 40


b2ap3_thumbnail_DrNelson.JPGBy: Jeffrey Nelson, DO FACOOG

 
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Dr. Jane Frederick speaks on "Weight and Obesity When Trying to Get Pregnant"

Dr. Jane Frederick speaks on "Weight and Obesity When Trying to Get Pregnant"
Dr. Jane Frederick

Weight can seriously affect a couple's chance of getting pregnant. Twelve percent of all infertility issues are weight related and being overweight and/or underweight has unique consequences for men and women. The goal of fertility specialists is to understand the relationship between weight and infertility with each fertility patient and then working to eliminate non-disease factors. Obesity impacts conceiving naturally and your IVF treatments. 

Obesity has also and has been associated with the following early pregnancy loss after IVF, a decreased pregnancy rate, decreased fertilization, higher gonadotropin requirements and an impaired response to gonadotropins.

When reviewing fertility issues, couples must factor in the length of time they have been trying to conceive, their age, weight and lifestyle. Many factors contribute uniquely to each patient and couple. There are a significant number of obese women who suffer from fertility issues. This could be because of irregular periods and frequently anovular (non-ovulatory) menstrual cycles. A large percentage of obese patients suffer from PCOS (Poly Cystic Ovarian Syndrome) a disorder commonly associated with obesity.

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Making the Decision About Family Balancing

Making the Decision About Family Balancing
Dr. John Wilcox

By: John Wilcox, MD FACOG 

Numerous factors lead couples to make the decision to balance their families using PGD, the gender selection technology. For some it may be the desire to raise a child of each sex and others may already have several children of the same gender and desire a child of the opposite sex to balance the family. Many patients undergoing fertility treatments for the second time and parents in their forties, also consider family balancing since they are likely to have small families. As you can see, the reasons for family balancing are varied but many people share conflicting emotions about making the decision. Some feel guilty and question whether it is ethical to select the gender of a child for family balancing. Others worry that they are playing God.

It is only natural to have a vision of your ideal family and want to see it realized.  Let’s face it, raising a boy is different than raising a girl and it’s ok to want to experience both. However, couples need to talk openly with each other about their feelings, however conflicted. Both partners need to look at their underlying emotional reasons for wanting to balance their families. For instance, if a woman wants a girl to share her love of fashion or a man wants a son to go to baseball games with, these parents may be disappointed if their children don’t live up to their preconceived notions. A good place to start the process of family balancing is discussing your feeling with your fertility doctor and a family counselor. Remember, always use counseling as a resource, not a last resort.

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Fertility Drugs’ Link to Breast Cancer Hinges on Pregnancy, Study Says

Fertility Drugs’ Link to Breast Cancer Hinges on Pregnancy, Study Says
Dr. John Wilcox

By: Dr. John G. Wilcox, M.D. FACOG

Study suggests fertility drugs may not pose a significant increased risk of developing breast cancer

A recent study published by the National Institutes of Health recently reported their results of 3000 women studied comparing 1400 women diagnosed with breast cancer before age 50 and 1600 of their sisters who never had breast cancer. Of the 3000 women studied, 288 reported using fertility drugs. 141 of the 288 women reported a pregnancy lasting 10 weeks or more. Results suggested fertility drug use without a subsequent pregnancy may slightly lower the risk of developing breast cancer before age 50. Of those women reporting a pregnancy following treatment, there was little difference in risk compared to women who never took fertility drugs at all. This is the latest study to suggest a marginal impact of fertility medication on breast cancer incidence. Dr. John G. Wilcox, M.D. FACOG, Laboratory Director of HRC Fertility, Pasadena, CA.

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Dr. Edward Dourron discusses on OC Register (Hoag Health) "Eight Things We Learned from Ocotomom"

Dr. Edward Dourron discusses on OC Register (Hoag Health) "Eight Things We Learned from Ocotomom"
Dr. N. Edward Dourron

A year ago, the Medical Board of California revoked the license of Dr. Michael Kamrava, finding he "did not exercise sound judgment" in transferring 12 embryos to Nadya Suleman, who already had six children at home. The ruling, while not surprising, was illuminating, and it's worth reflecting on the eight things we learned from Octomom:

1. Know How to Say No: There is a point where physicians have to make a judgment call. Pregnancies with triplets – let alone eight infants – put the mother at high risk of serious medical complications and put unborn children at risk for developmental disabilities. Doctors need to rely on their professional expertise and experience to know when to turn a patient down.

2. Beware the Patient with Tunnel Vision: Often when a patient comes to a fertility doctor, unsuccessful pregnancy attempts have made her anxious and determined. She might want to get pregnant even if she has underlying conditions that could put her or her baby at risk. Doctors have learned to be vigilant about preconception counseling and medical testing to determine whether patients are healthy enough to pursue pregnancy.

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