4 Advances That Make IVF More Successful Than Ever

The world of fertility medicine is on the up and up. Couples dealing with the challenges of infertility can be as stressful as having cancer. Fortunately, the latest advances in in vitro fertilization (IVF) are giving them a better chance than ever of achieving their dreams.

What Is In Vitro Fertilization?

IVF is a medical and surgical approach to conception that involves fertilizing eggs outside a woman’s body. Normally, women produce one egg per monthly menstrual cycle, but IVF requires several eggs to increase the effectiveness of each procedure. To boost egg production, women take a series of medications over the course of two weeks.

Mature eggs are then retrieved during a minor surgical procedure in a physician’s office, and fertilized in the laboratory with the partner’s sperm. After about five days, one or two of the developing embryos are inserted into the woman’s uterus or, more and more these days, biopsied, frozen, and saved for future use.

IVF treats infertility caused by various factors, including damaged or blocked fallopian tubes, male problems (such as low or no sperm count), endometriosis, anatomic abnormality, or unexplained infertility. Increasingly, IVF is being used to preserve fertility (through egg and embryo freezing), as well as to diagnose fertility problems.

Advances in IVF

1. Genetic screening. The most important advances in IVF over the past several years involve embryo biopsy and genetic analysis, which help address the challenge of embryos that look good in the lab, but turn out to be chromosomally abnormal. Having too many or too few chromosomes increases miscarriage rates and the likelihood of problems like Down syndrome.

Traditionally, fertility doctors chose the embryos to place in a woman’s uterus according to a grading system based on their appearance. But even top-rated embryos can turn out to have chromosomal abnormalities. Using new techniques, we can now safely biopsy a few cells from each embryo, send them off for genetic screening, and freeze the embryos while waiting for results.

What we learn allows us to then select only chromosomally normal embryos for transfer, rather than relying on their appearance alone. This reduces the risk of miscarriages by about half.

In addition, couples at risk of having a baby with a genetic disease, such as Tay-Sachs, cystic fibrosis, or sickle-cell anemia, may undergo IVF to have their embryos genetically diagnosed and substantially reduce the odds of transmitting the disease to their children.

2. Single-embryo transfer. Another advantage of chromosomal screening is single-embryo transfer, a method that addresses a major criticism of the fertility industry: multiple pregnancy (twins, triplets, or more). For many years, it was standard practice to transfer two or more embryos at a time to maximize the chance of a successful pregnancy. This led to a rise in women carrying multiples, which increases the risk of serious maternal and fetal complications.

Since genetic screening tells us which embryos are more likely to lead to healthy pregnancies and babies, in many cases we can now select just one chromosomally normal embryo to transfer. Research has shown that even women up to age 42 can achieve an approximate 60 percent pregnancy rate with single-embryo transfer — about the same as with two embryos, but with drastically less risk of twins.

3. Frozen embryos. With the shift to chromosomal screening, embryos are increasingly being frozen and then thawed and transferred in a later monthly cycle. In a recent study published in the Journal of Assisted Reproduction and Genetics, my colleagues and I showed that transferring frozen-thawed embryos to a woman’s uterus during a normal monthly cycle is more likely to result in pregnancy and live birth than fresh embryos placed into a uterus stimulated with fertility drugs.

4. New medications. Another IVF advance involves the medication used to increase the production of eggs and speed their maturation. The traditional means of triggering ovulation is through injections of the pregnancy hormone human chorionic gonadotropin (hCG). However, hCG can be problematic for some women, as it sets the stage for ovarian hyperstimulation, a potentially dangerous condition.

As a result, a growing number of fertility centers are moving toward the use of gonadotropin-releasing hormone agonist (GnRHa), which stimulates the brain’s own luteinizing hormones (LH). LH is the body’s natural trigger for egg production. It circulates long enough to ripen and prepare the eggs for harvesting, but not enough to activate ovarian hyperstimulation.

A new study has identified another promising therapy that stimulates the body’s own LH. Researchers found that administering the hormone kisspeptin instead of hCG effectively triggers egg maturation while preventing ovarian hyperstimulation in women at high risk for the condition. Before kisspeptin becomes widely available, however, further research is needed to directly compare it with GnRHa.

The Sooner, the Better

As you can see, several exciting developments are enhancing the success of IVF. However, if you have fertility issues, the best thing you can do to increase your chances of getting pregnant and having a child is to seek fertility counseling earlier rather than later. Since you are born with all the eggs you will ever produce, and the egg supply dwindles as you age, the sooner you seek assistance, the more likely a fertility specialist will be able to help you.

 

Source: Tanmoy Mukherjee, MD
Associate Director, Division of Reproductive Endocrinology and Infertility,
Mount Sinai Health System;
Co-Director, Reproductive Medicine Associates of New York;
Assistant Clinical Professor of Obstetrics, Gynecology and Reproductive Science,
Icahn School of Medicine at Mount Sinai

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Hiiiiiii FET Cycle

Hiiiiii Mid Cycle FET! If you unfamiliar FET stands for FROZEN EMBRYO TRANSER, and I happen to be in the midst of mine!

For all you geeks out there that are not familiar with some of this verbiage let me educate you :: A Frozen Embryo Transfer (FET) is a cycle in which the frozen embryos from a previous fresh IVF cycle are thawed and then transferred back into the woman’s uterus. An Embryo is an unborn or unhatched offspring in the process of development. ::

Last time I posted, I was at the end of my egg retrieval cycle. Hubs and I were deciding if we were going to do another egg retrieval to bank more eggs or move forward with an embryo transfer. Because we have a decent number of healthy frozen embryo babies this time we were presented with a couple more options on how to proceed with this IVF cycle… We decided to move forward with a transfer!

A few reasons we decided to move forward are 1. I wouldn’t have to put my body through all those nasty stimulating meds again. Affordability and health wise I think this was a smart decision. 2. We still have our second egg retrieval as insurance if we are unsuccessful at getting pregnant with any of our frozen embryos we have now. Win. Win. 3. We thought we would have gotten 5 eggs total with two egg retrieval’s based on the poor results we had last year with our first IVF cycle. Again, whatever this doctor is doing is a miracle and my body responded 1,000,00o times better than last time. We consulted with our doctor and asked what he suggested as far as doing another retrieval or going straight to a transfer. He said lets do the transfer! 3. We prayed and talked about it a lot and we both felt like this was the time. I am feeling excited, scared, anxious, calm, confident, all in one… is that even possible?

I have to say a FET cycle is kind of boring and calm and easy peasy so far. Going from 4 shots a day to just 1 a day and 2 every other day is cake. I am trying to focus on getting my body (aka baby palace) ready for this transfer. I am feeling so incredibly calm so far, my family is actually in shock, which is hard to do. Getting the healthy embryo’s seemed like the hard part and now that, that is over I really just need to focus on my mind/body health so that when these little babes are implanted back in me they want to stick around for a while… 9 months to be exact. I say “they” because we have decided to transfer two embryo’s. Our solo boy and one of the girls. Transferring two increases your chance of pregnancy. Yes we could have twins, we actually have a chance for triplets and quads if any of the embryo’s decide to split, but those stats are extremely low. Bring it on at this point I guess! My transfer will be sometime between the last week of March and the first week of April.

For now I am keeping calm and carrying on by doing almost daily yoga, meditation, and prayer. Lots of prayer. I am living in the now and not thinking about the future or what could or could not happen. I have so much faith in our doctor, in our embryologist, in the timing, in God, in the process. I know how hard this process is and sometimes it is easy to get lost in it. Lately I have been embracing the process. I have been leaning into the tension, the areas that may be a little uncomfortable and I have found the strength and calm on the other side. (duh I got that last part from yoga… such a yogi nowwww).

Namaste sistas.

 

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I still cannot believe all the incredibly good news we have received this week…. Pinch me. There is a GOD! Holy moly.

First off, we found out my husband was offered a full time Fire/Paramedic JOB!! He has been working so hard for the past 5 years to get a permanent firefighting position. There were so many times we discussed throwing in the towel or maybe it was time to start pursuing something else, but he never gave up. His persistent and passion finally paid off and he starts March 1! Yaaayyy!

The next day we received the news about our embryo’s… We had 8 embryo’s that went to genetic testing and wait for it…

5 PERFECT FROZEN BABIES!!! 

4 GIRLS + 1 BOY

I can hardly believe it. We only had 1 good embryo last time. And this time 5!!! 4 girls whaaaaat???!!!! So crazy. So awesome.

We have a TON to think about now. Do we do another egg retrieval as planned and bank more eggs or move straight to a transfer since we have a good amount to work with? We are going to talk about it a lot. Pray about it a lot. And talk to our Doctor. We only have a week to make a decision, since I will need to start meds next Saturday if we are moving forward with a transfer… Eeekkkk!

Long story short I am so, so thankful and overwhelmed right now- in a good way. I feel like the pieces are finally starting to come together. I am so glad we did not give up on hubby’s dream and I am so glad we did not give up on the dream of starting a family. I know we still have a long road ahead with the IVF, but today is a good day.

I have been praying every single day for 4 years for these two things. It has felt like a lifetime. I guess timing is everything. It may be 4 years to me, but for God or universe or whatever you believe, time is irrelevant.  Psalm 90:4 “For a thousand years in your sight are like a day that has just gone by, or like a watch in the night.”

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Huevo Retrieval

My egg retrieval was this past Friday, February 5th. All went according to plan and I survived! This being my second egg retrieval, I was far less anxious, and I was even looking forward to that drug induced nap. Seriously, going under is kind of awesome.

I’m probably the most annoying drugged up patient. When I got rolled into the OR I remember talking and talking and talking and then I was out. The doctor probably asked the anesthesiologist to, “give this chick a little extra so she shuts up.” ( Next time they will probably put me out before I even make it into the room). I would be interested to know exactly what I was saying. Hubs told me that when I was coming to that I kept saying how good I felt and was asking if I could have some more. I do remember I kept asking the nurse the same two questions because for the life of me I could not remember what she said! She told us we had gotten 11 eggs, but I kept saying 13. We got 13? No honey 11. 13? No 11. I remember before my retrieval a girl came out of her own harvest and I heard them tell her she had 13 eggs. That makes sense now… hahaaaaa. Hubs also told me that while I was coming to I kept trying to talk but all that was coming out of my mouth was “djfhkdejeroijdfdekjen”. Oh and when hubs told me he loved me in my ear while I was still asleep a tear came from my closed eye and streamed down my cheek. I guess I can be sweet and cute when I am unconscious. Seriously, you can’t make this stuff up!!

I like to think of an egg retrieval as picking apples from an apple tree. My ovaries are the tree producing these beautiful, juicy apples. The apples are all my little follicles. The doctor is the apple picker. He is in charge of taking his apple picker tool thingy and plucking each apple gently, one at a time, off of the tree. Making sure not to bruise or drop the apple on the ground he gently places the apples, individually, into his bag or test tube in this case. Then the magic happens!

Results thus far:

11 eggs retrieved >>> 5 more than last time! Which is a significant amount.

9 mature

9 fertilized! >>> I guess Hubs and I really like each other. Fertilization does not seem to be our issue- last time all of our eggs fertilized as well.

We will find out today if the other 2 eggs matured and fertilized. The embryologist will try and mature eggs that aren’t fully there yet after they have been retrieved in the lab… who knew! I think this makes our clinic pretty cutting edge since our last clinic did not do this. It’s cool because they give every egg a chance! Crossing fingers and toes that we have more good news today xoxo

Here is a picture of me posing as usual before the surgery.

egg-retrieval-time-thank-you-all-for-your-prayers--good-vibes-ivf-ivf2-eggretrievalday-eggs-letsdothis-posingasusual-friyay_24530197829_o

 

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Genetic Testing

Genetic testing. What? How? Why? And is it playing God?

What is Genetic Testing? There are two types of genetic testing that can be done on  embryos. Both genetic tests are preformed on a day 3 or 5 prior to the embryo being transferred into the uterus. The distinction between the two types of testing: PGD and PGS.

  • PGD, preimplantation genetic diagnosis, involves removing a cell from an IVF embryo to test it for a specific genetic condition (cystic fibrosis, genetic disorders, cancer, for example) before transferring the embryo to the uterus.
  • PGS, preimplantation genetic screening, is the proper term for testing for overall chromosomal normalcy in embryos. PGS is not looking for a specific disease diagnosis – it is screening the embryo for normal chromosome numbers.

PGS is the more common genetic testing done in IVF. It basically tests for down-syndrome and sex chromosomal abnormalities (i.e. embryos with an extra sex chromosome). These are the two types of chromosome abnormalities that can result in a live birth- all other genetic chromosome abnormalities usually end in miscarriage or never lead to a viable pregnancy.

How is this process done? After the eggs are retrieved, they are then fertilized using ICSI. For 3 to 5 days these embryos will continue to grow and split. The embryos that are at the appropriate stage will be sent off for these genetic tests. We will be doing a biopsy called trophectoderm biopsy, which is performed on day 5 or 6 of embryo development. It is performed at the blastocyst stage after the embryo has differentiated into an inner cell mass, a trophectoderm component and a fluid filled cavity. With trophectoderm biopsy at the blastocyst stage a small hole is made in the shell of the embryo and several cells that are precursors to the placenta (trophectoderm) are removed for testing

  • This technique has shown promising results in US IVF programs. It is now considered by many experts to be the biopsy procedure of choice for PGD and PGS testing.
  • Genetic testing, like many medical procedures, is not 100%. Embryo’s can be damaged in the process of collecting the cells, and can be graded abnormal when normal or visa versa.

Why genetic testing?

In general, there are 5 main groups of patients that might utilize PGS or PGD.

  1. Patients that are having IVF with advanced female age – 38 or older (common)
  2. Patients of any age with repeated IVF failure – usually defined as 3 or more failed attempts
  3. To screen for inherited genetic diseases
  4. Patients that are carriers of chromosomal translocations
  5. Patients that have had recurrent miscarriages

PGD / PGS and Age – aneuploidy screening (PGS) – checking the chromosomes

  • The most common reason that PGS is done in the US is for “advanced age”.
  • This would often mean older than about 37 in many programs offering PGD.
  • The logic relates to the fact that women of advancing age have increased rates of chromosomally abnormal eggs – which after fertilization will become chromosomally abnormal embryos.

Human eggs are often chromosomally abnormal – and the percentage of eggs with a chromosomal abnormality increases with increasing female age. In general, about 30-60% of human embryos have some type of chromosomal abnormality. This increases significantly with advancing female age.

Furthermore, in an IVF cycle that is not doing genetic testing they will grade growing embryos on day 3.  Healthy graded embryos will be transferred and/or frozen on day 3. Embryos with genetic abnormalities can look healthy from the outside- you would only know if they were abnormal by looking inside (genetic testing). The potential for transferring a genetically abnormal embryo is pretty high. These pregnancies usually end in early miscarriage. For example with our first IVF, cycle before our eggs were sent to genetic testing, we had 4 embryos that were graded good/good (which is the highest grade they can receive). Out of those 4 that were then genetically tested, we only had 1 normal egg. ONE. This raised a red flag for us and our doctors and is one of the reasons why we have decided to do genetic testing again with these 2 IVF cycles.

We decided to do genetic testing for a few reasons. 1. With the diagnosis of Low AMH my eggs are at higher risk of being chromosomally abnormal. (please click link for more info about AMH). 2. When doing genetic testing, you decrease your chance of miscarriage significantly. Miscarriage usually occurs because there is a chromosomal abnormality in the fetus. We have already been through so much I don’t know what would happen if we got all the way to a pregnancy and then I lost the baby. 3. It increases IVF success. 4. If given the option with genetic testing to bring a healthy child vs. an unhealthy child into the world, we wanted a healthy child. Not that an unhealthy child would be loved any less, but given the option we would go with the obvious. Which brings me to…

Is genetic testing playing God? I don’t know. This is a hard question. God created the world and life, so didn’t he create and give us medicine as well? Genetic testing has definitely opened the discussion for ethical and social issues. As of now genetic testing is solely used to weed out chromosomally abnormal embryos and embryos that have genetic diseases.  With that said, genetic testing does supply you with the gender of your healthy embryo’s, which could lead to gender selection. You do not have to find out the gender if you do not want to, but the information is there for you. Hubs and I want to transfer one healthy boy and one healthy girl. I guess that would be considered gender selection…  At some point in the future, tests will no doubt be marketed for genes that are associated with behavioral traits such as intelligence, sexual orientation, possibly even perfect musical pitch, or physical characteristics like height, hair color and eye color. A way for a parents to create a so- called “designer baby”. Many of these claims will be highly questionable.  And what about gene mutations that have, say, a 20% or 30% chance of causing disease when the child is in midlife? Should parents discard an embryo based on that percentage? Consequently, over time, certain disease will become relegated to certain social groups, but not others. The gap between the wealthiest 1% and everyone else is already expanding. Should we allow this method to widen it more in the genetic pool? Others see this technology as raising troubling issues of eugenics, which had horrific results under the Nazis, who sought to “purify” the gene pool in Germany, and eliminate people whom they felt were genetically inferior. I know I am talking a little extreme, but with the way science and the world are heading this is a big topic of debate. I just pray that doctors remain moral and ethical with the use of these tests.

My husband is devout in his faith. It took him a while to get on board with IVF, because at first he felt that IVF was “like playing God”. Obviously, after he learned more about the process, he was all for IVF to start a family. Myself on the other hand, I have my faith, but I am more “spiritual”. I didn’t know if I really wanted to do genetic testing. My husband was the one really pushing for it. I think it’s a bit ironic. I am glad we did genetic testing on our last IVF cycle. If we would not have, our journey would have been quite different and would have cost us a lot more money, time, and energy. This time around we are doing genetic testing again because of how many abnormal embryo’s we had during our last IVF cycle. If God blessed us with a child with special needs we would love and care for that child like no other, but we feel that because we have the opportunity to do genetic testing it would be unfair to bring a child into this world with health issues, when we can prevent it. Not all will feel the same. Some will downright think it is wrong. But, this is our journey…

“How beauteous mankind is,” Shakespeare’s Miranda exclaims optimistically in “The Tempest.” “Oh brave new world, that has such people in it!” Huxley used these words ironically. Between her hope and his pessimism may lie the reality.

source: CNN, Advancedfertility

 

 

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