Posts

2
Jun

IVF After 40 years of age – 2010 update

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This information is provided by CNY Fertility Center, where patients are accepted for IVF with no precondition or age cutoff. We offer patients who are in the older age group comprehensive information about their options to start, or add to their family. CNY Fertility Center provides quality, low-cost infertility treatments and IVF care with locations Rochester, Syracuse and Albany New York.
More than half of women over 40 years of age have difficulty conceiving, while others are still fertile. Patients who are over 40 and infertile are seen in IVF centers and tend to have lower success rates with treatments (using their own eggs) than younger women do.
Many women are delaying childbearing until later in life. Until an individual or couple tries to conceive, they don’t know if they fall until the fertile or unfertile category. Laboratory predictors of outcomes like FSH levels, follicle counts, and other ovarian reserve indicators are not absolute in dictating treatment success or failure. Most women over 40 have one or more indicators of a potentially low prognosis.
Two recent papers have reported detailed information for specific age categories. From Egypt, over 200 women aged 40 and above were evaluated for IVF outcomes. As women increased in age, their treatment cycles were more likely to be canceled due to a lack of ovarian response. Miscarriages were 40-67% of clinical pregnancies. The live birth rate for those who made it to egg retrieval was 11% in 40 year olds, 7.5% in 41, 5% age 42, 2% at age 43, and under 1% at age 44 and 45. (Hourvitz et al )
A study in Israel evaluated 842 patients ages 42 plus, between 1998 and 2006. Clinical pregnancy rates per cycle were 7.7, 5.4 and 1.9% for 42, 43 and 44 years old respectively. Many of these pregnancies resulted in miscarriages. Only one IVF cycle in patients aged 44 years resulted in delivery. None of the 54 cycles performed in women of 45 years or older resulted in a pregnancy. A marked decline in clinical pregnancy and delivery rates, accompanied by an increase in spontaneous abortion rates, was found in patients >42 years old (Serour et al).
Results at CNY for 2007 were 12.5% live births per egg retrieval in the 41-42 year group and no deliveries in the 43 and 44 year olds in that year. In 2008, 8% of 41 and 42 year olds who had retrieval had a baby. Above age 42, about 2% of women succeeded in having a birth.
It is often a challenging decision whether or not to use donor eggs or sperm to create a family. Many people desire a child who is genetically related to both parents. Men see a much lower decline in fertility with age, and technologies including IVF and ICSI can increase pregnancy rates for couples where the man has a severely low sperm count.
When maternal age is an issue, it is helpful to remember that the statistics apply to a group of patients. They are general predictors for 100 women. No one can say what an individual’s results will be. CNY Fertility Center helps couples make every reasonable effort to create a biological child, but also offers patients other options for their family building including donor eggs, donor sperm and donor embryos.
It is important to recognize that the use of donor eggs is a high success back up plan. This alternative has delivery rates close to 50%. Many couples where the woman’s age is over 40 will initially try an IVF cycle using their own eggs. Success can come with persistence and positive mental attitude. Among those who are unsuccessful with their own eggs, many move on to using donor eggs for the baby of their dreams. Using a combination of options is often the best plan.
References
A Hourvitz1,2, MD Ronit Machtinger2, MD Ettie Maman, MD Micha Baum, MD, PROF Jehoshua Dor, MD Jacob Levron Assisted reproduction in women over 40 years of age: how old is too old?
Reproductive BioMedicine Online 2009 http://www.rbmonline.com/Article/3872
[e-pub ahead of print on 24 August 2009]
Serour, G et al Analysis of IVF in … women aged 40 years and above. Fertil Steril In press 2010

2
Feb

IVF and Progesterone Treatment

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The following information is provided by CNY Fertility Centers in Syracuse, New York, Albany New York and Rochester New York. Low cost IVF and other infertility treatment is available along with an extensive range of holistic methods.

After ovulation, progesterone is produced by the corpus luteum, which comes from the follicle. This steroid hormone induces the lining of the uterus to support implantation and growth of the embryo.  For up to 8 weeks after the missed period, or 8 weeks gestation as physicians refer to it, the secretions of the corpus luteum are necessary. During the next week, the placenta produces enough progesterone to support the further development of the pregnancy. This is known from experiments 30 years ago involving removal of the corpus luteum during pregnancy.

Measuring progesterone levels in a menstrual cycle or in pregnancy are not very useful because of wide variations in output. A syndrome known as luteal phase defect is thus very difficult to diagnose.  Progesterone levels in pregnancy below 10 ng/ml are commonly associated with a poorly implanting pregnancy. These may indicate an impending miscarriage or tubal pregnancy.
In IVF, the follicles are aspirated with a needle, removing many of the cells which might be there otherwise to form the corpus luteum. Thus, since the early days of IVF, progesterone supplementation has been used to make up for the deficit created by removal of these cells.

The problem of questionable progesterone availability was further aggravated by the use of the gonadotropin-releasing hormone analogs. These drugs, Lupron, Antagon and Ganerelix, suppress the pituitary’s production of LH, cutting stimulation of the corpus luteum and thus cutting progesterone production. It is clear that progesterone supplementation is needed after these drugs are used, as they are in virtually all IVF protocols today.

Progesterone can be used after IVF treatment by either injection or vaginally. There has been a long and deep controversy regarding the use of the vaginal approach. Two key US studies showed that it did not work as well as injection and the painful progesterone shots became the norm in the US for the past 10 years. Further study however has now shown that clinical pregnancy rates after IVF are the same no matter which route is used.

It is also clear that supplementation is needed up to 7 weeks gestation and almost certainly not needed beyond 9 weeks gestation. The exact point is not known.

Vaginal options include gels and tablets approved for usage in infertility and IVF. These include Crinone which can be used once a day. It has been extensively studied and shown to be as effective as the progesterone shot. Others are Endometrin tablets and Prometrium tablets.

Although there has been some concern on this point, it appears that there is no evidence that the use of progesterone poses risks to the fetus.

Reference
Practice Committee ASRM SRE.  Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility Fertil Steril 2008

21
Jan

Solo Mothers

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IVF in single women with donor eggs and donor sperm
CNY Fertility Center has locations in Syracuse, NY Albany, NY and Rochester, NY. Fertility treatments are affordable and include low cost IVF (In Vitro Fertilization). Our caring and experienced staff provides confidential treatments for heterosexual couples, same sex couples and  unmarried individuals who are looking to conceive. CNY Fertility Center offers donor eggs, donor sperm and donor embryos. In this article we will explore the options for solo mothers using donor eggs and sperm IVF to create their family.

There is virtually no method for trying to conceive which has not been explored in this day of increasingly progressive options. There can be many different match ups between the sources of the sperm and eggs, thanks to the structure of the IVF technique. It seems that where there is a will, there is a way.

Over the past 20 years, the new class of “solo mothers” has emerged. This is an example of the strength of the drive for reproduction, despite seemingly overwhelming odds. One study focused on 11 single Israeli women who required both eggs and sperm from anonymous sources. These women’s biological clocks had indeed run out, as their average age was 46. Prior to treatment, these women were intensively interviewed regarding issues of older parenting and the living adjustments that would have to be made.

In most countries, it is only financially stable women with college educations who choose to become mothers in this fashion. In pro-baby Israel, the national health care system actually encourages this further, as it provides infertility treatment for producing up to two children up to the maternal age of 51, without regard to marital status. Out of the small Israeli study group, three women had not attended college.  Upon follow-up, socio-emotional development and mother-child relationships seemed satisfactory. All the women reported the highest possible levels of satisfaction with parenthood.

Several of these women were working full time; however, they were depending on extended families and day care facilities during those hours. Interestingly, the lack of a genetic bond did not seem to be a concern for the women: The gestational bond seemed quite strong and was distinguished from adoptive situations. This information may be of help to others considering egg donations.

It is known that IVF can produce multiple births, and this may carry some health risks for the children. In the small Israeli study, one set of twins had suboptimal health after a premature birth.  Certainly this risk is an important one to remember, if a single parent. The amount of work and time involved may be greater than “normal,” if circumstances such as this arise. Replacement of single embryos is a consideration for women in this situation. And that might mean an increase in the number of attempts to have a child; therefore, it might increase IVF cost.

Methods of low cost IVF can be applied in the pursuit of conception for the single woman. Egg donors may have low gonadotropin stimulation for fresh cycle therapy. Egg banks using frozen eggs are also now a realistic option to pursue. This is because the splitting of batches of donated eggs among two or more recipients lowers the cost of IVF.

There is debate on what to tell the child. Concerns have been raised about the previous secrecy involved and much increased openness with the children has been advocated. This and other related topics are covered in a recent book by Angela Best Boss and Evelina Sterling. It is of note that the writers provide a professional counseling service at www.myfertilityplan.com.   Also we recommend the referenced article published in Women’s Health on a related topic.

References:
Best-Boss, Angie and Sterling, Evelina. Having Your Baby through Egg Donation  2005.
Kirkamn M.  Egg and embryo donation and the meaning of motherhood.  Women’s Health 2003; 38: 1-18.
Landau R et al. Older single mothers and IVF with sperm and egg donation. Fertil Steril 2008; 90: 576-583

24
Sep

PICSI/HBA Multi-Site Clinical Trial

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CNY Fertility Center Syracuse is recruiting patients to participate in a multi-site clinical trial of the PICSI dish’s effectiveness. A PICSI dish is used to select mature sperm which bind to hyaluronan, and the sperm is then injected into an egg during an ICSI.

Intracytoplasmic Sperm Injection (ICSI) is used for about 99% of patients at CNY Fertility Center who are doing an In Vitro Fertilization (IVF) cycle. It is the process in which an embryologist directly injects one sperm into a mature egg, in an attempt to fertilize the egg, creating an embryo.
The embryologist selects the sperm using a microtool called an ICSI needle, under a large, high-tech microscope. The sperm are evaluated for their progression (swimming), as well as their morphology (shape), however neither of these attributes can definitively tell the embryologist that the sperm is mature.
A PICSI dish contains

hyaluronan microdots, to which only mature sperm can bind. Once the sperm are added to the dish the embryologist is able to select only the bound (mature) sperm, using them for injection into the egg. The concept is that mature sperm are more likely to be chromosomally normal, potentially increasing the fertilization rate and subsequent pregnancy rates.


CNY Fertility Center Syracuse is participating in a multi-site clinical trial of the PICSI dish’s effectiveness. We are currently recruiting patients to be in the clinical trial. If you are interested in participating and potentially having a PICSI dish used for the selection of sperm for your ICSI please speak to your nurse, doctor or contact Deb Woodhouse at dwoodhouse@cnyfertility.com.

24
Sep

Intralipids

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CNY Fertility Center in Syracuse, Rochester and Albany now offer an innovative new treatment called Intralipids to help women who have had recurrent miscarriage, multiple failed IVF cycles or multiple failed IUI cycles. Intralipids deactivate natural killer cells in a woman’s body which may prevent embryos from implanting and growing properly in the uterus.
New research has suggested that women who have experienced
recurrent miscarriages or multiple failed IUI or IVF cycles as a
result of natural killer cell activation may benefit from the use of
intralipids. Intralipids are synthetic and made from 1.2% egg
yolk phospholipids, 10% soybean oil, 2.25% glycerin and water.
It is administered through an IV 4-7 days before embryo transfer
or insemination.

Natural killer cells are regulated by the immune system. In
women who have autoimmune issues, the natural killer cells can
react abnormally to an implanting embryo, treating it as an
invading cell and signaling for the body to attack it. Studies
have found that intralipids can help to deactivate the natural
killer cells, allowing the embryo to implant on the uterine wall
and grow normally. Intralipids are re-administered 4-5 weeks
following a positive pregnancy test, to keep the natural killer
cells deactivated until the pregnancy can override the signals
being sent by the immune system.

Intralipids (approximately $100 per administration) are far less
expensive than Intravenous Immunoglobulin (IVIG) (approximately
$2000 per administration), and initial studies show
comparable efficacy for deactivation of natural killer cells and
pregnancy rates. Intralipids are well tolerated by patients with
few side effects and are created synthetically, unlike IVIG which
is a blood product. It takes about an hour and a half to two
hours for the intralipids to be administered through the IV.

For more information about intralipids call CNY Fertility Center or
ask your nurse if you are a candidate at your next appointment.