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9
Feb

Birds, Bees and Bunnies: The Biology of IVF – Part 1

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This article discusses the basic biology behind the process of In Vitro Fertilization (IVF) and may be helpful to couples who plan to undergo IVF. Technical terms may be found in a glossary at www.fertilitylifelines.com.

CNY Fertility Center has locations in Syracuse, Albany and Rochester, NY. CNY Fertility Center offers couples and individuals affordable fertility treatments including low cost IVF (In Vitro Fertilization) by our experienced and caring staff.
In the high school classroom, perhaps we giggled a bit about these slightly embarrassing topics. Now that we are trying to get pregnant we need to pay attention.  The story of reproduction is fascinating and complex and the more we know the more we can understand some of the terms used in IVF clinics which affect our outcomes.

In nature, for most women, the production of a single egg each month is automatic. The hormone changes required are treated lightly here.  In IVF, we must go to enormous lengths to be able to obtain this precious cell (the egg) in the laboratory.  More of the story can be found in articles on how the gonadotropin hormones work and how egg retrieval is done, elsewhere on this web site.

We begin with consideration of the egg, which measures a tenth of a millimeter, is barely visible, but is the largest and most complex single human cell. It provides the energy and structure to form a healthy embryo which can develop into a baby composed of a few trillion cells.  A perfectly competent egg is ready to be fertilized and develop to the 4 cell stage with a little help from the sperm. The sperm will provide 23 chromosomes, half of the genes and the centriole, critical to organize cell division. But (as some would argue, typical of the man), there is no energy provided by the sperm nor is there any follow-up responsibility. The leading contributions for assuring a next generation must depend on the egg.

The tiny egg which has been resting in the ovary for 20-40 years must suddenly, within weeks, awaken, mature and develop the ability to combine with the sperm and divide.  Rapid and complex changes give the egg competence to do these tasks.  The more we know about the complexities of the process it seems amazing that it ever works. Indeed, too often it does not.  There is much inefficiency in reproduction, especially in humans. The development of the eggs, the fertilization process, and early development often fail in nature. Even the most fertile young woman has about a 20% chance to conceive in one cycle.  Throughout evolution this has turned out to be just fine for the human species. Other animals are different. Famously the rabbit produces several eggs each month, and to make sure the timing is right the female bunny, the doe, ovulates by reflex after intercourse. Pregnancy follows automatically. Considering our behavior, it is a good thing that this is not the case in humans.

However the good luck of the bunny is not helpful to infertility patients, who are often frustrated with the low percentages which can be less than 5% per cycle.  They have to spend time and money to improve their conception possibilities. In fact after IVF, ongoing healthy pregnancy rates can be in the range of 40% in one month.  There is much technology involved to produce multiple eggs and embryos.
Related Articles

Birds, Bees and Bunnies: The Biology of IVF – Part 2 (Eggs!)
Birds, Bees and Bunnies: The Biology of IVF – Part 3 (Sperm & Embryos)

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

21
Jan

Embryo Transfer – Day 3 versus Day 5

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CNY Fertility Center has locations in Syracuse, NY Albany, NY and Rochester, NY. CNY Fertility offers affordable fertility treatments including low cost IVF (In Vitro Fertilization). Patients often have questions about the day that their embryos will be transferred back to their uterus following their IVF procedure. This article is a quick summary of the history and advantages of both Day 3 and Day 5 embryo transfers.
Until about 10 years ago, all embryos were routinely placed in the uterus on day 3 of the cycle. Embryos are then at the 6-8 cell stage.

(8 celled embryo – Day 3)
Culture methods then emerged which allowed healthy embryos to continue developing to day 5, the blastocyst stage which has several attractive features.  Most importantly it allows some of the embryos which are doomed to failure due to internal defects to fall by the wayside as they arrest and do not continue to develop. Thus the more hardy embryos are self selecting and the rate of implantation of each embryo is higher.  Culturing embryos out to the blastocyst stage reduced the number of embryos that were transferred back as well, reducing the incidence of multiple gestations.

(Blastocyst stage embryo – Day 5)
Initially it seemed as this was applied in IVF practice, that the ability to choose the more robust embryos by self selection in this manner would raise pregnancy rates. In a common scenario, the choice if a patient had 5 embryos available for transfer, all about equal in quality on inspection under the microscope, the option would be to replace 3 embryos on day 3 or two on day 5. It was hoped that the day 5 embryo transfer would yield higher results for the IVF patient. This has not turned out to be the case. It is however true that the number of triplets is reduced by use of the day 5 strategy, which is an important option to consider when the risk of multiples is paramount.

21
Jan

IUI with Clomiphene, a First Line Treatment for Infertility

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This information is provided for couples who may just be starting out in fertility treatments and are trying to conceive using IUI with clomiphene. CNY Fertility Centers provide infertility services including low cost IVF (In Vitro Fertilization) for couples who are starting or continuing their families in Albany, New York, Rochester New York and Syracuse, NY. In addition to our local services we work with patients from across the country and world offering affordable IVF and fertility treatments.

Unexplained infertility is when a couple can’t conceive although the woman is ovulating, and her fallopian tubes, uterus and partner’s semen results come back normal after testing. Some of the women have had endometriosis diagnosed and treated, thus are not truly unexplained, but do fit into this category in terms of an approach for treatment.

Clomiphene is inexpensive, and acts in women who already ovulate to stimulate production of several eggs during a treatment cycle. Clomiphene causes the brain to misinterpret blood estrogen levels. This induces the pituitary gland to produce a surge of the follicle stimulating hormone or FSH. The result is the production of more than usual numbers of follicles, each with one egg.  Intrauterine insemination (IUI) places more sperm into the uterus and then the fallopian tubes than could ever reach through intercourse. Thus more bullets are shooting at more targets.

The combined use of clomiphene and IUI has been shown to nearly double the results compared to using clomiphene alone to improve pregnancy likelihood (Guzick, 1998). The master student of IUI, Dr Richard Dickey and colleagues in 2002 compiled a large series in New Orleans and reported almost 10% success per cycle.

The distinguished Boston IVF group in a study led by Dr. Alan Penzias recently confirmed a cycle success rate of 11.5% (Dovey, 2008) from over 4000 cycles of treatment. The patients were ovulatory and some of the men had low sperm counts.  The success of treatments cumulatively over up to four cycles, was successful in 24% of patients under age 35. Age specific pregnancy rates per cycle ranges from 12% under age 35 to 4% over age 40. Corresponding decreases in overall success were seen according to age. Only one patient was successful (1.8%) of the 55 women treated over 43 years of age.

The study verified findings by others who found that 90% of success is found in three or four cycles. Those who are not pregnant by then should move to gonadotropin and IUI or IVF therapy.

At RBA in Atlanta, Dr Massey and colleagues found that the addition of a chemical called PAF to the sperm wash dramatically improved success rates (Roudebush 2004) to nearly double those without it. This is a reasonably simple method which more clinicians might use.

Those who are concerned with cost effective treatment for infertility continue to believe that clomiphene and IUI are a good treatment for younger patients who are trying to conceive, and fit the criteria outlined.

Selected References
Dovey S et al Fertil Steril 2008:90:2281-86
Guzick, DS et al Fertil Steril 1998;70:207-13
Dickey RP et al Fertil Steril 2002;78:1088-95
Roudebush WE et al Fertil Steril 2004;82:52-56

21
Jan

Low Cost IVF in the United States

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CNY Fertility Center, founded and directed by Dr. Robert J. Kiltz, with offices across New York State, offers low cost fertility/infertility treatment that include IVF, ICSI, PGD, Cryopreservation, Donor Eggs, and much more. Although fertility treatments are offered worldwide, wide variations are noted in different countries in regard to quality and availability. Medical tourism is becoming a popular means for consumers to find state-of-the-art medical care around the globe. We have integrated both Eastern and Western medicine to provide our clients with a holistic approach to their reproductive care. It is our goal at CNY Fertility Center to become the center of choice both across the United States and to our friends abroad.

Our mission is to provide comprehensive reproductive services in a compassionate, honest and friendly environment at a low cost to our clients. In 2010, Dr. Kiltz has created financial plans to minimize the stress on our clients on their journey to build their family. We offer multiple cycle discounts as well as IVF refund programs. Couples interested in donor eggs will also find that we offer exceptional rates in comparison to many other programs and we as well offer both multiple cycle discounts and refund programs for couples/recipients who are interested in pursuing donor eggs.

As our centers grow to offer services across the United States and around the world, we will strive to meet your needs. We understand the inconvenience of leaving your home for medical care and we will assist you in any way we can to make your stay in New York as comfortable and as convenient as possible. We will provide you with continuous support throughout your journey. Our staff is here for you and it would be our pleasure and our honor to help you build your family.

If you are interested in exceptional, quality care, in a warm environment, at a low cost, please visit our website at www.cnyfertility.com. If you have questions regarding any aspect of the services offered at CNY Fertility Center, please do not hesitate to contact us at (518) 690-0700. Our staff is available 24 hours per day, 7 days a week, to answer any of your questions. We look forward to working with you.

Justine Taylor, RN, BSN
Nurse Manager and IVF Coordinator
jtaylor@cnyfertility.com