ICSI is best for male infertility

Over 2 decades ago, ICSI (intracytoplasmic sperm injection) revolutionized the treatment of male infertility. The ICSI procedure involves injection of a single sperm into each egg at the time of IVF (in vitro fertlization). Before the development of ICSI, couples with sperm issues, what we call “male factor,” had very low fertilization and pregnancy rates, even when undergoing IVF. Now a days, because of the use of ICSI, poor sperm quality is a very unusual reason for an IVF cycle to be unsuccessful or to blame for poor fertilization. Over concerns about potentially poor fertilization, many fertility centers have chosen to use ICSI routinely to ensure optimal fertilization even when the male partner’s sperm is perfectly normal. At Princeton IVF, our philosophy has always been to allow fertilization to happen “naturally” in the dish when there is no history of sperm issues or poor fertilization. While ICSI had been shown to be quite safe, we feel that a more natural selection process makes more sense and research in the past has suggested that ICSI is only beneficial in male factor patients. A recent large-scale study recently published in the Journal of the American Medical Association has borne this out. ICSI  when used in IVF cycles used in couples without sperm issues had lower fertilization and lower implantation rates than non ICSI cycles.

New study confirms IVF is safe for women

One of the chief concerns couples have is the about the safety of the procedures that fertility specialists use to help them achieve pregnancy, such as IVF (In vitro fertilization). Most of us in the field know that serious complications to the mother-to-be can occur but are quite rare. A recent study with the lead author from Emory University looked through nationwide database of IVF clinics across the country over the past 12 years, and confirmed that while IVF does entail risks for women, those risks are quire small.

Is male infertility a sign of other health problems ?

In women who suffer from infertility, their difficulty in conceiving is sometimes a sign of underlying health issues. For instance, it will know that women who suffer from infertility have a higher rate of pregnancy complications, even if they conceived without treatment. One of the most common causes for infertility, polycystic ovarian syndrome (PCOS) is often associated with underlying metabolic problems and women with PCOS are more likely to develop medical problems such as diabetes, high blood pressure and heart disease. However, what is less clear whether this is also true in men. A recently published study suggest that men with fertility issues and sperm abnormalities may be more likely to have other seemingly unrelated medical problems.

Smoking and grandchildren- What’s the connection?

There are plenty of reasons to quit smoking. The health effects of smoking are well known and well documented, not just on your fertility, but a whole number of health issues including heart disease and cancer. Now, there’s yet another reason to quit smoking if you are pregnant  or trying to get pregnant. Cigarettes may actually affect a woman’s male offspring’s sperm quality. As reported in Human Reproduction, the male offspring of pregnant mice exposed to high levels of cigarette smoke had sperm with lower counts, lower motility and more abnormally shaped sperm (low morphology), and these male mice took longer longer to impregnate female mice who in turn gave birth to fewer mouse pups. So, what does this all mean? While we don’t yet know if this is true in humans (or even 100 % sure it is true in animals), exposure to tobacco smoke could not only harm your fertility (among other things) but also could harm your unborn son’s chances of fathering children. This is another good reason to quit.

Can Vitamin D make you more fertile?

In recent years, Vitamin D has become the all the rage in medical research. It seems everybody these days is deficient in Vitamin D and a whole range of medical conditions from cancer to osteoporosis to reproductive issues have been potentially linked to insufficient Vitamin D.  A recent study, which was in agreement several other previous studies, showed that women doing IVF with higher Vitamin D levels actually had significantly higher pregnancy rates than those who did not. While it is not clear at this time whether Vitamin D deficiency actually causes infertility or even whether supplementation will help couples conceive, it does suggest that maintaining healthy Vitamin D levels may contribute to good reproductive health.

Breast cancer drugs to treat infertility ?

This sounds kind of odd. Why would fertility specialists use a drug intended to treat breast cancer patients to help couples conceive? To those in the field, the concept is nothing new. Clomiphene (Clomid) is a close relative of Tamoxifen, a drug used for years to prevent the recurrence of breast cancer.  These drugs which block the action of the female hormone estrogen, cause hormone fluctuations that stimulate eggs to grow.  Over the past decade, doctors have begun to use another breast cancer drug called Femara or Letrozole to treat couples in with infertility. Like tamoxifen, letrozole is used to prevent recurrence in breast cancer patients, and like clomiphene, it can also be used to stimulate ovulation (release of an egg). Until now, clomid has been the gold standard to help make women ovulate since it is relatively inexpensive and safe. Recently, however, a large study was published suggesting that letrazole may actually be more effective than clomiphene  and result in fewer multiple births. Over time, it is likely that letrazole may replace clomiphene as  a first line fertility drug.

A world where everyone has infertility- coming soon to cable

The lottery- a future where everyone has infertility

Think going through fertility treatment today is stressful ? Imagine in a world in which everyone suffers from infertility, everyone needs donor embryos in order to get pregnant and there are not nearly enough embryos to around. Lifetime network plans to release a trailer for a series called the Lottery with just that story line. In the show, mankind faces extinction as no one is able to conceive and no babies are born. The only hope is in a small batch of embryos, the fate of which, and of mankind’s survival is left up to a lottery.

Marijuana and abnormal sperm

With some states choosing to legalize marijuana, we hear very little of cannabis’ effects on health, and even less on its impact on reproductive health. We have know for years that pot smoking can cause chromosomal breakage, and so for those couples trying to get pregnant, many reproductive specialists encourage both partners to quit when attempting pregnancy. Now, some new data out of the UK shows men who use marijuana are considerably more likely to have abnormally shaped sperm, Interestingly, in the same study, alcohol and tobacco did not.  Since even in normal men, it is normal to have some proportion of misshapen sperm, this finding in itself is not enough information to say that marijuana causes infertility. Still, why take the chance? This is just another good reason to quit if you are planning to start a family in the near future.

PCOS, inflammation and pregnancy

Polycystic ovarian syndrome (PCOS) is one the most common hormone problems in women of reproductive age as well as one of the most common causes for female infertility. While infertility caused by PCOS is often amenable to treatment, women with PCOS often have more complicated pregnancies, including problems such as gestational diabetes and pre-eclampsia.  One of the common threads with these issues is their association with inflammation. It turns out there may now be a link explaining why PCOS patients have more complications. A recent study shows that markers of inflammation are higher in PCOS women and become even worse when these women get pregnant. It could be that inflammation is the common link between in PCOS and a number of pregnancy complications.

Lesley Brown, the unsung heroine of IVF

Being that is National Infertility Awareness Month, this week seemed like an appropriate time to share this story. I recently attended a lecture given by one of pioneers in our field and one my personal mentors, Dr. Eli Adashi. The story he shared with the audience moved me and reminded us of our patients’ suffering and why we do what we do. In the history books, when one looks at the breakthroughs in medical infertility treatment, the birth of the first IVF baby does and will stand out as one of the great milestones. The protagonists in the story that everyone knows are, Drs. Steptoe and Edwards, the brilliant gynecologist and scientist team, and of course, baby Louise Brown herself. But the popular narrative leaves out perhaps the most important character in this drama, Lesley Brown, the patient herself.  Lesley was a reserved woman who never wanted attention but her delivery was one of the most famous events of the 20th century. She put up with repetitive surgeries and painful medical procedures knowing there was little chance they would work.  When she did IVF with Drs. Steptoe and Edwards, she was basically (and knowingly) a human guinea pig.  Nobody had any idea as to whether it could work, whether it was safe and if it did whether her child would turn out normal. On top of that she had to put up with moral outrage (and occasionally harassment) of those who opposed the very idea behind IVF. Without her bravery and perseverance, millions of couples would remain childless and millions of babies would never have had a chance at life. Lesley Brown passed away quietly in 2012 but the legacy she left has brought both hope and joy to millions.

Lesley Brown, the unsung heroine of IVF with her daughter Louise