Scratching your way to pregnancy- Endometrial biopsy before IVF

endometrial-biopsy-princeton-ivfIn recent years, endometrial scratching, irritating the endometrium (lining of the uterus) to help in making the womb more receptive for pregnancy has emerged as a new and unsual way to help couples get pregnant.  Recently, a group from Turkey presented data at the American Society of Reproductive Medicine meeting suggesting that performing an endometrial biopsy prior to IVF can improve pregnancy rates in women undergoing IVF by about 20%. In fact over the years, seeming against common sense, there have been a number of studies suggesting  that a biopsy and/or hysteroscopy may improve the chances for IVF success. At Princeton IVF, we have been using this technique for years, first in patients who failed cycles without any good explanation and then routinely in all our IVF patients. Although no one is quite sure why it helps, it is likely that the repair process from endometrial trauma helps to make the uterus more receptive to embryos.

Can Vitamin D make you more fertile?

fertility-vitamin-DIn 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.

How old is too old to try IVF ?

Pregnant womanWith stories of 45 year celebrities having babies (and sometimes even twins and triplets) with high tech treatments, most people think that age is not a barrier to successful treatment.  When using donor eggs from a young egg donor, that is definitely true. The chances for success with donor egg ivf is excellent, even for women in their late 40’s. However that is not the case in women using their own eggs. Pregnancies in women undergoing fertility treatment without the use of a donor over 45 are very unusual.  A recent report from Florida describes a 46 year old woman who is reported to be oldest woman to conceive from IVF with her own eggs. Is this a major breakthrough? Not really. The main determinant over whether a fertilized egg will develop into a healthy baby is whether the embryo is genetically abnormal. Genetically normal embryos are common in 25 year olds but pregnancy rates are never 100%. Likewise, the vast majority of  45 year olds’ embryos are abnormal, and so the pregnancy rates would be expected to be quite low but not exactly 0%. When confronted with these odds, most couples would chose not to try.

Is that pregnancy test accurate?

pregnancy testFor the most part fertility docs, obgyns and midwives assume that unless a patient checks it too early, that urine pregnancy tests are pretty accurate. However, a new study calls that into question. Researchers at Washington University in St. Louis looked at urine tests commonly used in hospitals and found a high proportion of what we call “false negative” results, meaning the test was negative but the woman is still pregnant. The reasons have to do with the chemistry behind the tests. Like blood pregnancy tests, urine kits are designed to test for a hormone called hCG, or human chorionic gonadotropin. Without boring you with all the details, lets just say that hCG exists in many different forms and the types of hCG released can change during the course of the pregnancy. So, while these tests are very accurate early on around the missed period, the types of hCG a pregnant woman secretes may change a few weeks later making it harder to pick up on the urine test.

Ethnicity and IVF success rates

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A recent study from the UK showed what many Reproductive Medicine specialists noticed for some time, that a couples’ chances for success with IVF vary based on ethnicity. In this paper published in the British Journal of Obstetrics and Gynecology, IVF success rates varied by race with white women having the highest pregnancy rates, followed by women of Southeast Asian descent, then African descent and then Middle Eastern descent. The reason for this is not at all clear. The number of eggs women produced, how many fertilized and the number of embryos transferred, did not differ based ethnicity.  However the implantation rate (the percent of transferred embryos that took) did differ among the groups. Why the embryos of some ethnic groups would be more likely to implant than others remains the big unanswered question.

IVF and a Good Night’s Sleep

bedA  study recently presented from a fertility center in Korea showed that women who got a good night sleep (7-8 hours) had the best outcomes from IVF treatment when compared to women who got less sleep or even more sleep.  Does this mean that sleeping increases your chances for pregnancy? Probably not, but it does confirm what we already know, that a healthy balanced lifestyle and reducing your stress will improve your odds of getting pregnant.

Weight does impact the chances for IVF success

We have know for years that being overweight can affect fertility and lower success rates for infertility treatments such as IVF. Some centers have even set weight limits on IVF treatment for this reason. However, it wasn’t clear if being overweight was harming the eggs or making the uterus less receptive to pregnancy. A recent study from Spain found that overweight patients had lower pregnancy rates even when they got eggs from a normal weight woman, meaning that this effect is due at least in part to a problem with the uterus. The take home lesson: weight loss may improve your chances of having a baby even with donor eggs. For more information from Dr. Sanjay Gupta’s Guide, click here