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.
In 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.
As we reported in our blog earlier this year, fertility specialists in Sweden transplanted uteri into women who were unable to carry a pregnancy to help them. They were presumably motivated by one of the remaining challenges in Reproductive Medicine, helping women who were born without a uterus, or have had their uterus removed or have severe scar tissue in the uterus making it difficult or impossible to carry a pregnancy. The only options for these couples until now has been to use a gestational carrier with IVF to carry the pregnancy for them, what most people think of as a “surrogate.” Picking up on research that began over a century ago, doctors in Sweden used modern surgical techniques and medications to enable transplantation of the uterus. There is now some good news on this front. One of these transplants in Sweden resulted in a healthy live birth. The pregnancy and birth were not without complications. The baby was born 9 weeks early and the mom developed pre-eclampsia, a serious condition in pregnancy also known “toxemia” whose symptoms include high blood pressure and swelling. The doctors are also unsure if the uterus will be usable for a second pregnancy. Still, this an exciting first in Reproductive Medicine.
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.
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.
It is quite common for both OBGYN and Fertility doctors to encourage their patients who have had multiple miscarriages take baby aspirin in order to reduce the risk of future pregnancy losses. The problem with this is that these recommendations were never really backed up by research to see if aspirin is really effective in preventing miscarriages. In order to determine if this common practice was effective, the NIH conducted a large trial to see if taking daily baby aspirin would reduce the risk of subsequent miscarriage in women with 1 or 2 prior miscarriages. Unfortunately, as reported in the journal Lancet, baby aspirin did not help and these women were no more likely to experience another pregnancy loss than those who took a placebo. The one bright spot in this study: women who took had a single loss early in pregnancy within the last year and took baby aspirin were more likely to actually become pregnant.
For 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.
In the world of Reproductive Medicine, and much to the delight of our Obstetrician colleagues, we are always looking for new ways to reduce the risk of twins and other multiple births. Multiple pregnancies significantly increase the risks of all sorts of complications for mother and baby. It was a nice change of pace when I came across this great blog entry from the Renee Jacques at the Huffington Post about some cool and interesting facts about twins. So here they are:
- Identical twins do not have identical fingerprints
- Massachusetts has the highest number of twin births in US, followed by Connecticut and third our state of New Jersey. Not surprising considering we have lots of couples going through IVF and other infertility treatments and a law mandating coverage.
- Mirror image identical twins have reverse asymmetric features.
- Identical twins are not completely genetically identical
- Moms of twins may live longer
- Tall women are more likely to have twins
- Women who eat more dairy are more likely to have twins.
- It is possible for twins to have two different fathers
- Twins interact with each other in utero
- Some conjoined (Siamese) twins can experience each others senses.
- 40% of twins communicate with their own language.
Be sure to visit her original article here.
Most Reproductive Medicine specialists know that our overweight patients often need higher doses of fertility medications, whether that is pills (clomiphene or Femara), or injections (Follistim, Gonal-F, Bravelle or Menopur). When we do IVF cycles, we also add a medication to prevent ovulation such as Lupron, Ganirelix or Cetrotide, and for the most part, the doses are not adjusted based on a patients weight. It turns out that doctors in Colorado looked at one of these drugs, Cetrotide (Cetrorelix) and found that overweight women actually metabolize the drug faster, meaning that the currently used dosing may not be sufficient in these patients. So, what does that mean? If the cetrotide does not last in the system long enough, premature ovulation may occur, and your IVF cycle could be cancelled. It may mean that we need to use higher or more frequent dosing in heavier women.
One Australian Fertility Specialist says yes, the classroom is the perfect place to learn about this, as reported on Yahoo News 7. Surveys continually show that the public, both women and men understand very little about their own fertility, and this is perpetuated in the media by stories of miracle late life pregnancies. Many women understand very little about how their own reproductive systems work, and even less about the true effect of age and lifestyle choices on their ability to have a family. Most of us reproductive specialists see patients all the time whose infertility could have been prevented. This doctor in Adelaide sees education as a sort of preventative medicine for infertility and is advocating making fertility education a part of the school curriculum in his country, along side with contraception. Will it work? And could it happen here in the US?