Dr. Schmidt, one of the Center’s lead physicians, and the Center’s Senior Embryologist, Dr. Jellerette-Nolan were recently on WFSB TV’s Better CT Show discussing male infertility.
See the video below:
Dr. Schmidt, one of the Center’s lead physicians, and the Center’s Senior Embryologist, Dr. Jellerette-Nolan were recently on WFSB TV’s Better CT Show discussing male infertility.
See the video below:
Taking the first steps on the path to seeing a fertility specialist may be difficult or even overwhelming for some patients. Patients are sometimes nervous about seeing a specialist because they don’t know what to expect, or they are fearful of receiving bad news. The article below, Why People Won’t Seek Help, by Jane Frederick, M.D touches on this subject.
Knowing what to expect at a consultation may offer reassurance and help alleviate some of these concerns. At the Center for Advanced Reproductive Services, we strive to make this a comfortable, stress-free process for all of our patients. We offer free fertility phone consultations for patients at different points in their fertility journey. The call will be scheduled between you and one of our board certified physicians at The Center and last about 15 minutes. Your fertility phone consultation will be an opportunity for you to obtain information about our program and learn about general treatment options.
Simply fill out this form to request your free fertility consultation.
Why People Won’t Seek Help for Infertility
Given that the majority of all infertility diagnosis’ can be treated with today’s medical technologies and advancements, it is surprising that many couples still suffer in silence when they fail to get pregnant after months and even years of trying. My research shows there are various reasons why couples choose not to seek help for their infertility and it is my goal to address these reasons and why they are easily overcome.
Reason #1 – Not aware they could see a specialist at this time in their process
Reason #2 – Fear of multiple births
Reason #3 – MD or OB/GYN did not suggest seeking an infertility specialist soon enough
Reason #4 – Lack of knowledge about treatment – believe In Vitro-Fertilization (IVF) is the only option
There are various other reasons beyond these four that I will be including in a series of articles for couples who are hoping to conceive. It is extremely important for couples to never lose hope; everyone who wants to build a family eventually is able to do so when they have the courage to take the steps to move forward and take control of their future.
Dr. Schmidt, one of the Center’s lead physicians, and the Center’s Senior Embryologist, Dr. Jellerette-Nolan will be making an appearance on WFSB TV’s Better CT Show on Thursday, July 24th. They will be discussing male infertility.
For tickets to the show, click on the Better CT link here.
Below is an interesting article in the New York Times about the different testing techniques used to determine the strongest embryos to use for IVF.
The Center for Advanced Reproductive Services offers our patients the opportunity to participate in the MultiCenter Registry with Eeva (MERGE) Research Study. Eeva: The Early Embryo Viability Assessment Test is an investigational test to be used by IVF laboratories to analyze early embryo development and to aid in the selection of the best embryo for transfer. Click here for more information on the study.
Fertility Clinics Scan for the Strongest Embryo
Annika Levitt initially resisted the fertility clinic’s suggestion that only one embryo—rather than the usual two or more—be transferred to her uterus because she was too small to risk carrying more than one baby. “You go through all that and you put only one back in?” she recalled thinking, fearing it would lower her chances of becoming pregnant.
But her embryos had been tested for chromosomal abnormalities, giving a fair degree of confidence that the chosen one was healthy. “Knowing that it was the strongest of the strong was reassuring,” she said. Ms. Levitt, who lives in Morris County, N.J., gave birth to a girl from that embryo and is now pregnant from another single-embryo transfer.
The chromosomal testing is one of the techniques now coming into use to help fertility clinics answer one of their most vexing questions: Which test-tube embryo or embryos will give a woman the best shot at having a baby? Another new technique uses time-lapse imaging to study the development pattern of the embryo. Both techniques can potentially provide more information than the approach now used to judge an embryo’s fitness, which is to look at its shape under a microscope.
That could increase the sometimes frustratingly low efficiency of in vitro fertilization. And if clinics can be nearly certain that an embryo is fit, they might feel more comfortable transferring only one embryo rather than two or more, as is common practice. That would reduce the chances of producing twins or triplets, which face greater health risks than single babies. “What’s really good about this is we get high rates with singletons,” said Dr. Richard T. Scott Jr, clinical and scientific director at Reproductive Medicine Associates of New Jersey, where Ms. Levitt went.
But some experts say the new techniques, which can add thousands of dollars to the cost of in vitro fertilization, are being heavily promoted without data supporting that they truly improve pregnancy rates. For some women, they say, chromosomal testing, an invasive procedure, might even worsen their chances of getting pregnant. “A significant portion of women may actually be hurting themselves by doing that,” said Dr. Norbert Gleicher, medical director of the Center for Human Reproduction, a fertility center in Manhattan.
The chromosomal testing is called preimplantation genetic screening, or P.G.S. This is different from a related technique called preimplantation genetic diagnosis, which tests embryos for specific mutations with the goal of preventing the birth of a baby with a genetic disease. With the chromosomal screening, the goal is mainly to improve birthrates, not influence the traits of the baby.
Ms. Levitt, who is 33, initially sought in vitro fertilization to avoid having babies with a genetic disease for which she and her husband carry mutations. Despite some doubts, use of the new techniques seems to be expanding rapidly. “We doubled the volume in 2013 over 2012,” said Dr. Santiago Munné, director of Reprogenetics, a laboratory that does embryo screening for fertility clinics.
Other laboratories that do this include Genesis Genetics, Reproductive Genetics Institute and Natera. Dr. Scott’s clinic developed its own test, which it also performs for other clinics. Illumina, the largest manufacturer of DNA sequencing machines, is also making a push into the arena. It acquired BlueGnome, a British company that sells DNA chips used by some laboratories to do the testing. Illumina also recently introduced a system that uses sequencing for embryo screening.
On time-lapse imaging, Auxogyn, a Silicon Valley start-up, just received clearance from the Food and Drug Administration to market a computerized system that predicts the fittest embryos. It will face off against Unisense FertiliTech, a Danish company that sells a time-lapse system called the EmbryoScope.
P.G.S. can add $4,000 or more to the price of a cycle of in vitro fertilization, which usually costs at least $10,000 to $15,000. Time-lapse imaging can add several hundred dollars to $1,500 or more. Insurance might not pay for such testing.
Even for younger couples, as many as half the embryos created in a test tube have chromosomal abnormalities, a major reason embryos fail to implant in the uterus or result in miscarriages. So it seems logical that weeding out the defective embryos would increase the chances of a successful pregnancy. But that has proved illusory once already.
An earlier generation of P.G.S. was used for about 10 years — until a randomized clinical trial in 2007 showed that testing actually decreased the chance of getting pregnant. How could that be? One likely reason was that the testing itself damaged some embryos. Also, the test could assess fewer than half of the 23 chromosome pairs, so it was not very accurate in determining if an embryo was normal.
Proponents of P.G.S. say that has now changed: The new techniques can assess all the chromosomes. Also, the old technique involved removing one cell from a three-day-old embryo containing only eight cells. The new testing is generally done on five-day-old embryos, which have more than 100 cells. That makes it safer to remove multiple cells, giving a more accurate result than if only one cell is tested.
Still, critics say, if the test is at all inaccurate, some good embryos might be thrown out or defective ones chosen.
A study presented at the European Society of Human Reproduction and Embryology meeting on June 30 found that different testing techniques can yield different results for the same embryo, suggesting that not all the tests are accurate.
Also, some embryos die between Day 3 and Day 5 and lose the chance to be transferred. While those embryos might have been abnormal anyway, there is a chance that waiting five days to test could be costly, especially for older women, who produce fewer eggs.
Christine Peixoto of Lebanon, N.J., for instance, produced only one embryo that survived for five days and tested normal. But she failed to become pregnant. The next year, at age 39, she had three 3-day-old embryos transferred, without testing. She gave birth to a girl.
Still, data is accumulating showing the technique can help improve pregnancy rates, particularly in younger women who produce more eggs and therefore more embryos to choose from.
One study involving about 100 women under age 35 found that 71 percent of the women in the group whose embryos were tested became pregnant compared with 45.8 percent of those whose embryos were selected based only on their shape.
For women over 35, who often need more help getting pregnant, a small randomized study by Dr. Scott’s clinic and the Colorado Center for Reproductive Medicine found a higher live birthrate in those who had P.G.S. — 74.5 percent versus 53.7 percent in the control group. However, Dr. Gleicher, the critic, said the women in this study had a more favorable prognosis to begin with than many older women.
Use of time-lapse imaging presents a noninvasive alternative, in that it does not require removing cells from the embryo. Auxogyn’s system, called Eeva, takes images of the embryos every five minutes or so for the first three days. It uses an algorithm to calculate a score on how fit the embryo is based on the timing of certain events, such as how long it takes cells to divide.
“It improves pregnancy rates substantially more than anything that is out there, and without invasion,” said Dr. G. David Adamson, chief executive of Advanced Reproductive Care, a network of fertility clinics, who has been a consultant to Auxogyn.
So far, however, there has been no published data showing that use of the system improves pregnancy and live birthrates. There is a study showing that the Eeva test is better than embryo shape alone in predicting which 3-day-old embryos will survive to five days in the incubator. Presumably those would do better in the womb as well.
FertiliTech’s EmbryoScope leaves it to each clinic to analyze the time-lapse images. Niels Birger Ramsing, the company’s chief scientific officer, said that clinics differ in how they culture embryos, so the timing of cell division events can differ. That makes it difficult to develop an algorithm that would work for all clinics, he said.
Stay up late? How it could hurt your fertility (from Fox News)
Women who want to become pregnant or are expecting a baby should avoid light during the night, a new report suggests.
Darkness is important for optimum reproductive health in women, and for protecting the developing fetus, said study researcher Russel J. Reiter, a professor of cellular biology at the University of Texas Health Science Center in San Antonio.
In a review of studies published online July 1 in the journal Fertility and Sterility, Reiter and his colleagues evaluated previously published research, and summarized the role of melatonin levels and circadian rhythms on successful reproduction in females.
The evidence shows that “Every time you turn on the light at night, this turns down the production of melatonin,” Reiter said.
Melatonin, a hormone secreted by the pineal gland in the brain in response to darkness, is important when women are trying to conceive, because it protects their eggs from oxidative stress, Reiter said. Melatonin has strong antioxidant properties that shield the egg from free-radical damage, especially when women ovulate, the findings reveal.
“If women are trying to get pregnant, maintain at least eight hours of a dark period at night,” he advised. “The light-dark cycle should be regular from one day to the next; otherwise, a woman’s biological clock is confused.”
Eight hours of darkness every night is also optimal during pregnancy, and ideally, there should be no interruption of nighttime darkness with light, especially during the last trimester of a pregnancy, Reiter said.
Turning on the light at night suppresses melatonin production in women, and means the fetal brain may not get the proper amount of melatonin to regulate the function of its biological clock, he said.
Animal studies have suggested that disturbances in the mother’s light and dark environments may be linked with behavioral problems in newborns. This has led some researchers to speculate that similar disruptions of the light and dark cycles when a woman is pregnant may be related to the rise in attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorders in young children.
“We have evolved for 4 million years with a regular light-dark cycle that regulates circadian rhythms,” Reiter said. “We have corrupted this with the development of artificial light, which disrupts the biological clock at night and suppresses levels of melatonin.”
“There is a biological price to pay for disturbing the light,” Reiter said.
What women can do
Darkness is necessary for a regular biological clock and to produce a good dose of melatonin, Reiter said. However, he noted, “staying in darkness has nothing to do with sleep.” Sleep is nice, Reiter said, but it’s the darkness that’s needed for the brain to produce melatonin.
He recommended making sure the bedroom is dark, with no outside light coming in through the windows, or from a television or gadget’s glare. Those who want a night-light should choose a red or yellow light, rather than a white or blue light, which can disrupt circadian rhythms. And those who can’t sleep should avoid turning on the light.
PGD (Preimplantation genetic diagnosis) is an exciting technology that offers couples at risk an alternative to pregnancy termination of an affected fetus. In addition, PGD offers the promise to become an important tool in IVF by selecting a single embryo with the greatest potential for implantation, thereby maximizing pregnancy outcomes and at the same time reducing the risk of multiple births. You can read more about PGD here.
Below is an interesting article from Fox News by Julie Revelant explaining pre-implantation genetic screening (PGS) and pre-implantation genetic diagnosis (PGD).
OTC is a genetic disorder that causes ammonia to build up in the blood and then travel to the central nervous system. It can cause neurological damage and even be fatal. Because there’s no cure, Alexis’s brother takes several medications just to stay alive.
Through genetic testing, Alexis discovered that she, with her mother and two out of her three sisters were all carriers of the disorder. If Alexis had a child, there was a 50 percent chance that her baby would have the condition. Still in college, Alexis was devastated and worried if she would ever have a healthy baby one day.
After learning about her options, she decided that, when she was ready to have children, she would opt for pre-implantation genetic diagnosis (PGD), a procedure that screens embryos created through IVF for genetic abnormalities. “After I found out I was a carrier, I already knew the path that I wanted to take to be able to have children,” she said. “I didn’t want my future children to have to worry about it at all.”
Now married and hoping to start a family, Alexis underwent PGD in 2012, but the pregnancy didn’t take. She tried again and found out she was pregnant the day after Christmas. In August 2013, Alexis delivered a healthy baby girl.
What is pre-implantation genetic diagnosis?
PGD technology was developed in the 1990s, but only recently has it started to become more popular and a more viable option for couples who want to ensure their baby won’t inherit serious, even fatal, genetic conditions like Tay-Sachs, Cystic Fibrosis, and Spinal Muscular Atrophy (SMA) and genetic mutations like the BRACA gene, known to cause breast cancer. For couples who are both carriers of an autosomal recessive gene, their baby has a 1 in 4 chance of inheriting that genetic disorder.
According to the Society for Assisted Reproductive Technology, 5 percent of the more than 165,000 infertility cycles used PGD in 2012. PGD also eliminates the need for a mother to undergo chorionic villus sampling (CVS) or amniocentesis—or having to decide to terminate a pregnancy. “It gives patients the option of making this decision long before pregnancy,” Kaplan said.
Couples who undergo PGD can also opt for pre-implantation genetic screening (PGS), which screens embryos for chromosomal abnormalities that either don’t result in a pregnancy, cause disorders like Down Syndrome, or cause a miscarriage. “We know that a large percentage of human embryos are actually abnormal,” Kaplan said. For women under age 35, half of their embryos will have a chromosomal abnormalities.
For couples who have had multiple miscarriages, PGS may be able to help them have a healthy pregnancy, depending on what’s causing the miscarriage. If a normal embryo is implanted, it’s more likely that it will result in a healthy pregnancy.
“The chances of having a healthy baby are so much higher,” Kaplan said.
What you should know
According to Dr. Jamie Grifo, program director of the New York University Fertility Center, a woman’s age and her ovarian reserve are also key factors when looking at outcomes. For a single chromosomally normal embryo, there’s a 55 percent baby rate.
And for couples struggling with infertility, “We’re going to be doing this on everybody eventually,” Grifo said. “It’s going to be the standard.” The technology can also help to reduce the number of ectopic pregnancies, miscarriages, multiple pregnancies and preterm delivery. According to a study Grifo conducted that was published in the Journal of Assisted Reproduction and Genetics, PGD and PGS increased the pregnancy rate, reduced the rate of miscarriage, Down Syndrome and multiple births. These pregnancies are also healthier and babies are more likely to deliver larger and at full term.
Although PGD and PDS are very effective at ensuring the embryo will not be affected, there’s always a small chance, which is why Sturgeon was advised to have her daughter undergo genetic testing to be sure.
These procedures are also pricey, costing upwards of $6,000, not including the cost of IVF. Insurance may cover PGD, but not PGS.
PGD and PGS are not without controversy, as some people object to it for ethical, moral or religious religions. Yet ultimately, it’s up to the parents to decide what is right for them.
“Our job in the medical world is to give patients choices,” Grifo said. “If they’re comfortable with the technology, it will give them a better quality of life and prevent disease from occurring.”
My boys each have a little photo album stuffed full of ultrasound pictures. Yes, there are enough pictures to fill an entire album. My sister jokes my boys will be radioactive someday because they had so many ultrasounds. Their very first photos are pictures of them when they were embryos. The other day it hit me like a ton of bricks that my boys are getting older and someday we will make the decision to tell them that they were born through IVF. I always knew that someday we would tell them. I feel when a family has a secret, kids can sense that. I don’t want my kids to find out from a cousin who had a little too much to drink at a family wedding fifteen years from now.
One of the standard questions I get from people when they find out we have two kids through IVF is “Will you tell them?” I always respond, “Of course we will tell them.” It really is the best lesson in living with passion and with love that we can share with our boys. We will tell them you were wanted and loved so much even before you were born. We knew it was not going to be easy for mommy and daddy, but we were ready to fight. Our decision to have you was so full of love that we were not going to give up easily. We will tell them that they are miracles and destined to do great things. When my oldest wants to try out for college baseball but is afraid of failure, I will remind him of how scared mommy and daddy were that IVF might not work. But if something is terrifying and amazing then you have to do it. And I will remind him that the things you want most in life do not always come easy, but when you succeed the reward will be that much sweeter.
I used to fret over exactly when we would tell the boys. Do you tell them over their morning Cheerios? “By the way boys, you’re both test tube babies.” Do you tell them when they are in seventh grade, when they are studying reproductive health? “Hey boys, it’s not easy as they say it is to get pregnant.” Do you tell them when they are married and trying to have their own kids? “It may take you a while to get pregnant…sorry.” I have replayed all these scenarios in my head, and I don’t think any of them feel right. So I concluded that this is not something one can plan for. I guess it is like telling someone you love them for the first time. You can’t plan for that. You’ll just know in your heart when the time is right. We will know when to tell our boys that they are miracles and destined to do amazing things. Because really it is not how you get here, it is what you do while you are here.
Jen is mom to two amazing boys, thanks to the help of the Center for Advanced Reproductive Services. She’s also a middle school teacher and a peer support leader for Resolve. She credits her incredible husband for his support through their journey together.
Couples normally have a 20% chance of conceiving each month, and that is without any sort of planning, charting, or timing. Primary infertility becomes a concern when a woman under the age of 35 has been trying to conceive for one year without success, and a woman over the age of 35 has been trying for six months. However, if you have had a child previously, there may not be a need to delay more than three to six months before seeking a fertility evaluation.
Secondary infertility is classified as difficulty conceiving or carrying a pregnancy to term after successfully conceiving and carrying one or more children. There is often a misconception that because a couple has conceived in the past, they will be able to conceive at any time in the future. Unlike primary infertility, secondary infertility is more difficult to diagnose due to the fact that couples hesitate to seek treatment. Often, they feel guilty for their desire to have another child and settle on the idea that maybe their family of three was meant to be.
Before receiving an official diagnosis of secondary infertility, a couple having trouble conceiving is subject to plenty of unsolicited advice from family and friends. The inability to have a child after already having one or more children may put strain on interpersonal relationships, and cause couples to put off major life events like taking a new job or traveling. There may be a greater sense of confusion and doubt: “Do we really need fertility treatment since we had one child in the past? Are we wasting money? Maybe this will happen if we just try a little longer.” Having a child or children in the past does not guarantee a person’s ability to have more children. Couples seeking a fertility evaluation sooner than later are provided peace of mind and a game plan for family building.
Here are some of the benefits to seeking a fertility evaluation for secondary infertility:·
Remember, there is no shame in wanting another child. Only you and your partner can truly decide when you have finished building your family and there is no commitment to fertility treatment required. Utilize resources like the Patient Care Advocates at FertilityAuthority.com for learning more about fertility doctors who specialize in secondary infertility. First published on the Fertility Authority by Kim Griffiths.
Interesting article in Money magazine, chronicling one couple’s five-year struggle—emotional, physical and financial—to have a baby.
At the Center, our goal is to help every patient who wishes to pursue services to find a way to pay for their care. We continue to offer new programs on a regular basis plus free financial counseling, so please talk to us to find out what you might qualify for. More information here.
Interesting piece from NPR on how maternal age affects eggs and gene disorders. Did you know that with our PGD (preimplantation genetic diagnosis) program, over 40 life-threatening and debilitating genetic diseases may be screened before embryonic implantation.
More information on PGD here.
We women are all too aware that as we get older the risk of having a baby with genetic disorders goes up. All of a woman’s eggs are primed up and ready to go before we are born. But the ones we ovulate later are more prone to genetic errors than the earlier ones.
As a friend of mine surmised, “We age, so you kind of think our eggs would, too.” For a long time, doctors have thought that was true. They call it the “production-line hypothesis.”
But they now think they were wrong about that. “It doesn’t look as though the first-formed eggs are any better than the later-formed eggs,” says Terry Hassold, a chromosome biologist at Washington State University and a co-author on a study that was published last week in the American Journal of Human Genetics.
Birth defects and genetic disorders are often caused by chromosomal abnormalities, which happen when either the mom’s egg or the dad’s sperm contains the wrong number of chromosomes. Proteins called crossover proteins help chromosomes sort themselves out.
The chromosomes are like dance partners, says Ross Rowsey, a doctoral student and lead author on the paper, and these crossover proteins help them correctly pair up. “If those dance partners aren’t connected, it is just as likely that they will pull to the same side of the ballroom as to the opposite side of the ballroom,” he says. When the chromosomes aren’t matched in pairs, that can lead to trisomy, or one extra chromosome, as in Down syndrome, or monosomy, just one chromosome, as in Turner’s syndrome.
To find out if the egg cells that develop later are more prone to chromosomal abnormalities than those that develop first, Rowsey counted the number of crossover proteins in the egg cells of fetuses with different gestational ages.
“We saw that there is an extraordinary amount of variation between eggs, and between females,” he says, “but they do not vary by time.” That is, the egg cells of younger fetuses had about the same number of crossover proteins as the egg cells of older fetuses. He looked at fetuses between 14 weeks and 26 weeks in gestational age.
So then why does the risk of birth defects increase as women get older?
It’s more likely that there’s no one maternal-age effect on eggs, Rowsey says. “There are many different factors that come into play, and we have to explain them all.” The proteins that bind chromosomes together may degrade over the years that the egg is waiting in a woman’s ovary, Rowsey says. The number of eggs that women have is also depleted over time, so there might be fewer good ones to choose from.
Whatever the causes, the maternal-age effect is undeniable. “The rate of chromosomal abnormality appears to be hard-wired into our species,” says Hassold. “The only thing that moves the dial is maternal age.”
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