Take a closer look at retrieved oocyctes in the lab being prepared for fertilization by having their cumulus cells removed….
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An Embryologist’s View
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Dr. Kaylen Silverberg airs on YNN Austin
Don’t miss Dr. Silverberg’s interview on YNN Austin on Tues Aug. 23rd where he discusses the latest egg freezing technology and get a look at Austin IVF close up.
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The Menstrual Cycle
By Maggie Landwermeyer, MD
Hill Country OB/GYN AssociatesIt is pretty much universal…most women hate their period. We call it by many endearing nicknames: “Aunt Flo”, “The Monthly Curse,” – you get the idea. We all know it is a necessary evil for reproductive health. Let’s take a closer look at the menstrual cycle and learn about it.
Ovulation occurs when a mature egg is released into the fallopian tube in hopes of conception and subsequent pregnancy. Calculating the day of ovulation is kind of tricky. This is because it is typically a constant 14 days from ovulation to the first day of menstrual flow. However, the number of days between the first day of the period and ovulation is variable. To determine ovulation, count backwards 14 days from the first day of bleeding. This is typically the day that ovulation occurred in the previous cycle. You should be able to then predict when the next ovulation is likely to occur.
The lining of the uterus thickens throughout the month in hopes of sustaining a pregnancy. However, if the egg is not fertilized by the sperm, hormonal signals cause the lining of the uterus to shed. This is the menstrual bleed. The menstrual cycle begins (on average) at age 13 and ends (on average) at age 52. The range of normal can be from 21 to 35 days from Cycle Day 1 to the next Cycle Day 1. Average length of bleeding ranges from 3 days to 10 days.
Hemorrhage concerns occur if a woman soaks through a pad/tampon an hour for 2 consecutive hours, or becomes light-headed, dizzy, or feels like she may pass out. Contact your provider if these symptoms occur.
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New Fetal Blood Test Available
A new fetal blood test is available to determine a baby’s sex as early as seven weeks into pregnancy…
for the full article in The New York Times:
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Thanks to Texas Fertility Center, Austin Just Got A Little “Cooler”
You may have recently seen our announcement of the first baby born from a frozen donor egg in Texas. We are so happy and proud to have been able to bring this new technology to Texas and we look forward to using it to help many more of our patients in the near future. Unless you follow this field closely, you may be wondering what the big deal is, since we have been freezing sperm and embryos and using donor eggs and sperm for years. In fact, this latest accomplishment is significant for many reasons.
While it’s true that we have been freezing both sperm and embryos for decades, eggs have been extraordinarily difficult to freeze successfully.
There are many reasons for this, not the least of which is that the egg is the most complex cell in the human body. When we get a sperm specimen for freezing, it may contain 50-100 million sperm. When we freeze and then thaw the specimen, only 50-60% of those sperm may survive. That leaves us with plenty of viable sperm to use. Similarly, when we freeze embryos that have at least 8 cells, 80+ or more will survive the process (ie. at least one cell of the original 8 will survive intact – enough to make a completely normal baby). When we freeze an egg, on the other hand, there is only 1 cell to begin with. If that cell fails to survive, it’s all over.
So how do we freeze and why don’t cells always survive?
In fact, “freezing” of eggs is really “freeze drying”. The egg, the largest cell in the body, is composed mainly of water. If we simply freeze the egg, the water can form ice crystals, which can damage the chromosomes (DNA) inside and ruin the egg. Therefore, rather than freeze the egg, we have to first remove the water. We then replace the water with a non-toxic “antifreeze” that allows the other structures inside the egg to survive being frozen at 400 degrees below zero for a long time.
The technology that we used in the past to accomplish egg freezing involved putting the egg in a medical-grade plastic vial and slowly dropping the temperature using a programmable freezing machine. Once the egg reached a specific temperature, we would drop the vial into liquid nitrogen in order to rapidly complete the freezing process. Using this technology, about half of the eggs would survive, and programs around the world reported pregnancy rates of 2-3% per egg. Therefore, one could expect a 40% or so pregnancy rate if we could freeze 20 eggs – something that very rarely happened, as only our youngest patients even produce that many eggs.
Our new technology, developed in conjunction with good friends in Atlanta, uses a different type of non-toxic “antifreeze” and other equipment that allows us to rapidly freeze the eggs. They have been using this technology for several years now, and have reported 50-55% pregnancy rates with the use of 6 or fewer eggs.
Worldwide, there have now been several hundred babies born from egg freezing technology. Although the technology is obviously too new to definitively declare it to be free of long term side effects, so far no adverse effects have been reported.
So why is this new egg freezing technology such a big deal? In fact, there are many types of patients who can benefit from this new technology. Cancer patients can have their eggs successfully frozen prior to undergoing chemotherapy, radiation, or surgery. Women who want to electively preserve their fertility can now take advantage of this new technology to give them some degree of comfort that they will be able to conceive at an older age.
In addition, for the past 10 years or so, we have been prohibited from using fresh donor sperm for insemination – due to the risk of transmission of such diseases as HIV, Hepatitis B, Hepatitis C, and syphilis, among others. Sperm donors undergo testing for these potentially infectious diseases; they then produce sperm specimens which are frozen for a minimum of six months, and then they are retested to ensure that they are still disease free. Unfortunately, as we have not been able to successfully freeze eggs, couples who used donor eggs have had to risk acquiring these diseases as a result of using fresh eggs. Now, as a result of this new technology, couples using donor eggs can have the choice of using frozen donor eggs that have been quarantined and are, therefore, disease free.
As most successful IVF programs report pregnancy rates from fresh donor eggs in the range of 50% or so, there is no “fall off” in the chance for success by using frozen donor eggs. On the other hand, the most successful IVF programs, such as ours, have reported donor egg pregnancy rates of 70% or so per cycle, so there would be a slight decrease in the chance for pregnancy. The good news is that couples at TFC who desire donor eggs now have a choice.
Is this technology available everywhere? In fact, many IVF programs say that they can freeze eggs. The overwhelming majority, however, have never reported a successful birth once the eggs have been thawed and used. The key question to ask is not can they freeze eggs, but have they produced a successful pregnancy.
We believe, as a result of reported successes like ours, that the FDA will soon require IVF programs to use only frozen donor eggs. We are so happy that this technology will allow TFC to remain on the forefront of fertility treatment and we will continue to strive to develop more technologies to make fertility treatment even more successful and safe for our patients.
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Texas Fertility Center Celebrates First Frozen Egg Donor Birth in Texas
You may have recently seen our announcement of the first baby born from a frozen donor egg in Texas. We are so happy and proud to have been able to bring this new technology to Texas! See the full story below…
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Obesity & Reproduction
Obesity is an increasing problem in the United States; women/men of a reproductive age are not excluded from this problem. It is estimated that approximately 31% of white women, 38% of Hispanic women, and 49% of black women in the U.S. are overweight or obese. Many people are aware of the problems that obesity can cause – but many are not aware of the reproductive consequences.Infertility in obese women is often (but not always) caused by ovulation problems – ovulation may be occurring very infrequently or not at all. Thus, women may have increasingly irregular/erratic menstrual cycles or no menstrual cycles at all. However, there is some evidence that this is not the only way that fertility can be affected. Although it is not known for sure, some research suggests that elevated levels of insulin (the hormone that allows the body to use glucose effectively) in overweight/obese women may be another factor which reduces fertility.
Studies done on women who have undergone IVF have, in general, shown there to be an adverse effect of carrying extra weight on the success of treatment. These studies also indicate a higher risk of early pregnancy loss for overweight or obese women undergoing IVF.
What is known for sure is that obesity increases the risk of many complications of pregnancy: pre-eclampsia, gestational diabetes, and need for c-section. The risk increases with the BMI (body mass index). Also, obesity has been linked to an increased risk of birth defects. In addition, there are concerns about the impact that maternal obesity may have on the subsequent development and health of the child.
Some providers believe that women should achieve a BMI of 30 who are not achieving results with lifestyle changes alone, some medications may be helpful in enhancing weight loss. For women (or men) who have a BMI >40 (or over 35 with serious co-existing medical problems), weight loss surgery may be a better and more efficacious option.
Addressing weight issues is never easy. Many folks may have already tried weight loss in the past with mixed results. However, the potential benefits for reproductive health are significant. Now is the time to make changes for a healthier you and a healthier pregnancy!
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Winning at the Fertility Waiting Game
French writer Alexandre Dumas once quipped: “All human wisdom is summed up in two words: wait and hope.” These words encapsulate what it’s like to live and cope with infertility. If you have tried unsuccessfully for one year (six months if you are over 35) to get pregnant, the wait for a diagnosis is over. You are among the one in eight American couples considered infertile. Infertility is a unique disease in that it often suspends patients in monthly wait-hope-despair cycles; the frequent ups/downs of the trying/waiting can exacerbate already existing stress.
To help equip you for the wait to get pregnant, Texas Fertility Center offers monthly seminars as well as printed and online educational materials. We believe it’s empowering to inform oneself about: the treatment options available through assisted reproductive technology (ART); financial strategies for funding fertility; and the link between wellness and fertility.
Concentrate on Financial Matters
If you’re just beginning the active phase of fertility treatment, you’re likely focused on the cost of treatment. A conversation with the Texas Fertility Center billing office will help you understand the financing options available to you. We recommend having a frank discussion with your partner about how you will pay for the cost of fertility treatment. Will you rely on a savings account? Take a second job on nights or weekends? Sell a car or use investments to fund your cure?
Multiple cycles increase your odds for a successful outcome. That’s why Texas Fertility Center partners with ARC to offer discounts on multiple cycles and a refund guarantee. You should also decide a cut-off point. How much time, money and emotional reserves will you devote to pursuing a baby?
Treat Yourself Like a Mom-to-Be
Don’t wait for a positive pregnancy test to start adopting a healthy lifestyle. A pregnant woman will tailor her diet to nourish a growing baby, adding more whole foods and cutting back on processed foods and trans fats. In what’s known as “the nurse’s study,” researchers from Harvard and other institutions found a link between red meat and infertility and associated a plant-based diet (legumes, nuts, soy) with increased fertility. Ask our TFC nurses to make recommendations on foods to avoid and those to incorporate into your diet to enhance fertility.
Our TFC fertility doctors also recommend maintaining a healthy weight. Too much or too little body fat will interfere with ovulation, so strive to maintain a body mass index (BMI) between 19 and 25.. Of course, you’ll also want to abstain from cigarette smoking and drug and alcohol use. Finally, the link between stress and infertility appears to be real, although no study conclusively proves it. Experience tells us that a regular practice of meditation, massage, deep breathing and moderate exercise improves your mood and outlook. During the rigors of fertility treatment, you’ll want to take proactive steps to nurture yourself and relieve stress.
Connect as a Couple
Before you decided to start a family, you chose to start a life together. Celebrate that! Try to take mental breaks from fertility treatment and pursue activities that you both enjoy. Sign up for a 5K, visit a bed and breakfast, take in a midnight movie or a Sunday matinee at the theatre. Once you have a baby or toddler, your couple time all but disappears. You would, of course, gladly trade that free time for a baby, but try to focus on bolstering your relationship now, before you feel the all consuming pull of parenthood’s daily demands.
Although it may feel like life stands still for you while all of your friends move on to parenthood, the wait will end. You’ll have a resolution to this journey. The team at Texas Fertility Center will work diligently to help you get pregnant. Meanwhile, focus on steps you can take now to improve your relationship, health and finances.
Robert Epstein, Ph.D., editor in chief of Psychology Today, says the “non-behavior called ‘waiting’ can have enormous benefits in a number of domains.” Find creative ways to fill the time before conception. And remember: We live in an instant gratification society, but your baby — whether biological, donor assisted or adopted — is worth the wait.
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Male Smokers and Fertility
What We Know about Smoking and a Woman’s FertilityIt is well accepted that smoking is detrimental to ovarian function and female fertility. Smoking has been shown to be toxic to ovarian follicles and eggs, demonstrating a direct correlation between smoking and decline in fertility.
Excessive smoking is linked to the premature onset of diminished ovarian reserve (loss of eggs from the ovary) which leads to a decline in fertility. In fact, several studies report that pregnancy rates from in vitro fertilization (IVF) are reduced by 45-50% for women who smoke! Also, women exposed to second hand smoke had lower chances of success than their non-smoking peers. In cycles where a couple’s embryos are placed into a gestational carrier, pregnancy rates were lower (19% vs. 44%), if the carrier was a smoker.
In this study, all of the embryos came from couples who did not smoke. The conclusion of this study was that smoking adversely affected the vascular blood flow to the uterus, making it less receptive in regard to implantation. To make matters worse, smoking increases the chance of a miscarriage once a woman does become pregnant. This is a compounding negative effect on fertility.
Male Fertility and Smoking
Many couples have assumed that smoking is not detrimental to the male in regard to fertility as long as the sperm count is normal. However, there is evidence that smoking is harmful to sperm and sperm function.
Pregnancy rates for couples undergoing IVF were evaluated for male non-smokers and to smokers. Women who had non-smoking partners had a higher pregnancy rate (32% vs. 18%). It was thought that reason for the lower pregnancy rate was that the sperm from the male partners who smoke had more difficulty fertilizing an egg. However, this study also evaluated the 2 groups where eggs were directly injected with sperm , a procedure called intracytoplasmic sperm injection (ICSI).
Despite utilizing this technique, there was still a difference in the pregnancy rates (38% vs. 22%). ICSI did not increase the pregnancy rate for the women with male smokers. Therefore, the problem with male smokers was not simply that the sperm was unable to penetrate the egg. Male smokers clearly have a lower chance of fathering a pregnancy.
This should be enough evidence to convince a man to discontinue smoking. Never mind the other risks associated with smoking such as lung cancer, bladder cancer, esophagus cancer, throat cancer, larynx cancer (voice box), mouth cancer, stomach cancer, leukemia, heart disease, stroke, artery disease, chronic lung disease, premature aging of the skin, etc…
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Alternative Parenting
We are so fortunate in these modern times with the medical advances that have been made to make parenting possible for so many people who otherwise may never have had the chance. Alternative parenting includes single women, gay and lesbian couples, older women needing donor eggs as well as women with partners with severe male factor who need donor sperm. Just to think that only about 30 years ago none of these people would have been able to fulfill their dream of having children of their own.
For single women who have not met Mr. Right yet, they can undergo insemination with donor sperm when they are ovulating, provided no other co-factors contributing to infertility are present. They can also “bank for the future” so to speak by freezing their eggs and then undergo IVF when they do find Mr. Right if natural conception does not occur. Freezing eggs with the new vitrification technology is an excellent option especially for women under 35 since they should still have good quality eggs that they can freeze for the future. Women with cancer can take advantage of egg freezing or embryo freezing before going through chemotherapy and come back years later to use their frozen eggs or embryos without any deterioration in quality irrespective of the length of time frozen. For women that are older and no longer have good quality or quantity of eggs, IVF with donor egg is an excellent option with pregnancy rates approaching 80%. For lesbian couples insemination with donor sperm either with a natural cycle or with some “fertility” meds is an excellent option. For gay men, they can undergo IVF using an egg donor and a gestational carrier.
At Texas Fertility Center we follow ASRM and FDA guidelines on third party reproductive and are grateful to have an excellent IVF laboratory as well as support staff to help us build families, whether it is helping couples the traditional way or those that seek alternative parenting options.
