Global IVF Launches First Video Guest Expert Series

Global IVF strives to bring you the most current and useful information regarding all things infertility related around the world. Every month, Global IVF features ‘experts’ in their field – a reproductive endocrinologist, a reproductive clinic, an embryologist, a reproductive lawyer, a medical tourism company, a therapist, etc. Not only will you be privy to their inside information and expertise, with many of them you will have the chance to ask and get answers to your own specific questions!

This week Global IVF is featuring Guest Expert Dr. Daniel Potter of Huntington Reproductive Center and MicroSort West in Laguna Beach CA. This is the first video in a three part series featuring Dr. Potter. Doctor Potter’s active research interests include gender selection, ovarian reserve testing, endometrial preparation for IVF with donor egg, embryo cryopreservation and frozen embryo transfer. Dr. Potter is also author of the book: What to Do When You Can't Get Pregnant: The Complete Guide to All the Technologies for Couples Facing Fertility Problems (Marlow and Company, New York, New York 2005.)

About Global IVF:
To fill the niche in the ever-growing trend in cross-border travel for reproductive care, Kathryn Kaycoff-Manos and Lauri Berger de Brito founded Global IVF.com, the ultimate Global Guide devoted to Infertility and all related services available worldwide.

Free membership to GlobalIVF.com also includes bi-monthly newsletters and full access to Global IVF’s blogs and online chat forums, allowing intended parents to share experiences and collect advice about specific clinics and treatments currently offered worldwide.

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Infertility Lingo: Terms That You Should Know

If you are trying to get pregnant and are dealing with infertility, you might find some of the medical jargon and frequently used terms more than a little bewildering.

Here are some of the more commonly used terms with brief, easy to understand definitions:

ART: Assisted Reproductive Technology. This refers to basically any procedure that involves taking eggs from a woman’s ovaries and combining them with male sperm.

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Anti-Mullerian Hormone test

Stock photo by gmarcelo
AMH assessment is also useful in fertility assessment as it provides a guide to ovarian reserve and identifies women that may need to consider either egg freezing or trying for a pregnancy sooner rather than later if their long-term future fertility is poor.

Measuring AMH alone may be misleading as high levels occur in conditions like polycystic ovarian syndrome and therefore AMH levels should be considered in conjunction with a transvaginal scan of the ovaries to assess antral follicle count.

In view of it's potential use to assess a woman's ovarian reserve and future fertility, measurement of AMH is sometimes called the biological Body Clock Test. see www.ukbodyclock.com

It also has the potential to rationalize the program of ovulation induction and decisions about the number of embryos to transfer in assisted reproduction techniques to maximize pregnancy success rates whilst minimizing the risk of ovarian hyperstimulation syndrome (OHSS)

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Infertility Causing Gene, Smad-3 Identified

Scientists at Virginia Commonwealth University have identified a gene, which they assert causes infertility. They said that, such types of genes send molecular signals used for the ovarian follicle development. This may be a guiding source for learning the fertility related issues in humans.

The scientists used a mouse model to examine the role of Smad-3 in the early stages of follicular growth.

They on careful observation found that, follicle-stimulating hormone, or FSH needs a particular gene to function in the body. So they confirmed that, the mice didn’t experience normal ovulation due to the absence of such gene.

Further, the researchers concluded that Smad-3 is an important class of proteins that are essential for follicle development.

"Learning precisely how the FSH receptor is regulated is an important step in understanding the subtle defects in signal transduction that can interfere with follicle development and female fertility and could lead to new types of fertility treatments," Prof Elizabeth McGee said.

These findings have been published in the current issue of 'Biology of Reproduction' journal.

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Have you considered taking DHEA?

Barad D.H., Gleicher N. Increased oocyte production after treatment with dehydroepiandrosterone (2005) Fertility and Sterility, 84 (3), pp. 756.e1-756.e3.
Abstract Objective: To describe a case of dramatically improved ovarian reserve in a 42.7-year-old woman who was using the dietary supplement dehydroepiandrosterone (DHEA) as well as acupuncture.

Setting: Private IVF center.

Patient(s): A 42.7-year-old patient with initial severely decreased ovarian reserve. Intervention(s): Serial ovulation induction with concomitant use of DHEA dietary supplementation as well as acupuncture.

Main Outcome Measure(s): Peak E2 concentration, oocytes retrieved, and cyropreservable embryos. Result(s): In her first treatment cycle peak E 2 was 1,211 pmol/mL. After seven months of DHEA supplementation her peak E2 in cycle 8 was >18,000 pmol/mL. Because of fear of hyperstimulation we reduced her gonadotropin stimulation by 25%. In the ninth cycle peak E2 was 9,178 pmol/mL, resulting in retrieval of 17 oocytes (16 embryos). In the last 11 months the patient has undergone nine treatment cycles while continuously and dramatically improving her ovarian response and banking of 66 embryos overall.

Conclusion(s): This case illustrates the possibility that ovarian function may be salvaged, even in women of advanced reproductive age.
©2005 by American Society for Reproductive Medicine.

Barad D., Gleicher N. Effect of dehydroepiandrosterone on oocyte and embryo yields, embryo grade and cell number in IVF (2006) Human Reproduction, 21 (11), pp. 2845-2849.

Abstract Background: The aim of this study was to investigate the effect of treatment with dehydroepiandrosterone (DHEA) on fertility outcomes among women with diminished ovarian reserve.

Materials and Methods: This is a case-control study in an academically affiliated private infertility centre. Twenty-five women with significantly diminished ovarian reserve had one IVF cycle before and after DHEA treatment, with otherwise identical hormonal stimulation. Women received 75 mg of DHEA daily (25 mg three times daily) for an average of 17.6 ± 2.13 weeks. We performed a comparison of IVF outcome parameters, before and after DHEA treatment, including peak estradiol (E2) levels, oocyte and embryo numbers, oocyte and embryo quality and embryo transfer statistics.

Results: Paired analysis of IVF cycle outcomes in 25 patients, who underwent cycles both before and after DHEA supplementation, demonstrated significant increases in fertilized oocytes (P < p =" 0.001)," p =" 0.005)">

Conclusion: This study confirms the previously reported beneficial effects of DHEA supplementation on ovarian function in women with diminished ovarian reserve.
© 2006 Oxford University Press.

Barad D., Brill H., Gleicher N. Update on the use of dehydroepiandrosterone supplementation among women with diminished ovarian function (2007) Journal of Assisted Reproduction and Genetics, 24 (12), pp. 629-634.

Abstract Objective: We assessed the role of DHEA supplementation on pregnancy rates in women with diminished ovarian function.

Design: This is a case control study of 190 women with diminished ovarian function. The study group includes 89 patients who used supplementation with 75 mg daily of oral, micronized DHEA for up to 4 months prior to entry into in vitro fertilization (IVF). The control group is composed of 101 couples who received infertility treatment, but did not use DHEA. The primary outcome was clinical pregnancy after the patient's initial visit. We developed a Cox proportional hazards model to compare the proportional hazards of pregnancy among women using DHEA with the controls group.

Results: Cumulative clinical pregnancy rates were significantly higher in the study group (25 pregnancies; 28.4% vs. 11 pregnancies; 11.9%; relative hazard of pregnancy in study group (HR 3.8; 95% CI 1.2-11.8; p<0.05).>Conclusions: DHEA treatment resulted in significantly higher cumulative pregnancy rates. These data support a beneficial effect of DHEA supplementation among women with diminished ovarian function.
© 2007 Springer Science+Business Media, LLC.

Fernandez-Shaw S., Ruesta C., Cercas R., Pons I. Use of dehydroepiandrosterone (DHEA) in low responders [Uso de dehydroepiandrosterone (DHEA) en bajas respondedoras] (2008) Revista Iberoamericana de Fertilidad y Reproduccion Humana, 25 (4), pp. 233-238.

Abstract Objective: To compare results in IVF cycles from patients with ovarian failure before and after treatment with Dehydroepiandrosterone (DHEA). Method: We included 16 patients with ovarian failure and a previous IVF cycle with a very low response. Ovarian stimulation was carried out following short protocols with recombinant FSH. We compared paired IVF results from women before and after treatment with DHEA (75 mg for 4 months).

Results: Basal FSH and estradiol were the same before and treatment with DHEA. Treatment with DHEA lowered the number of cancelled cycles and increased, although not significantly, the number of growing follicles, retrieved oocytes, mature oocytes, embryos and pregnancies obtained. Out of the 16 patients enrolled, one got pregnant spontaneously after two months of treatment with DHEA, 4 abandoned the study and 11 performed a cycle of IVF after treatment with DHEA.

Conclusion: Exogenous DHEA might be a concomitant treatment to offer to low responders to improve their ovarian stimulation, increasing the number of patients that achieve embryo transfer, and improving therefore their chances of pregnancy. However, success of this treatment is moderate, since patients, even after treatment with DHEA, continue to be low responders.

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Delay motherhood by 'removing ovary for storage'

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Women will soon be able to delay motherhood into their 40s and beyond by having one of their ovaries removed and stored, the doctor behind the world's first whole ovary transplant has said.

Dr Sherman Silber, performed the transplant between two twins last year and the recipient, who cannot be named, is due to give birth in London today.

The technique will offer hope to women undergoing treatment for cancer which can leave them infertile by allowing them to store an ovary before having cancer treatment and then re-implanting it once they have the all clear.

Full story: http://www.telegraph.co.uk/health/women_shealth/3437100/Delay-motherhood-by-removing-ovary-for-storage.html

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Age not FSH determines IVF aneuploidy risk

Analyzing the influence of age and basal levels of follicle stimulating hormone on the risk for aneuploidy in women undergoing IVF.

The risk of embryonic aneuploidy in women undergoing IVF is significantly influenced by age but not by follicle stimulating hormone (FSH) levels, say scientists.

Researchers from the Lister Fertility Clinic in London, UK, note the decline in fecundity seen in women of advanced maternal age “is attributed to reduction of ovarian reserve and deterioration of oocyte quality.

Journal abstract

Full article: http://www.spainfertility.com/2008/08/29/age-not-fsh-determines-ivf-aneuploidy-risk/

From: SpainFertility: the destination for fertility tourists

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Three pregnancies despite elevated serum FSH & advanced age

ABSTRACT: Although the transfer of fertilized donor oocytes is the most efficacious mode of conception for infertile women with hypergonadotrophism associated with incipient or apparent ovarian failure, there are many individuals who, for religious, ethical, or personal reasons, would prefer to try to conceive with their own oocytes.

The three cases presented here represent extremes to date for (i) highest serum FSH concentration in a woman with incipient ovarian failure (n = 2), and (ii) the oldest woman with apparent overt ovarian failure (n = 1) to have successful pregnancies. All three cases were treated for only a short time with pharmacological dosages of ethinyl oestradiol with luteal phase support with progesterone.

The peak FSH (mIU/ml) in cases 1 and 2 was 143 and 127 respectively. The precedents set in these cases can help physician–patient consultation when patients enquire whether there is a certain critical FSH concentration above which pregnancy is not possible or an age over which successful pregnancy could not be achieved even if ovulation despite ovarian failure was possible.

First case: A 36 year old gravida 1, para 1 presented with a 3 year history of infertility. Her estradiol was less than 20 pg/ml, her FSH was 143 mIU/ml. Conceived 2nd cycle, delivered vaginally at full term.

Second case: A 35 year old woman presented with primary infertility and oligomenorrhoea. FSH of 22 mIU/ml, estradiol was less than 20 pg/ml. She had a successful full-term delivery.

Third case: a 45y old woman, last menstrual period was 6 months previously, FSH of 35. She delivered a full-term healthy baby

Human Reproduction, Vol. 15, No. 8, 1709-1712, August 2000© 2000 European Society of Human Reproduction and Embryology

Source: http://humrep.oxfordjournals.org/cgi/content/full/15/8/1709

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Technique measures a woman's 'biological clock'

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A technique has been developed by scientists to tell a woman how fast her biological clock is ticking and when menopause is likely to hit.

Sandy Martinez, a 30-year-old manager of actors, is busy building a career, but she also wants to raise a family.

She wonders how long she can put it off. "Obviously your body's not the same when you're older, so that is a concern to me," she told CTV News.

"A woman of say, 30 or 32, who's thinking about whether to press on with her career, or wants to get into a better financial situation to have a family, could be rest assured they have more time," said Dr. Hamish Wallace, one of the study's authors.

"What we have done is to come up with a method that may allow us to predict for a woman what ovarian reserves she has and at what age she is likely to experience the menopause," Wallace, a pediatric oncologist and lecturer at the University of Edinburgh, told Reuters.

The Scottish scientists say they can do this by measuring the volume of a woman's ovaries using ultrasound.

This could also tell them how many eggs a woman has left, which could have a significant impact on fertility treatments.

"The ultrasound measurement is taken to work out the volume of the ovaries. If the ovaries are larger than average for her age, then she is likely to have a later menopause and if they are smaller she is likely to have an earlier one. Essentially we try to quantify by how much, by how many years," Dr. Thomas Kelsey, a computer scientists at the University of St. Andrews, told Reuters.

Women start with an estimated 800,000 eggs, but that number declines over time.

By the time a woman reaches 37, she's down to about 25,000 eggs. At that time, the rate of decline speeds up. The ovaries shrink until almost all the eggs are depleted. At that point, menopause occurs.

That generally happens at age 50, but can happen between the ages of 42 and 58.

Wallace and Kelsey reported their findings in the medical journal Human Reproduction.

"It is going to be useful for couples who have fertility problems because it is an easy way for the fertility clinics to work out essentially whether it is worth doing IVF (in-vitro fertilization) or whatever treatment," Kelsey said.

For example, a woman with a number of fertile years ahead might be better off trying to conceive naturally or to space out fertility treatments, he said.

Conversely, if the egg supply is low, it might not be worth it, he said.

Two instances in which the diagnostic method won't work is for women taking oral contraceptives or those suffering from polycystic ovarian syndrome, which causes infertility.

The scientists are planning to do longer-term studies to track young women until they hit menopause.

"It opens the door to the possibility of screening women for early ovarian aging. These women may be at increased risk to their general health from the effects of having an early menopause," Wallace said.

But some warn against the use of this technique by perfectly healthy women.

"The difficulty of getting pregnant goes up as you get old. And the risk of miscarriage or Down's Syndrome goes up as well. So it's not just how many eggs you've got," Diane Allen of the Infertility Network.

Study: Ovarian reserve and reproductive age may be determined from measurement of ovarian volume by transvaginal sonography

Source: http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20040617/fertility_study_040617?s_name=&no_ads=

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