Which Path to Choose? Infertility Questions
Infertility questions lead us to ask, is it better to know the worst possible news or not? I'll bet we all agree about the best possible news.
That, we want to know.
CCS, Comprehensive chromosomal Screening, is a genetic screening process that tells us whether or not all the chromosomes in an embryo are intact. Normal. Since just about sixty per cent of miscarriages are caused by chromosomal abnormalities, the ability to definitively tell whether there is an abnormality or not is highly significant.
And I'm going to admit right here that I'm a little baffled. Here's why. I've heard from several women lately that are over forty, that they would rather not know prior to IVF (in vitro fertilization) and transfer (replacing fertilized eggs, embryos, into the uterine cavity) whether there were embryo abnormalities. The chances in a woman over forty that an embryo would have significant problems are increased.
That does confuse me. Why wouldn't you want to know if it significantly decreased the possibility of a pregnancy loss? Why wouldn't you want to know if there was no possibility of a pregnancy because none of the embryos were healthy enough to create a successful pregnancy?
What would be the advantage of not knowing?
Genetic Screening: 3 Thoughts on Different Choices
I have a good imagination. Maybe even above average. Sometimes it gets me into big trouble. But here goes with a few thoughts on the subject of genetic screening and other choices. I welcome hearing from you, to add to these ideas.
One. Perhaps being able to go through the process of IVF and not succeeding is a way of feeling that you have done absolutely all you can to become pregnant. To know that you've given it your all.
Two. Perhaps you have that nagging feeling that sometimes even the best scientific testing can be wrong and a perfectly healthy embryo will slip by and that you will be the person to continue on with a healthy pregnancy and baby.
Three. Perhaps you feel that allowing nature to take it's course is a choice that you are most comfortable making. That if it means a miscarriage or a baby with mild to significant health problems, that is the right choice for you.
OK, having thought it out, I feel less confused. I'm sure there are more reasons than the three above that I just listed. I have a good imagination, I know, though I'm sure that there are other explanations out there. (I'd love for you to share them with me, confidentially or here, on the blog.)
Personally, I know how hard this decision can be to make. To know or not to know? My choice was to know when faced with that personal dilemma about the breast cancer genes. I was terrified to know either way. Paralyzed, terrified. I felt pretty sure that if I had the genes, I wouldn't make the decision to have what was at the time, healthy breast tissue, removed. When I realized that there were actions that I could and should take if I did have the gene or genes, I gathered up my courage and had the test done. Believe me, it took a lot of digging to find that courage.
I was lucky. Very lucky. I did not test positive for the genes. It does not ensure that I will not get breast cancer, but it's one less reason to be concerned. Some of the testing that would have been necessary had I tested positive for the gene is not necessary having tested negative. It's one less thing to worry about.
Making Educated Healthcare Decisions
I feel lucky that I was able to find the courage and support to have the question answered. It was gnawing at me, not knowing. I worried, secretly and not so secretly. I know that I would have been devastated had the answer been positive. And I know I would have picked myself up and done everything in my control to make the healthiest, most educated decisions about my health care that were possible. What I didn't know was the extant of how worried I was until I knew that the results were negative. The burden that I was carrying was lifted. And I didn't even know it was there until it was gone.
That was my answer.
What's yours? To know or not to know? And why?
Lisa Rosenthal's Google+
Dr. Spencer Richlin Explains Why an Obstetrician Cares About Fertility Screening
Part of my job at Reproductive Medicine Associates of Connecticut (RMACT) is outreach to local Obstetricians/Gynecologists (OB/Gyn). The most pleasant way that is done is that I accompany one of our board certified reproductive endocrinologists (Dr's Mark Leondires, Spencer Richlin, Joshua Hurwitz, Cynthia Murdock and Shaun Williams) to a lunch at the office of an OB/Gyn.
Yesterday, it was Dr. Richlin and myself. I hadn't seen him in a while. I didn't forget how smart he is, really, I didn't. Listening to him explain the difference between PGD (pre-genetic diagnosis) and CCS (Comprehensive Chromosonal Screening) though, reminded me again how smart he is.
Be very clear, when you have two physicians talking about medical issues, as a lay person, I tend to get a bit lost. Less so these days then years ago. Also, they are kind and explain some of it as they go. Sometimes, like yesterday, they get so excited that the conversation just spirals away from me. It was fascinating listening to these men and women talk in such an animated way about their chosen fields of medicine and noticing where they intersect.
Why does an Obstetrician Care About CCS?
Why should an OB/Gyn care about CCS? Simple answer. One that I understood easily. Less pregnancy loss because there are almost no chromosomal abnormalities in the tested embryos (not zero, but less than 2% error rate). Given that almost 25% of all pregnancies result in miscarriage, that's important for an OB/Gyn to know. Pregnancy loss is hardest on the parents to be, without a doubt. I know. I had two of them. Pregnancy loss is also very challenging for a doctor's office to handle. There is the medical piece of it, which is often very straight forward, but not always. There is also the emotional piece of it, which is far less straight forward and needs to be handled on a patient by patient basis. There is often a lot of grief around a miscarriage even more potent when infertility was a struggle first. Our doctors and medical staff grieve with us when there's a loss.
Another reason that an OB/Gyn should care about CCS? Single pregnancies. When an embryo that has been found to be healthy is transferred back, the chances of pregnancy are much higher (and the risk of miscarriage much lower) and therefore allows for less embryos to be transferred back. Twin pregnancies frequently result in healthy babies and healthy moms. Often, though, there are more complications for both the babies and the mothers, even in a twin pregnancy. Certainly when we start to talk about higher order multiples (pregnancies of 3 or more), there will almost certainly be complications and probable compromises in the health and well being of the babies and the mother. An OB/Gyn would much prefer to see patients who are pregnant with one baby; they know that there is a much greater chance of a healthy baby and mom and much less chance of complications.
I got all this yesterday, again, while having the honor of hearing these physicians speak to one another. Yet another reason that I love my job! Fascinating conversations about women's health and family building, with doctors that really care. What's not to love?
CCS: Top Fertility Specialist Dr. Leondires Discusses New Fertility Technology
Dr. Mark Leondires
, Medical Director of Reproductive Medicine Associates of CT, recently spoke with reporters from WTNH about the breakthrough and award winning new fertility technique called "Comprehensive Chromosomal Screening". CCS
, as it is also referred to, is an embryo screening technique available in only five fertility centers in the United States.
How CCS Improves Pregnancy Rates
CCS can verify that all 23 pairs of chromosomes are healthy and normal. Techniques used in the past, including PGD
(Preimplatation Genetic Diagnosis) could screen up to 9 chromosomes and focused mainly on single gene disorders.This reduces the miscarriage rate tremendously as the majority of first trimester miscarriages are due to chromosomal abnormalities. This technique also reduces the occurance of multiple births
as one can be more confidant about the viability of the embryos that are replaced into the uterus.
Dr. Leondires takes you step by step through this process in the interview, as well as showing you how CCS looks in the lab itself.
This week is going to be the week of the videos on the blog. A young friend of mine shared the video that I am embedding today. Maybe it will seem off topic to you, given that this is an infertility blog. Keep in mind that it does speak to fertility treatment, just not for an infertility problem, per se.
It may not fit your individual politics or your moral belief system. I offer it this morning as a breath of fresh air or a ray of light, corny as that sounds. It would be hard for me to believe that anyone could see the young man speaking and feel anything but pride about having him part of the human race. I am interested in what you think about this; please feel free to share it with me privately if you wish. Of course, I'm trying not to give too much of this away, watch and see what you think.
Tomorrow, we’ll have the segment about Comprehensive Chromosomal Screening (CCS) that aired last week on WTHN for those of you who haven’t seen it. Dr. Mark Leondires, Reproductive Medicine Associates of CT Medical Director, along with our lab, were on discussing the different aspects and realities of CCS (a type of embryo screening that can look at all 23 of the pairs of chromosomes). I’ve been around the field of infertility for 23 years, ever since I was a patient. CCS is in the top five most significant breakthroughs that I’ve seen in that time. Check the blog tomorrow to hear more about it from Dr. Leondires who explains it so well.
I’m taking an informal poll. This is not going to be a statistically relevant study, just trying to find out what people are like best.
When it comes to infertility and fertility treatment, lots of us get sensitive, upset and scared about different pieces of the puzzle at different times. I’ve been writing this blog for over a year now and would love to know which blog touched you the most. Or upset you the most. Or best expressed how you felt the most.
So could you please pick your top three and send the title to me? I’d love to know why you liked the particular pieces that you chose as well. One of the reasons that I’m requesting this is that we have the opportunity to post this blog where it will find other readers. I figured I’d use the benefit of your wisdom to choose a few to start out with.
Top three blogs. Would love and appreciate the help. Remember that any response to this blog comes directly to me, it will not post unless you state that you would like me to post it. It can, of course, be anonymous or simply read only be me. Please let me know in your response.
Fertile Yoga is on in Norwalk and Brookfield this weekend. Peer support group meets from 9:30-10:00 in Norwalk and then Fertile Yoga. If you haven’t tried it, we’d love to have you. No class next Saturday, January 22.
Other things that are going on at RMACT:
Ladies Night In will be coming to Norwalk! By popular request, our support group that runs once a month in Danbury will also be held in Norwalk. Details posted soon.
Considering a pre-natal/in-between yoga class for those of you who are pregnant or about to be pregnant. Working on the details. Class likely to be offered in Norwalk. If this is something that you are interested in, please let me know via blog response.
Embryo Screening- CCS- Comprehensive Chromosomal Screening- Please read Wednesday’s blog to hear about this breakthrough technique. I can safely say that it is among the top three most exciting protocols that have been developed since I’ve been involved with infertility. That’s about 22 years. I can’t say enough for what we are now able to offer, in terms of embryo screening and selection.
Some things should be read in their entirety. This is one of those pieces. Written by our wonderful PR person, Tally Jacobs, a valued member of the RMACT team, it speaks of genetic screening news that is breakthrough and breathtaking, as well as award winning. As powerful as the storm that is swirling around us. Read on to hear more about it:
Breakthrough Testing Technique Identifies Genetic Abnormalities with Greater Accuracy in Embryos Before Pregnancy
Reproductive Medicine Associates of CT Partners with NJ Affiliate for Award-Winning Clinical Study of Comprehensive Chromosomal Screening
Norwalk, CT (January 10, 2010) – Reproductive Medicine Associates of Connecticut fertility centers(RMACT) recently participated in a breakthrough study titled "A Prospective Randomized Controlled Trial Demonstrating Significantly Increased Clinical Pregnancy Rates Following 24-Chromosome Aneuploidy Screening: Biopsy and Analysis on Day 5 with Fresh Transfer," which was led by Richard Scott, M.D. and Nathan Treff, Ph.D., of Reproductive Medicine Associates of New Jersey (RMANJ), an affiliate of RMACT.
This study, which earned the top research award from the American Society for Reproductive Medicine (ASRM) in October 2010, examined technology that is the first and only fully validated system to reliably evaluate all chromosomes in a small biopsy obtained from an embryo during in vitro development. This is the first and only prospectively randomized trial showing real benefit from pre-implantation genetic screening (PGS) and RMACT is the only fertility practice in New England to offer it.
“This technology will revolutionize reproductive medicine,” said Mark Leondires, M.D., Medical Director of RMACT and Lead Physician for RMACT on the Clinical Study. “The purpose is to identify the best embryos for a healthy pregnancy. By selecting chromosomally normal embryos without damaging them, pregnancy rates were dramatically increased to more than 90 percent and miscarriage rates were lower compared to the control group. This data is historic in its nature and implications.”
Sustained implantation rates were 75 percent in the study group, much higher than compared to 56 percent in the control group. Clinical pregnancies, which are a typical result of genetic abnormalities, were significantly lower in the study group (60 percent) than versus the control group (92 percent).
“Our goal is one embryo, one healthy baby," said Dr. Scott - one of our top fertility doctors. "So, the driving force behind most of our research is to assess reproductive competency to better predict which embryo will most likely produce one healthy baby. This is the first study of its kind that has shown dramatically improved clinical pregnancy rates with blastocyst biopsy, 24 Chromosome Aneuploidy Screening and fresh embryo transfer. Though similar screening technologies are being marketed, none have been validated through the critical studies, culminating with a randomized clinical trial, which provides this high level of medical evidence.”
The procedure starts when a couple goes through in vitro fertilization (IVF) treatment with intracytoplasmic sperm injection (ICSI); the embryo is then grown to the blastocyst stage and a small biopsy of five to 10 cells is taken from the embryo on day five to six days of life. The biopsy sample then goes through computer analysis to identify any abnormalities among the chromosomes. This process identifies chromosomal disorders such as Down syndrome before the embryo is transferred into the female patient’s uterus. This error rate of the technology is less than one percent in more than 4,000 embryos tested.
What separates this technique of Comprehensive Chromosomal Screening (CCS) from other PGS processes is that the embryo is able to grow for five or six days, allowing the cells to split and the chromosomal analysis to be more accurate. In addition, since the technology can be used to find small breaks in chromosomes and even single gene disorders it defines itself as the most robust and reliable technology for evaluating pre-conception embryos available. RMANJ has previously shown 24 chromosome analysis technology to be significantly more reliable than other existing methods. However, with this latest clinical study, the new technology has been improved because it no longer requires freezing embryos for weeks before thaw and use. The breakthrough is based on a shorter timeline, which has better results; the same comprehensive screening is conducted within hours instead of days. It is the first technology of its kind that allows for assessment of blastocysts and still enables a fresh embryo transfer, which generally has a higher success rate than freezing embryos.
The study included patients seeking IVF who were less than 43 years old and had no more than one prior failed IVF cycle. The control group underwent routine care and typical screening methods, whereas the study group underwent biopsy of the blastocyst and CCS on day five.
In a related retrospective evaluation presented with this research, the study shows that this new technology dramatically decreases the occurrence of abnormal pregnancies such as Down or Turner syndromes. This technology will allow women in their late thirties and forties, who normally have a high risk for genetic abnormalities, to nearly eliminate these risks and thereby maximize their chances for a successful pregnancy with in-vitro fertilization. CCS represents a major step forward in helping patients have healthy pregnancies and thereby allowing them to choose a single embryo transfer to minimize the risk of twins.
“A singleton pregnancy is the safest for mother and baby,” stated Leondires. “This technology will allow couples to choose a single embryo transfer without jeopardizing their chance for success. It is truly an amazing advance which will change the landscape of reproductive medicine in the future for both patient and physicians.”
Infertility affects 7.3 million Americans and for 20 percent of infertility patients the cause is unknown, according to The National Infertility Association. Through 24 chromosome aneuploidy screening, fertility doctors can determine which embryos are normal, increase healthy pregnancies while at the same time reduce the number of miscarriages. The technology will transform reproductive medicine and instill confidence in transferring only one embryo, leading to fewer multiple gestations. In addition, for patients who have had several miscarriages, it can enable them to make informed decisions about their next steps, such as working with an egg donor.
Reproductive Medicine Associates of Connecticut (RMACT) specializes in the treatment of infertility. With Connecticut fertility clinics and egg donation offices in Norwalk, Danbury and Greenwich, and affiliate New York fertility clinics serving Westchester, Putnam and Dutchess counties, our team of Board-Certified Reproductive Endocrinologists offer a wide range of infertility treatments from ovulation induction and intrauterine insemination (IUI) to the most advanced assisted reproductive technologies including IVF, egg donation and preimplantation genetic diagnosis (PGS). The RMACT team of fertility doctors includes Drs. Mark P. Leondires, Spencer S. Richlin, Joshua M. Hurwitz and Cynthia M. Murdock. All physicians are members of the American Society for Reproductive Medicine (ASRM), the Society for Assisted Reproductive Technology (SART) and the Fairfield County and Connecticut Medical Societies. RMACT’s IVF laboratory is accredited by the College of American Pathologists (CAP), and CLIA; other accreditations include the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Institute for Ultrasound in Medicine (AIUM). RMACT offers individualized infertility treatment plans in a patient-focused and supportive environment. Support services, such as, infertility treatment financing, psychological counseling, acupuncture and yoga are also available. For more information visit, http://www.RMACT.com.