And, Yes, it's also Thursday's blog because of technical difficulties yesterday.
Every few years, a reproductive technology comes along that revolutionizes infertility treatments for patients.
Comprehensive Chromosome Screening is, arguably, one such technology. Reproductive Medicine Associates of Connecticut in partnership with Dr. Richard Scott of Reproductive Medicine Associates of New Jersey (www.rmanj.com) are proud to announce that we are the only center in Connecticut who can offer patients access to this important tool.
What is Comprehensive Chromosome Screening (CCS)?
Aneuploidy is the term used to describe any embryo with either too many or too few chromosomes. Most people are not aware that aneuploidy is the cause of greater than 60% of miscarriages, as well as the most likely reason that patients do not get pregnant from an in-vitro fertilization (IVF) cycle.
The purpose of CCS is to analyze, select and transfer only embryos that do not have abnormalities in their number of chromosomes. Screening embryos in advance can help achieve higher implantation rates and fewer pregnancy losses, particularly for women 35 or older, couples with multiple-failed IVF cycles or implantation failure, and couples with repeated miscarriages.
Potential CCS Advantages: Technologies Screen Embryos for All 23 Pairs of Human Chromosomes
The more traditional technique of identifying aneuploidy in IVF embryos was performed with an older technology called fluorescent in situ hybridization (FISH). FISH has many technical drawbacks including the fact that it can only study, at most, 11 chromosome pairs out of all 23 pairs of chromosomes. Therefore 12 or more chromosomes, then, are not examined, resulting in only partially screened embryos which can lead to miscarriages or infants born with chromosomal disorders. Additionally, FISH requires removal of only a single cell on day 3 of development. This greatly decreases the accuracy of the testing and may even harm the embryo as there are only 6-10 cells at that stage of development. In fact, several well-regarded research studies have shown that using FISH on day 3 embryo does not improve outcomes over traditional IVF.
Conversely, during CCS, we obtain 5-10 cells on a day 5 or 6 embryo called a blastocyst. Biopsying the embryo at a more advanced cell stage dramatically increases the accuracy of this testing and minimizes potential damage that the biopsy can cause on the embryo because it has several hundred cells by then.
Another advantage to CCS is that we can greatly reduce the odds of a couple having multiple pregnancies (twins or triplets). It arms clinicians with the knowledge that they are transferring the most chromosomally fit embryo, therefore precluding the need to transfer multiple, unscreened embryos in the hope that one will be healthy enough to create an ongoing pregnancy and a healthy baby.
The new analytical technology involves quantitative real-time polymerase chain reaction (qPCR) and allows for the evaluation of all 23 pairs of human chromosomes from several embryonic cells. The ability to determine this chromosomal information with such a high rate of precision in a fresh embryo transfer is available at only five centers across the entire country which are affiliated with our practice director Dr. Richard Scott.
Comprehensive chromosome screening (CCS) is the future of embryo screening and is a proprietary patent pending technology.
The application of qPCR won the general prize paper at the 2010 American Society for Reproductive Medicine (www.ASRM.org) meeting as the first prospective, randomized trial to demonstrate a significant improvement in ongoing pregnancy rates using aneuploidy screening. This is the highest research honor in reproductive medicine in the United States and highlights the acceptance of our procedures for CCS by the national professional societies.
Please call us at Reproductive Medicine Associates of CT, 800-865-5431 for more information.
Good news for those of us pursuing families when our 30’s are just a memory. Dr. Richard Scott, of Reproductive Medicine Associates of New Jersey (and Laboratory and Practice Director of RMACT) , in a lecture presented at ASRM (American Society of Reproductive Medicine), had this to say,
"When we counsel our patients, we should tell them that there are significant risks that come with age for pregnancy-induced hypertension, gestational diabetes, preterm delivery, intrauterine growth restriction, and placentation disorders," Dr. Scott said. "However, none of these are of an order of magnitude where we would counsel our patients not to pursue planning for a family."
This comment was made after discussing the risks associated in becoming pregnant and delivering a child slightly later in life. A little disheartening that not only is it more difficult to become pregnant after we have turned 40, it is also more of a risk to carry the baby to term. Dr. Scott also had this to say:
“We don't necessarily understand whether an older woman's maternal environment is intrinsically different at age 48 or age 52 or whether we just see differences in outcomes because she is more likely to have hypertension, diabetes, be overweight or have hypothyroidism,"
Let’s look at the conversation around the age of our eggs and the information that our general health does not necessarily affect the quality. In other words, we can be fit, eating properly, exercising properly, and abstaining from drugs and alcohol and still have eggs that are of poor quality. Not exactly empowering, nor particularly motivating. Then reread the statement above from Dr. Scott. What is encouraging to me in his statement is that here is where how we are caring for ourselves, our bodies, our minds does matter tremendously. If it is not intrinsic that being older when carrying a pregnancy creates a higher risk, than the state of our health does come into play and is something that we can do something about. It’s a reason to make changes in our lifestyles, a way to become proactive in our treatment.
The name of the session we’ve been discussing? "Wrinkled Parents: Medical, Ethical, and Psychosocial Issues of Parenting at an Older Age." Reported in ASRM news, Andrea Braverman, PhD, also from RMANJ, made this eye opening comment:
"There's more to parenting than just having a pulse," she said. "The thing that we come back to over and over again is not that you just have a pulse but rather how active are you."
Dr. Braverman went on to discuss the advantages as well as the disadvantages of older parents.
Financial considerations that older parents often encounter include balancing conflicting financial demands of saving for college tuition versus retirement savings. Dr. Braverman said social issues for older parents will include the challenges of socializing with parents who may be a decade or two younger and therefore have different life and career demands. Older parents may also approach parenthood with disparate needs with one parent ready for retirement at an earlier age than the other.
Dr. Braverman additionally listed the advantages versus the disadvantages of older parenting. Advantages of older parenting include readiness, maturity, financial stability, and enjoyment, while the disadvantages included lower energy level, social stigma, a generation gap, and lack of a peer group with fellow parents.
This session also included the ethical and even touches upon some of the legal issues involved in treatment for older patients. Judith Daar, JD, discussed some of the restrictions and policy issues.
In addressing the legal and ethical perspectives, Judith F. Daar, J.D., Associate Dean, Whittier Law School, and Clinical Professor, University of California-Irvine School of Medicine said that no federal or state law prohibits delivery of assisted reproductive technology (ART) based on the age of a patient.
Where does this leave us? Why did I choose to write about this, out of all the different aspects being presented at ASRM?
This is the good news. We do get pregnant, that’s why. Despite the statistics being lower and having to use more procedures, we do get pregnant. And we do parent children, even when we don’t become pregnant. We parent children through surrogacy or adoption. So shouldn’t we know what the issues of parenting are past the age of 40?