Pregnant with Twins: One Couple's Reaction
Bear with me, there’s a blog out there that I want to comment on concerning IVF and twins. Namely, the blog about a couple who is pregnant with twins and are “pissed off” about it. Being me, I have a few things I want to say first.
Becoming pregnant and having a safe and healthy delivery and beautiful baby afterwards.
Those are the goals when you are up against infertility issues.
A lot of us go through a period of wishing, hoping, and even praying for twins.
You have your baby. And your baby has its sibling.
And so you’re done.
Some of us stay in that phase and are thrilled when that is what comes to pass. Two babies at the same time. Twins.
Many of us move on to feeling that one at a time, or simply one is a safer, healthier, even saner choice.
IVF and Twins: Elective Single Embryo Transfer (ESET)
Certainly the infertility field and most board-certified reproductive endocrinologists and fertility programs are moving away from multiples with elective single embryo transfer (ESET). There are many reasons why conceiving, carrying and delivering a single baby is preferable to multiples.
Main reason: it’s safer for baby and mom. The outcome is more predictable with just one at a time.
Really. We all know this.
Thank goodness so many twins and multiples are born healthy and strong and vital. And that so many moms make it through just fine as well. That’s a huge comfort for any of us carrying more than one. Good prenatal care, eating properly, exercising moderately, sleeping and listening to your doctor’s advice carefully will help ensure a good outcome.
This is the longest preamble in history to talk about the blog on CNNHealth yesterday.
Title: “We’re Pissed” to be pregnant with twins.
Here’s a quote from the dad to be: "To say we're excited would be an exaggeration," the dad wrote on Babble.com in an anonymous post that recently started trending on social media. "More truthfully, we're pissed. And terrified, and angry, and guilty, and regretful."
I know this is not politically correct. I know that we’re all supposed to be happy and thrilled because there’s a healthy, on-going pregnancy and that infertility has been conquered. I know that those of us who are still not pregnant could feel really resentful and angry towards this couple for speaking out about their upset.
I want to send them a thank you note.
What I have learned about human nature is that we are not unique. Well, we are, of course. We are all individuals and have our own DNA and personalities. Of course we do.
We also have a lot more in common with every other human being on earth than we do with any other species.
That’s a lot to have in common.
And in my humble opinion, there are folks out there that are relieved that this couple opened their mouths and said what they were not comfortable saying. Because it’s not politically correct or okay. And they said it anyway. They have voiced what some of us may have felt when we found out that there was more than one gestation.
That they’re scared. And upset. And maybe they would have preferred childfree to two at one time.
I thank them because if it relieves guilt and shame for other people pregnant with more than one, then that’s a good deed.
Pregnancy Emotions and Honest Admissions
Admitting to mixed or even negative feelings is not easy to do. But it’s honest. And it’s not a predictor, by the way, about how they will do as parents. Feelings aren’t reality. Feelings can pass. They can change and shift, especially with the help of a mental health professional.
Many of us are thrilled to become pregnant with multiples.
But not all of us.
And for those of us who are not, I applaud this couple for speaking so frankly about what others may not want to say. It can relieve the shame and guilt of these feelings.
So please, let’s not judge them. They’re not asking you to feel differently. And they are entitled to how they feel and to say it out loud. I know it’s hard to hear. Still, they have the right to say it.
More tomorrow on how to make choices and avoid situations that truly are not right for you.
Lisa Rosenthal's Google+
A Tribute to Dr. Robert Edwards
It is with great sadness and a profound feeling of loss that I share the information that Professor Sir Robert Edwards, who was a pioneer in the field of treating infertility and creating families, has died this week. He was responsible, with Dr. Robert Steptoe and others, for creating in vitro fertilization. Read below the blog that I wrote when Dr. Edwards won the Nobel Prize.
It will give you an idea of the magnitude of the impact Dr. Edwards had on the fertility treatment that is available today. For all intents and purposes, he and Dr. Steptoe were primarily responsible for in vitro fertilization (IVF). If you are the parent of a baby or babies that have been conceived with IVF, consider the vast company that you are keeping, that Dr. Edwards was so intricately involved in creating. According to IVF.net, there are over three million IVF babies worldwide. Please give your children an extra hug today in tribute to this wonderful pioneer.
Pioneer of In Vitro Fertilization (IVF)
The blog below, written to celebrate the Nobel Prize:
A very exciting news announcement earlier this week shook the reproductive health community in the best possible way. The Nobel Prize, arguably the most famous and prestigious scientific prize awarded each year, has been bestowed on Dr. Robert Edwards. Dr. Edwards was one of two men responsible for the first In Vitro Fertilization (IVF) baby in the world (Louise Brown). Dr. Edwards worked with Dr. Patrick Steptoe as far back as 1968, creating the first fertilized human embryo in a laboratory setting.
Read what Scientific American had to say:
"Edwards, a professor emeritus at the University of Cambridge, began research on the problem of infertility in the 1950s. The first "test-tube baby," Louise Brown, was born in 1978, an event that the Nobel expert panel called "a paradigm shift." Since then, approximately four million babies have been born worldwide via IVF, many of whom now have children of their own."
Something else to be noted:
"Since it was first awarded in 1901 the Nobel Prize in Physiology or Medicine has rarely been bestowed on an advance that has led to such a singular clinical application (last year's Nobel in physiology or medicine was awarded to Elizabeth Blackburn, Carol Greider and Jack Szostak for their work with telomeres and telomerase), and it has rarely been given for work in reproductive research."
Read Medical Director of Reproductive Medicine Associates of CT (RMACT), Dr. Mark Leondires' comments about Dr. Edwards, along with many others from our team:
The achievement of Dr. Edwards has had a profound effect on the world. Not only has he helped millions of couples achieve the dream of having a family, but his work has led to over 4 million new lives. These live represent children who were truly a gift to their parents. This work has opened up new doors and continues to open eyes across the globe. I am still in awe at the time of embryo transfer to see dividing embryos under the microscope. I thank him for his work and courage in the face of adversity. I hope to proudly continue his legacy and dream to help infertile patients conceive and have families.
~Dr. Mark Leondires
We all recognize and pay tribute to Dr. Robert Edwards pioneering contribution to our field. Through his work so many families and children have been touched. He made such an important contribution to science and society.
~Dr. Spencer Richlin
Dr. Robert Edwards’ pioneering effort blazed a path that we, reproductive endocrinologists and fertility patients together, are still following today. Not only was his work, along with Dr. Patrick Steptoe, a monumental achievement in science and medicine, it has helped millions of people achieve their dreams of family-building. IVF has helped usher over three million babies into the loving arms of families. It all started with their work and dreams, 35 years ago. Every one of us here at RMACT is proud, and humbled, to stand on Dr. Edwards’ shoulders and continue the work of helping patients create their families.
~Dr. Joshua Hurwitz
The awarding of the Nobel Prize to Dr. Robert Edwards is a long overdue recognition of his and Dr. Patrick Steptoe’s pioneering work in developing IVF. It is so important because of the statement it makes about the importance of In Vitro Fertilization (IVF). There are over 4 million babies, children, and adults out in the world today who would not be here today if it was not for their discovery. This award also represents the fact that IVF is in the mainstream and is no longer considered to be an experiment, but a legitimate medical treatment that has the potential to benefit many more people.
~Dr. Cynthia Murdock
Even though we recognize the pivotal role he played 35 years ago with the first IVF birth in England, he has influenced the field of reproductive endocrinology for his entire career. Even in the early 60’s, he was working closely with Dr. Georgeanna Jones and her husband Dr. Howard Jones to understand the interactions between sperm and egg that have allowed fertilization to occur outside of the human body. Eventually, the Drs. Jones reported the first successful pregnancy after in vitro fertilization in the United States. And even in the new century, Dr. Edwards was a fixture at professional meetings, challenging even the most modern research into the molecular mechanisms of reproduction, and influencing a new generation of scientists as he influenced the other pioneers of our field. He was truly an extraordinary scientist, dedicated to the advancement of knowledge and learning.
~Dr. Shaun Williams
It goes without saying that Noble Prize winning, Dr Bob Edwards was a brilliant scientist. He was also much more than that. Long after his 1978 success with the birth of Louise Brown (the first IVF baby), he continued to be passionate about improving embryo culture. At scientific conferences in years past, he would engage and mentor more junior embryologists, such as myself, in thought provoking discussions. He challenged and inspired those of us in the field to be our best, all toward his ultimate belief that all families deserve to parent a healthy baby. Dr Edwards will be sadly missed but there is no question that his IVF legacy has changed & will continue to change our world for the better.
~Dawn Kelk, PhD, HCLD
I have had the pleasure of meeting Dr. Robert Edwards many times over the past two decades. He is always charming and acts as though he has all the time in the world for whatever conversation he is immersed in. Dr. Edwards always supports patient organizations by giving interviews, participating in events and discussing the importance of the work that they do. Although first and foremost a scientist, his obvious concern for the patient, for those needing the techniques that he was at the forefront of creating, is always apparent. He very much understands the human side of what his work has allowed.
To have IVF called a paradigm shift by the Nobel expert panel is an acknowledgement of reproductive health that has not occurred in any way before. It is huge. Really no other way to say it, it’s simply huge. And it validates all of you using this technology. This is not a lifestyle choice, this is not frivolous, this is important, life changing medicine. A paradigm.
Without a doubt, Professor Edwards will be sorely missed. For his academic and scientific brilliance, as well as his compassion and sense of humor. Our sincere condolances to his family, friends and colleagues.
Lisa Rosenthal's Google+
Hugh Jackman on Infertility and Les Miserables
I took my own advice yesterday.
It was Christmas so I went to a movie. It was packed, which was not surprising as Les Mis was opening.
The full title, of course, is Les Miserables, but most of us know it as Les Mis.
By the way, it is a no brainer to go see a production of Les Mis with Hugh Jackman, Russell Crowe, Anne Hathaway, Eddie Redmayne and more. At least for me. And by the fact that the theatre was full, by many others as well.
I am not much of a groupie. Celebrities don't really light me up all that much. I've been known to call my best friends from parties or galas where there were "stars" floating around because, simply? I don't care all that much.
There are a few, though, that are exceptions.
Hugh Jackman is one.
For all the obvious reasons. He's gorgeous, with a fabulous accent. And he's a good, even frequently, a great actor. He can do funny really well too. And he's even got a lovely singing voice. There have been very few times that I've been disappointed by him in the theatres. Including live on Broadway.
He also spends a lot of time in my neck of the woods. He is seen fairly regularly in the town that I spend most of my time in and is known as a gracious, friendly man. And a great father. He picks his children up and does a lot of very regular things with them, casually with no big fanfare. Just a regular, albeit, fabulous looking dad.
Talking about IVF, Miscarriage and Movies
I was surprised by the interview with Katie Couric on December 18, 2012, where he shared the multiple IVF (in vitro fertilization) procedures and subsequent miscarriages that he and his wife experienced.
Why surprised? Not because of the infertility factor. We know how often people experience infertility problems. One in six or eight couples, depending on the statitistics you use. Infertility occurs incredibly frequently. Surprising, isn't it? Given how alone some of us feel going through fertility treatment.
Why do we feel alone? Because very often, we don't talk about it. Not with our friends, not with our families. Not in a nationally broadcast interview.
So why was I surprised about Hugh Jackman's challenges with infertility?
Because he chose to share it. The interview was really about the opening of this movie, no? I'm thinking that it was, given that the movie was coming out a week later and he played a big part in making this movie happen beyond starring in it.
He shone the light on infertility in an interview where he could easily have focused on the movie or other aspects of his family and life.
He chose to speak about infertility, IVF cycles and miscarriages. He chose to speak about grieving losses and the healing that occured after his son was born.
I always liked and admired Hugh Jackman.
Now, though, I think I'm a fan.
Affordable IVF: Are Raffles for Infertility Treatment an Appropriate Option?
In the discussion of affordable IVF treatment, maybe today's blog should just be one quote from The New York Times article, "Clinic Raffles Could Make You a Winner, and Maybe a Mother," published on October 2, 2012.
That quote would come from one of my fertility heroes, who also happens to be my best friend, Pamela Madsen. Pamela's been a national and international spokesperson in the field of infertility for over two decades. As evidenced by The New York Times interviewing her for this article. Here's her quote. Oh, in for a pound here, I'll share the entire paragraph.
“It is against the law to raffle off a puppy, but we’re allowed to raffle off the opportunity to have a baby?” said Pamela Madsen, a founder and former executive director of the American Fertility Association, a nonprofit organization based in New York City. “What if they were raffling off chemotherapy? Would we be O.K. with that?”
I have to admit here, that this is not a topic that I am passionate about. Not. If you have read this blog before, even once, you will know that I am passionate about many issues around infertility, fertility and fertility treatment. For some reason, raffling off IVF cycles just hasn't rocked my boat.
Considering Free In Vitro Fertilization (IVF) Cycles
There is the side that a lucky person or couple gets a free IVF (in vitro fertilization) cycle. I get how that is appealing and even advantageous.
Then I look at the advertising around it. The marketing around it. It's not even that awful. Tasteful even. Maybe. Maybe not. (Sending in a video, explaining the depths of your desire and the desperation that you are experiencing around not having a child or the financing needed?) And then my skin does start to crawl a bit.
For a few reasons.
One of which is that if a fertility program truly wants to help someone with a free cycle, it's easy enough to create a scholarship program and QUIETLY give a reduced or free IVF cycle. The idea that one would need to be sympathetic (pathetic?) enough to win a cycle would argue that all those who did not win were somehow not worthy enough. And we all get enough of that feeling throughout treatment, no?
Then there's the fact that infertility is a medical condition. It's even considered a disease, by the AMA (American Medical Association). How do we raffle off treatment for a medical disease and then expect and get the respect needed to lobby for insurance coverage or insurance mandates? Perhaps a fertility programs' money and altruism is better spent supporting those efforts, quietly or not. Unfortunately, those efforts will not get an article in The New York Times.
Or perhaps it's just as simple as Pamela said it, which she discusses in more detail at her blog, The Fertility Advocate. We're not allowed to raffle off a puppy. It's illegal. Why? Because it's demeaning? Because it's not an ethical way to treat a living being? Because it's been proven in the past to have deleterious effects that weren't expected or anticipated?
I'm grateful to have a community, full and robust, to have helped me out here about why IVF cycles being raffled is not in the best interest of patients. Sometimes, you just need a little help from your friends. Or a lot.
Thank you to Pamela Madsen, Terri Davidson, Amy Demma, Rachel Gurevich, Mary Moritz Fusillo, Elizabeth Swire Falker, Keiko Zoll, Alissa Vitti, Kristen Magnacca, Mike Berkley, Sharon LaMothe, Fertility Authority and more. You have all helped me with seeing things around this issue, whether you know it or not!
Big, extra special thanks to the entire team at Reproductive Medicine Associates of Connecticut (RMACT), who instintively knew, way before me, that this was not the right thing for them to participate in. Who quietly support patients with financial needs, who give money to Resolve (The National Infertility Association) and The AFA (American Fertility Association) to support legislative efforts, who personally give of themselves every single day.
Good things for friends and community.
IVF Coverage Proposed for Veterans
There's a bill being considered in the U.S. Senate to expand fertility coverage, specifically IVF (in vitro fertilization), to veterans who need it. Eric Tucker reported the story for the Associated Press and the IVF story appeared in The Seattle Times on August 18, 2012.
I'm in favor of it.
My reasoning is if someone has served in the armed forces, has been wounded in a way that affects his/her fertility and reproductive ability, I believe that it's only fair that their health insurance should cover their IVF attempts.
To be perfectly honest though, I believe that there should be fertility treatment coverage for all men and women who have impaired fertility.
It also makes sense to have medical health insurance coverage for problems that you have with your spleen, or gall bladder or heart. Or any other organ or system in your body.
That's what medical health insurance is for, isn't it? To cover the financial aspects of medical coverage when something isn't functioning properly in your body.
Access to Fertility Treatment Insurance
Why isn't there more access to insurance for fertility treatment? Why isn't fertility treatment covered?
Why isn't it covered?
It's been described as being elective, for one.
I don't get it.
It's elective that someone's fallopian tubes are blocked and an egg can't move through them to her uterus?
It's elective that a woman's thyroid and hormones don't respond the way that they should and don't produce enough estrogen?
I don't get it.
These are not choices that any of us make, anymore than we choose any dysfunction of our body.
Just for the record, I agree that medical insurance should cover treatment of erectile dysfunction. And reconstruction after mastectomies. These are treatments related to our bodies dysfunction and disease.
Reproductive Health and Equal Treatment
Why is reproductive health any different? How does it become elective because there's a baby involved?
How does it become more of a responsibiility of a health insurance agency to cover fertility treatment because the cause is from active, military duty?
Read what one veteran had to say about his experience with fertility treatment, medical insurance coverage and IVF. Especially notice the last paragraph.
"Robinson, the now-29-year-old Marine who suffered the broken neck, said he started exploring ways to have children — something he and his wife had always discussed — during an extensive rehabilitation process.
They tried artificial insemination, which didn't work because of poor sperm quality resulting from his injury. They spent $6,000 of their own money on IVF and got pregnant on the first try — and now have 8-month-old twins Collin and Leah.
"Everyone deserves to have a chance at a family. We were able to save the money and stuff like that. But maybe for someone who isn't able to do that, I would hate to see that they don't have that option," he said."
Note that he did NOT say, "everyone deserves a chance at a family" . . . unless they have blocked fallopian tubes, insufficient hormones, unexplained infertilty.
Just that everyone deserves a chance at a family.
I couldn't agree more.
PATIENT FACT SHEET from ASRM (American Society for Reproductive Medicine)
Sperm Shape (Morphology): Does It Affect Fertility?
How do doctors decide if a man might have a fertility
For many years, experts have focused on semen analysis, but research studies show that the number of sperm (count) and the movement of sperm (motility) do not always predict fertility very well by themselves.
It may also be useful to look at the shape of the sperm (morphology),
which is also one of the important parts of the semen evaluation.
An updated way of determining sperm shape is called the
Kruger's strict morphology method. Kruger morphology is
a useful system that helps doctors determine if a sperm is
normally shaped or not. It was originally used to predict
the success of in vitro fertilization (IVF), a fertility treatment
in which the sperm are mixed with the woman's egg
in a laboratory.
More recently, it has been used to tell if
intracytoplasmic sperm injection (ICSI) is a necessary
treatment. ICSI is a procedure that helps a sperm fertilize
an egg by injecting a single sperm directly into the center
of the egg.
Even though it is used for these purposes, not all physicians
and scientists are sure that strict morphology method alone
predicts success with IVF or whether it indicates the need
Characteristics of normal sperm
A normal sperm has:
• a smooth, oval shaped head that is 5-6 micrometers long
and 2.5-3.5 micrometers around (less than the size of a
• a well defined cap (acrosome) that covers 40% to 70% of
the sperm head
• no visible defect of neck, midpiece, or tail
• no fluid droplets in the sperm head that are bigger than
one-half of the sperm head size
Intercourse versus artificial insemination
For patients with fertility problems, sperm morphology may have an effect on your ability to achieve a pregnancy. If the strict sperm morphology is more than 4%, there may be little difference in success whether timed intercourse or artificial insemination is utilized.
A successful pregnancy using IVF depends on many of
factors: how many eggs are fertilized, whether the fertilized
eggs grow into embryos, and whether the embryo implants
in the woman's uterus. When strict morphology is 4% or
less, eggs may have a better chance of fertilization with the
use of ICSI.
Frequently asked questions
If an abnormally shaped sperm fertilizes the egg, does
that mean that my child will have genetic abnormalities?
There's no scientific link between the shape of a sperm and
its chromosomal content. Once the sperm penetrates the
egg, fertilization has a good chance of taking place.
However, there may be some male offspring who will
inherit the same type of morphology abnormalities.
Whether routine investigation of Y-chromosome abnormalities
should be initiated when low morphology is noted is
Are there any substances that I can reduce or eliminate
exposure to (e.g., alcohol, tobacco, caffeine) in order to
improve the shape of my sperm?
Studies haven't shown a clear link between abnormal sperm
shape and these factors, but it's a good idea to try to eliminate
use of tobacco and recreational drugs and limit your
consumption of alcohol. These substances reduce sperm
production and function in several ways. They may hurt
sperm DNA (material that carries your genes) quality.
Studies have not shown a clear link between caffeine consumption
and changes in sperm shape.
Are there any dietary supplements or vitamins that I
can take to improve morphology?
Dietary supplements or vitamins have not been clearly
shown to improve sperm morphology. Some specialists do
recommend that you take a daily multivitamin to improve a
number of body functions, including reproductive health.
The American Society for Reproductive Medicine grants permission to photocopy this fact sheet and distribute it to patients.
Dr. Spencer Richlin
Dr. Spencer Richlin is Surgical Director and a fertility specialist in reproductive endocrinology at Reproductive Medicine Associates of Connecticut (RMACT). In addition, he is Division Chief of Reproductive Endocrinology at Norwalk Hospital. Dr. Richlin is Board Certified in both Reproductive Endocrinology, Obstetrics and Gynecology.
Board-Certified Reproductive Endocrinologist: Infertility Specialist – Connecticut & New York
Prior to joining RMA, Dr. Richlin served on the faculty of Loma Linda University School of Medicine, in California, as a Clinical Assistant Professor of Gynecology and Obstetrics. He is a member of both the American College of Obstetrics and Gynecology and of the American Society for Reproductive Medicine.
Dr. Richlin has published numerous abstracts, articles and book chapters, and is the lead author of the IVF section in Danforth’s Obstetrics and Gynecology, 9th Edition. He coauthored with Dr Leondires the “Infertility” chapter in the text “Avoiding Common Errors in Obstetrics and Gynecology. This is due out in 2011.
Dr Richlin received his undergraduate degree in psychology from The University of California at Berkeley, and his medical degree from the University of Southern California’s School of Medicine. He completed two internships, in Emergency Medicine and Obstetrics. Dr. Richlin served his residency at The Stamford Hospital in Stamford Connecticut from 1995-1999, where he was named Berlex Best Teaching Resident.
He then completed his subspecialty fellowship in reproductive endocrinology and fertility at Emory University’s School of Medicine in Georgia. Then he carried out research projects in in vitro fertilization and intrauterine lesions such as fibroids and polyps. There he wrote book chapters on abnormal uterine bleeding and endometrial ablation.
Editor's side note- Look for a personal interview with Dr. Richlin next week where you can learn more about why he chose to go into the field of fertility treatment as well as what he likes to do when he is not practicing medicine.
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.
Some of us fertility patients want to know everything. Everything from every number on any bloodwork done to every measurement on an ultrasound to every detail in an IVF cycle, to every possibility of any procedure that might be necessary in the future. Some of us just find it infinitely more comforting to know the details and all the possibilities. We hope that then nothing can take us by surprise.
It's even more aggrevating, then, as a patient, when we realize that we can't know everything in advance. Can't plan around allthe known factors because things can change so quickly. Without a doubt, fertility treatment is a science. But it is also an art. Like a house of cards or setting up dominoes, one thing depends on the three or four or seven hundred and fifty things that come before it.
Since this seems to be my week for going out on a limb, here I go again.
The experience of infertility, fertility treatment and trying to conceive with difficulty sets us up very well for having children.
I spoke with my best friend the other day. Her younger son is in his first year of college. He is a really bright young man. Not surprising. He was a bright baby, bright little boy, and now, he is a bright young man. Like many of us, he had to listen to many conversations about not living up to his potential while he was in middle school and high school. Remember those conversations? Maybe you don't. I do. I remember hearing about applying myself and staying focused. Blah, blah, blah. He’s excelling in college. After all those years of dealing with expectations that weren’t met, they are now being surpassed.
My point here is that raising children brings up the unexpected. Over and over and over again. Sometimes just in the space of a moment or two. My point here is that we have expectations of what our children will be like from the moment that there is desire to have a child. My point here is that we have expectations that can take us by surprise, over and over again. We can be disappointed by what our children can and cannot do, want to and don't want to do.
And we think we have some control. Infertility sets us up to understand to expect the unexpected. To hear one thing and then find out that it's all changed. That a cycle that almost gets cancelled is the one that works. That the perfect cycle doesn't work, we don't get pregnant.
Infertility teaches us that control is something that we hold onto like a life raft, hoping not to drown. When sometimes what we need to do is let go. That sometimes, the tighter we clutch to the life raft, the most we miss the other opportunities to save ourselves.
My favorite joke, perhaps of all time, goes like this. A man is drowning in the ocean. He prays to heaven above, for the first time in years, to save him. A dolphin swims by and offers him a lift, he says no, he's waiting for a higher power to save him. He thanks the whale that offers him some help, but he's waiting for a higher power to prove itself by helping him. He turns down the rowboat, the ship and the yacht who offer him help as well.
You've probably guessed the punch line by now. Right, the man drowns, goes to heaven, meets his higher power and angrily asks why he wasn't saved. His higher power looks at him and asks.... who exactly did you think sent the dolpin, whale, rowboat, ship and yacht?
So as we’re clutching onto our floatation device, my advice to all of us, don’t ignore all the help that floats by. Help comes in some very unexpected ways sometimes.
Good morning. Today is Wednesday, our day to focus on the medical aspects of fertility and treatment. Fertility treatment often has a language all it's own. Here's another term that is significant in testing and treatment that you may not understand as thoroughly as you might like, Day 21.
On Day 21 of your cycle, your fertility specialist will want to check the levels of progesterone and estradiol (E2) in your system and the thickness of your endometrium (uterine lining).
Day 21 testing checks a woman’s progesterone level to confirm that ovulation has occurred. It is done on the 21st day of the menstrual cycle (Day 1 is the first day of flow, not including any spotting). A low Day 21 progesterone level suggests the cycle was anovulatory (no egg was produced). If no egg is produced, pregnancy cannot be achieved.
The timing of ovulation, and the associated peak in progesterone, is related to the subsequent menstrual period, not the preceding one. In an average cycle of 28 days, the time between ovulation and the next period is about two weeks, so progesterone is measured about seven days before the expected period, or on Day 21. However, if a woman’s cycle is longer or shorter than 28 days, the testing day will be adjusted accordingly. For example, a woman with a 35-day cycle would be tested for progesterone on Day 28.
Serial estradiol (E2) levels are often measured for monitoring superovulation in intrauterine insemination (IUI) and in vitro fertilization (IVF) treatment cycles.
If you are not ovulating, there are steps that can be taken to help release the eggs, including drugs. Your fertility specialist will discuss these options with you.
An ultrasound exam is also used to measure your uterine lining to determine if it is thick enough for a fertilized egg to implant.
Day 21, explained. If there are other phrases that you hear and would like to understand, try our glossary. Our doctors at RMACT, along with our excellent nursing staff, have written it, for you.