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By: Lawrence B. Werlin, M.D.
Reproductive Endocrinologist, Infertility Specialist
Principal Investigator, PGD Study, Genesis Network for Reproductive Health
Medical Director, Coastal Fertility Medical Center
IVF success rates are dependent on a variety of factors. Age of the oocyte, embryo quality, and endometrial lining receptivity are all possible factors. Recently, we have begun to look directly at the embryo from a genetic standpoint as being a factor with respect to success.
For each IVF cycle, the Reproductive Endocrinologist and his/her team must decide which of the many embryos produced are to be implanted and which not. The effectiveness of that decision is the ultimate determinant of the success of the cycle. Recent enhancements in abilities to read the Human Genome have brought greater science to this process of embryo selection.
The improvements mentioned above have found their place in the IVF process through a procedure called Preimplantation Genetic Diagnosis (PGD). In a PGD procedure one is able to determine either the chromosomal make up of an embryo, or to look at specific single gene defects such as Tay Sachs Disease, Cystic Fibrosis or Sickle Cell Anemia. Up to this point, Chorionic Villus Sampling and Amniocentesis have been used to evaluate these abnormalities, however these tests occur after pregnancy has been achieved.
The Genesis Network for Reproductive Health, funded by an educational grant from Organon, Inc, recently conducted an IRB approved, randomized, prospective study evaluating three (3) high-risk groups of patients which may be at greater risk for genetically abnormal embryos/aneuploidy. These three high-risk groups include 1.) Recurrent Pregnancy Loss (RPL), 2.) Advanced Maternal Age (AMA), which we define as greater than 38 yrs of age, and 3.) Repeated failed IVF cycles (FC), defined as greater than two (2) failed cycles. A total of 57 patients have been enrolled in phase one of the study from 8/1/01 – 8/30/02. All patients were randomized into either control or PGD. All underwent various stimulation protocols, followed by ultrasound guided oocyte retrieval and ICSI on all mature oocytes. In the PGD group, embryo biopsy and blastomere fixation was done on Day #3 post retrieval on all 6-8 cell embryos. Flourescent Insitu Hybridization (FISH) analysis for chromosomes 13, 15, 16, 17, 18, 21,22, X and Y were performed at St. Barnabas hospital in New Jersey. Results were received on Day #4-5 post retrieval, and embryo transfer was done on Day #5 post retrieval. In the control group, embryo transfer was done on Day #3 or Day #5 post retrieval, based on physician preference.
Overall, in all 3 groups, 63% of embryos biopsied were abnormal. Approx 30% of women who underwent PGD had no embryo transfer due to all embryos being abnormal.
In the RPL/PGD group, 63.6% achieved pregnancy, as compared to 37.5% of the controls. In the AMA/PGD group 43% achieved pregnancy, as compared to 25% of the controls. Finally, in the FC/PGD group 20% achieved pregnancy, as compared to 0% of the controls. Overall, for all 3 PGD groups, the pregnancy rate was 43% as compared to 27% for the controls. Although the numbers are still small, it appears that the overall pregnancy rate between the PGD and the control groups approaches statistical significance.
In conclusion, a number of findings were evident.
1) PGD confirms that aneuploidy is a common cause of RPL.
2) It appears that in patients with RPL, the trend indicates that PGD may be beneficial.
3) It is not clear as yet, whether PGD is beneficial in the AMA group.
4) PGD clearly offered no benefit in the FC group.
5) In view of the large numbers of abnormal embryos in each group, couples may consider alternative options earlier such as donor oocytes, donor embryos, and/or adoption.
Though PGD is already very beneficial, it is in its infancy and will no doubt be enhanced in the future. There are 14 chromosomes that we do not screen through PGD. At the present time we can only look at 9 specific chromosomes mentioned above for aneuploidy. Newer technologies such as Comparative Genomic Hybridization (CGH) will allow us in the future to look at all 23 chromosomes. Also, there is an obvious concern that ethical standards must be applied to the application of PGD and rigid guidelines for its uses must be established. Further discussions will ensue to address these issues.
About the author: Dr. Lawrence B. Werlin is Medical Director of Coastal Fertility Medical Center, located at 4900 Barranca Pkwy, Suite 103, Irvine Ca 92604, and at 5 Journey St., Ste 220, Aliso Viejo, CA 92656. You may phone him at (949) 726-0600, or visit their website at coastalfertility.com. He is also the principal investigator in the Genesis Network PGD study.
Our fertility clinic focuses on helping you build your family regardless of your sexual orientation or the gender you choose to identify with. We are even taking further steps to make LGTB people feel more welcome at our fertility clinic. Each of our patient-facing staff goes through LGTB training to let family-building clinicians provide necessary support and make you feel highly welcome.
Coastal Fertility Medical Center offers one of the most advanced fertility treatments and is completely transparent regarding the costs of procedures and any other expenses that you may have to pay before commencing your treatment. This differentiates us from some fertility clinics that reduce prices before the signing of the contract but charge you extra later on. We make sure our patients are well aware of any possible extra pricing that may occur over the course of their treatment.
The infertility industry is currently segmented, with each service or treatment being handled by a different provider. Our all-inclusive model simplifies an otherwise complex and difficult process. We are here to revolutionize the infertility industry by offering a one-stop-service model to assist our patients through infertility challenges while reducing physical, emotional, and financial risks.
Our globally respected team of specialists are helping improve IVF technologies to enter into a generation of better outcomes for infertility. Although you’ll have a doctor guiding you, you are also going to benefit from the experience and insights of other doctors during case review collaboration meetings, which take place every week. So, you won’t just rely on the expertise of a specialist but benefit from the knowledge of many reputed fertility experts.
Our team specializes in difficult cases and help patients who may have been considered “hopeless” at other fertility clinics. Thanks to our personalized solutions, expertise, and internal collaboration, weare able to maximize pregnancy success rates that are well above the industry average, even in difficult infertility cases.
We know that every situation is different and that everyone requires different treatments. Unlike facilities that take “a one-size-fits-all” approach for all cases, our fertility specialists use more than 40 customized protocols to raise the chances of success. The customized approach even extends to our fertility laboratory. Our on-site lab director and his highly-experienced team nurture every embryo and egg to increase the odds of success of each cycle.
Coastal Fertility Medical Center offers one of the most advanced fertility treatments and is completely transparent regarding the costs of procedures and any other expenses that you may have to pay before commencing your treatment. This differentiates us from some fertility clinics that reduce prices before the signing of the contract but charge you extra later on. We make sure our patients are well aware of any possible extra pricing that may occur over the course of their treatment.
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Following the Preimplantation Genetic Screening process, which helps ensure there are normal chromosome numbers and detects possible genetic disorders, the most healthy embryo(s) are selected to be implanted into your or your chosen surrogate’s womb. 2 weeks after the transfer of the embryo, your physician will conduct a final blood test to determine the level of hCG (human chorionic gonadotropin) in your body. Increased hCG levels usually indicate a positive pregnancy test.
For fertilization to take place, the collected egg and sperm are combined in a petri dish and cultured in an embryo incubator. This dish is closely watched to check whether any of the eggs have been fertilized. Once the egg is fertilized, it is referred to as an embryo or a blastocyst on the 5th day of development. Our in-house embryologist carefully nurtures every embryo to the right time, even if it means working outside the standard business operating hours. For instance: If an oocyte is not mature, our laboratory will wait for it to mature and then ICSI it at the right time.
The egg retrieval is a slightly invasive medical procedure that takes about 20 to 30 minutes. You will be given an anesthetic to make you sleep for the duration of the procedure. Using ultrasound technology, your doctor will harvest your eggs transvaginally with a small, hollow needle connected to an ultrasound probe. Once your eggs are collected, your partner’s semen or donor sperm you have pre-selected is used for fertilization. The sperm are washed and prepared, and the top-quality sperm extracted is used to fertilize the eggs.
Your doctor will create a customized medication schedule that contains information about the fertility medications and hormone injections you have to take. Medication and injections are taken to encourage your ovaries to mature a large number of eggs for fertilization. Since women don’t respond to fertility drugs and hormones the same way, personalized protocols are crucial to the IVF cycle success. At Coastal Fertility, we will monitor you closely, letting you understand the changes occurring in your body and keeping track of how your egg follicles are growing.
On-site consultations typicallyinclude a standard fertility evaluation, consisting of a physical examination, complementary follicular ultrasound, and testing to enable your doctor to know your present fertility status and draw up a treatment plan.
This consultation includes a detailed medical evaluation with a doctor. You and your physician will review your health records and have enough time to talk about your goals and get answers to your questions. We recommend that you jot down all your questions before the visit to allow you to make the best use of the time spent with your doctor.
Your Reproductive Endocrinologist will take all factors into consideration and create a comprehensive plan of care, otherwise known as the treatment plan. This plan will include treatment recommendations from the physician and enable your financial coordinator to make a precise quotation once you meet.
Our globally respected team of specialists are helping improve IVF technologies to enter into a generation of better outcomes for infertility. Although you’ll have a doctor guiding you, you are also going to benefit from the experience and insights of other doctors during case review collaboration meetings, which take place every week. So, you won’t just rely on the expertise of a specialist but benefit from the knowledge of many reputed fertility experts.
The infertility industry is currently segmented, with each service or treatment being handled by a different provider. Our all-inclusive model simplifies an otherwise complex and difficult process. We are here to revolutionize the infertility industry by offering a one-stop-service model to assist our patients through infertility challenges while reducing physical, emotional, and financial risks.
Our fertility clinic focuses on helping you build your family regardless of your sexual orientation or the gender you choose to identify with. We are even taking further steps to make LGTB people feel more welcome at our fertility clinic. Each of our patient-facing staff goes through LGTB training to let family-building clinicians provide necessary support and make you feel highly welcome.
We know that every situation is different and that everyone requires different treatments. Unlike facilities that take “a one-size-fits-all” approach for all cases, our fertility specialists use more than 40 customized protocols to raise the chances of success. The customized approach even extends to our fertility laboratory. Our on-site lab director and his highly-experienced team nurture every embryo and egg to increase the odds of success of each cycle.
Our team specializes in difficult cases and help patients who may have been considered “hopeless” at other fertility clinics. Thanks to our personalized solutions, expertise, and internal collaboration, weare able to maximize pregnancy success rates that are well above the industry average, even in difficult infertility cases.
Upon your arrival, you will check in with a Patient Care Coordinator. We will obtain your insurance information for benefits verification, a copy of your identification and take a picture for your electronic medical chart
Coastal Fertility is the leading provider of fertility solutions located in Orange County. Join us to get free updates on fertility news, treatments, infertility solutions and more.
Coastal Fertility is the leading provider of fertility solutions located in Orange County. Join us to get free updates on fertility news, treatments, infertility solutions and more.