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Learn More About Fertility Preservation During National Infertility Awareness Week 2014

Knowledge and information are essential when dealing with fertility.  “It’s important to stay up-to-date on the latest technologies” states Dr. Marcelo Barrionuevo, a fertility specialist at IVF FLORIDA.  In honor  of National Infertility Awareness Week (NIAW), we at IVF FLORIDA, a leading south Florida fertility center, resolve to help you learn more about infertility and how we can help you start a family of your own.

Did you know that men have a biological clock too?  Age has only recently become a risk factor associated with men as well as women.  The “biological clock” has long been a cautionary tale for women, and it was thought that men had no similar concern, but scientists are learning that in fact, they do.  Studies show that older men have increased risks in fathering children with birth defects and developmental disorders.  Since many women and couples are choosing to delay having a family (past the age range of 35-40), it is important to be well informed and know your options and solutions. 

Often, women and couples do not know they have fertility problems until they try to become pregnant, but in some instances, it may be known ahead of time that their ability to reproduce is in jeopardy.  Whether you have been diagnosed with cancer or are just planning for later, the fertility specialists at IVF FLORIDA can help you explore treatment options.  One such solution is Fertility Preservation or Egg Freezing.  According to IVF FLORIDA fertility specialist, Dr. David Hoffman, egg freezing is “the new frontier in fertility treatment.”  The preservation process involves a relatively new technology called vitrification, a procedure where tissue is placed directly in liquid nitrogen and undergoes a flash freeze. 

If you’d like to learn more about when to seek fertility treatment, take a moment to watch the video below.  Let IVF FLORIDA open the door to the possibilities for you or someone you love.

IVF FLORIDA's Dr David Hoffman Discusses Latest Advances in Fertility Treatments

South Florida’s CBS4-Miami recently featured IVF FLORIDA in a story on the use of EmbryoScopes, a new incubator technology that dramatically improves the success of fertility treatment.  Fertility specialist Dr. David Hoffman talks about this “game-changing” technology that allows stronger embryos to be chosen, decreases the risk for multiples and provides new hope for couples struggling with infertility.  IVF FLORIDA is proud to be one of only 12 Fertility Centers nationwide and the only one in the state of Florida with EmbryoScope technology.

VIEW THE VIDEO HERE

What to Expect During an Egg Retrieval and Embryo Transfer

Often times the IVF cycle is preceded by a 3-week course of oral contraceptives.  Some literature has suggested that success rates are better following a 3-week course of ovarian suppression.  The stimulation always begins at the start of the cycle in which the eggs will be retrieved and usually is between the second and fourth days of the cycle. 

Typically a patient undergoing fertility treatment will be given instructions for injections for 4 days and then instructed to return to assess the response which we determine with an ultrasound to measure the size of the growing follicles, the small cysts which contain the eggs, and the blood estrogen level which is the primary byproduct of the developing cycles.  Once we determine that the eggs are mature with the ultrasound measurements and estrogen levels, we use a different hormone to trigger ovulation. 

The egg retrieval has to be precisely timed so that we can retrieve the eggs shortly before the ovaries would otherwise release them.  Once they are released into the pelvis it becomes much more difficult to recover the eggs and the usual time interval from the injection to the planned time of the retrieval is approximately 34 hours, but we do allow a few hours grace period.  The egg retrieval is done with IV sedation so you should be very comfortable through the procedure. You may experience some pelvic discomfort for a day or so after the procedure. Since it is surgery there are potential complications and these include bleeding, infection, damage to other organs, and problems with the anesthesia. In practice, all of these complications are extremely rare.

The eggs are removed using a vaginal ultrasound with a needle guide so that the ovary can be entered through the back wall of the vagina where it is very thin and the fluid within the follicles containing the eggs is then drawn through the needle, collected in a test tube, and given to the laboratory for identification of the eggs.  On the same day of the retrieval, the eggs will be fertilized either by adding a predetermined concentration of sperm to the dish containing the egg or by injecting a single sperm directly into the egg, ICSI (intracytoplasmic sperm injection).

The following day we will be able to determine whether the eggs fertilized or not and they are then observed for 3 to 5 days after the egg retrieval.  Depending on how they are developing they may be transferred either 3 or 5 days after the retrieval.  The recommended number of embryos to be transferred depends on the patient's age and for most women, under the age of 35, we are recommending 1, or no more than 2 embryos be transferred.  For women over the age of 39, we will transfer up to 5 embryos.  This reflects the higher proportion of abnormal embryos in older women and even though more embryos are transferred, the pregnancy rates and multiple pregnancy rates are lower in older women.  The most common reason an IVF cycle is unsuccessful is that the embryos produced have the wrong number of chromosomes to develop into a normal embryo.

Additional information on both the egg retrieval and embryo transfer process can be found on the IVF FLORIDA website.

If you have questions or would like to schedule an appointment, please contact us today.

Egg Quality and Other Success Factors in Fertility Treatment

So you are planning on an IVF cycle.  What can you expect?  IVF is the most successful infertility therapy available.  It is high tech and complex but at the heart of it involves uniting an egg and the sperm and ensuring that a normal-appearing embryo arrives in the uterine cavity.  Ultimately the success depends on the quality of the egg and sperm and the receptivity of the uterine cavity. 

The most important IVF success factor by far is the egg quality and this is most influenced by the age of the woman providing the egg and her "ovarian reserve."  The ovarian reserve is a concept which reflects the remaining number of eggs.  While we cannot put a specific number on the number of eggs remaining, we can identify women who have significantly above average numbers of eggs and those that have significantly less than average. 

In general the egg quality, i.e., the likelihood that the egg has the necessary 23 chromosomes to produce a healthy baby, follows quantity and most importantly decreases with maternal age. The ovarian reserve helps us estimate the chance of success and guides us in terms of the choice of drugs and dose to stimulate the ovaries to produce more than one egg.

Prior to beginning an IVF cycle, you will have completed an evaluation to make sure that the uterine cavity is normal, to determine via the semen analysis the best way to fertilize the eggs, and to exclude any preexisting condition which may reduce the chance of IVF success or complicate a subsequent pregnancy.

More detail on the steps involved in the IVF process, are detailed here. For questions specific to your situation, please contact a fertility specialist.

NOTE: In Dr. Ory's next IVF FLORIDA blog post, egg retrieval and the embryo transfer process will be explored.

Eat, Drink and Be Fertile?

"The Holiday Season."  That single phrase likely conjures a mix of memories, emotions, sentiments, and anticipation.  For many of us, the holiday season is an opportunity to gather with friends and family and to share in traditions both old and new.  There are parties to attend, religious observances to be remembered, and shopping to be done.  And then there is the food (oh, the food!) foisted upon us from seemingly every conceivable direction.  My mouth still waters in thinking back to the Christmas dinner my wife prepared last year - beef tenderloin with whipped horseradish, spiced potatoes, green bean casserole, and pumpkin cheesecake for dessert.  I also recall, less fondly, my pants fitting a little bit tighter and the bathroom scale coldly confirming what I already knew to be true.  The New Year's resolution then invariably turns out to be some vague commitment to A) weight loss, B) exercise, C) better diet, or D) all of the above.    

For couples dealing with issues of fertility, matters of weight and diet often take on an additional gravity.  When meeting with patients in my fertility clinic, one of the most common questions that I am asked is, "What kind of diet should we be on to improve our fertility?"  The answer to the basic concept of lifestyle change to improve fertility is nuanced and there is no "one size fits all" response to the question. 

There does exist a clear relationship between weight and fertility.  Women who are either
overweight or underweight can have an extended time to conception.  On average, it takes women with a body mass index (BMI) greater than 35 or less than 19 twice as long and four times as long, respectively, to conceive. (There are numerous online calculators to  determine your own BMI - simply use the search term "BMI calculator" to find one.)  Obesity is closely associated with difficulty ovulating, poorer response to fertility treatments, and increased rates of miscarriage.  In men, obesity can be linked to a lower quantity and quality of sperm, lower testosterone levels, and an increased incidence of erectile dysfunction.

A recent study from Harvard showed an improved response (more eggs retrieved) in IVF treatment in overweight and obese women who had a modest, short-term weight loss prior to initiating a cycle (Chavarro, et al. Fert Steril 2012).   Moreover, a normalization of body weight in women at the extremes of BMI has consistently been shown by multiple researchers to improve pregnancy rates and pregnancy outcomes. 

While a healthy diet is generally recommended to patients for reasons both related and unrelated to fertility, many patients are unclear as to what constitutes a healthy diet.  Little evidence exists that dietary variants such as vegetarian diets, low-fat diets, antioxidants, or herbal supplements have a positive impact on fertility.  Studies have shown, however, that there may be a benefit to increasing slowly digested carbohydrates (fiber-rich carbs) over simple sugars.  In addition, reducing animal protein in favor of plant protein, using  unsaturated vegetable oils, drinking whole milk instead of skim (surprisingly),and staying hydrated with water instead of sugary soda can all help improve fertility based on observational data from the landmark Nurses' Health Study.

Alcohol consumption does not have a clear association with fertility.  Studies looking at the effect of alcohol on fertility have shown conflicting results.  Both an increased and a decreased fertility rate with moderate alcohol consumption (up to 2 drinks per day) have been reported.  Still other studies have shown no effect.  A practical recommendation would be to limit alcohol consumption to less than two drinks per day while trying to conceive and most importantly, stop alcohol consumption altogether with pregnancy. 

Caffeine, like alcohol, is probably best taken in moderation.  High caffeine intake (5 or more cups of coffee per day or 500 mg of caffeine) is associated with decreased fertility.  During pregnancy, there is evidence to suggest that 200 - 300 mg of caffeine per day (the equivalent of more than two cups of coffee) is linked to a higher miscarriage rate.  One to two cups of coffee per day or its equivalent while trying to conceive or during pregnancy does not appear to have an adverse effect.

Finally, stop smoking.  Women who smoke enter menopause one to four years earlier on average than their non-smoking counterparts.  In addition, women who smoke are 60% more likely to be infertile than women who do not.  Lastly, smoking during pregnancy increases the chance of miscarriage.  The evidence regarding male fertility and smoking is less established.

Taken in sum, the bottom line is to enjoy this holiday season with your friends and loved ones with moderation being the key.  And if you have that extra slice of grandma's pumpkin pie or one more flute of champagne, fear not, New Year's is just around the corner and you can pledge anew that this will be the year that you will keep your resolution.