Tuesday, June 30, 2009

WFWW-Progesterone Options for IVF

WFWW-Progesterone Options for IVF


If you ask women who have gone through an IVF cycle which the part they consider as the most difficult, it would likely be the progesterone injections. Traditionally progesterone in oil has been used and consists of deep intramuscular injections of an oily substance. Since IVF became a clinical treatment thirty years ago, we have been searching for an effective, more acceptable alternative. As you may be aware Reproductive Partners in Los Angeles and Orange counties currently has an ongoing study comparing an FDA approved vaginal medication with a new subcutaneous, easier injection.
One of our sister Integramed practices has just reported in the journal Fertility & Sterility results of a study comparing intramuscular progesterone with a variety of vaginal preparations. Among patients using vaginal progesterone, there were no statistically significant differences in outcomes between the vaginal and IM progesterone treatment groups. There was a 50.0% pregnancy rate among patients treated with vaginal progesterone and a 51.5% rate among matched IM progesterone patients. The live birth rates were 47% in the IM versus 47.5% in the vaginal progesterone groups. There were no statistically significant differences in miscarriage rates between groups.
Our current study goes one step further by comparing the only vaginal progesterone approved by the FDA for pregnancy support, Endometrin, with a new easy subcutaneous injection. If you meet the inclusion criteria you can still join the study and be eligible for free progesterone medication and an honorarium. For more information, call your nearest Reproductive Partners office or (877) 273-7763.

Wednesday, June 24, 2009

Sex Ratio/Identical Twins in Blastocyst Transfer

WFWW-Sex Ratio and Identical Twinning in Blastocyst Transfer


One of the most frequent questions I am asked is whether IVF treatment, and blastocyst transfer in particular, increase the number of offspring of one sex.

According to a compilation of four studies published in the June 2009 issue of Fertility & Sterility, a higher male-female ratio after Day 5 blastocyst transfer compared with Day 3 cleavage-stage ET was 1.29:1 in favor of male offspring. This is not high enough to recommend this as a sex selection technique, but will be somewhat reassuring to those wanting a male child.

The study also looked at the chance of identical twins (monoztgotic twinning-MZT) in Day 5 transfers which has been said to be increased over Day 3 transfers or natural conception. They reviewed the results of nine studies incorporating almost 41,000 cycles and found the risk of MZT after blastocyst transfer was significantly higher compared with cleavage-stage transfer by a factor of 3.04:1. MZT is not a desirable result as it can create a more risky pregnancy for the babies, especially if they are in the same amniotic sac.

Wednesday, June 17, 2009

Recurrent miscarriage question

Wisdom from Wisot Wednesdays


With eight previous miscarriages what tests should I DEMAND?

Q. I have just lost my 8th baby due to early pregnancy loss. All losses have been at 11wks or earlier. The hardest part was there was a great heartbeat and a perfect looking baby. My OB/GYN said I was having a textbook perfect pregnancy. Of course I let my guard down, got excited and lost the baby almost 2 weeks later. The OB who did the D&C said she would have testing done on the placenta. What tests is she talking about? And more importantly we want to have a baby and are ready emotionally to try again, so what tests should I have done before we try again?
Kelly

A. I am so sorry to hear about your repeated losses. You can be sure that your enthusiasm had nothing to do with the loss. The test the doctor wanted to do on the placental tissue was probably to examine the chromosomes to see if the baby was normal or abnormal. That could provide clues on what is causing the problem and how to deal with it.

Once you recover from this miscarriage you might want to see an Ob/Gyn who treats recurrent miscarriage or a reproductive endocrinologist to review your history and see what tests are appropriate. Yours does not sound like the typical case and I really can't tell specifically which tests should be done from this information. Generally the tests will check the following issues:
• the chromosomes of both partners
• the quality of the woman’s eggs with hormone tests
• abnormalities of the uterus
• infection with an organism-ureaplasma
• progesterone levels/development of the uterine lining
• abnormal antibodies in the woman’s blood
• heredity blood clotting problems in the woman

By the way, when anyone approaches a doctor I would recommend that one not start the interaction by “demanding” that something be done. Start by listening to the doctor’s advice and then add any “request” you may have with the reason you want something done. The best doctor-patient relationship is one of mutual concern, cooperation and trust. If one does not feel that their doctor is concerned about their problem, not willing to reasonably cooperate or they do not trust the doctor, it is best to find another doctor.

Arthur L. Wisot, M. D.

Thursday, June 11, 2009

It has been a few months since I blogged on Redbook magazine's blog, The Infertility Diaries. In the feature, Wisdom from Wisot Wednesdays," I answered reader's questions. Since that blog no longer exists, I am going to resurrect WFWW on my blog. Here is the first entry. You can post new questions as comments to this message.

Wisdom from Wisot Wednesdays

When to perform an insemination?

Could you please give your opinion on what is the best time to perform an insemination (IUI) without any drugs in relation to the detection of the LH surge? Is it before or after detection of surge and please be specific with hours. There seems to be a lot of differing info on best times.

I usually recommend that a single insemination be done in a natural cycle the day after an LH surge is detected by an ovulation predictor kit. That’s because the surge usually precedes ovulation by 36 or more hours. You are detecting the surge sometime after it happened. Most women test once a day in the afternoon or evening, so they should be close to ovulation by the next morning. The egg has about 12-24 hours to be fertilized and the most sperm specimens can maintain good motility for 48 hours in the wash media, so the IUI does not have to be done at the exact time of ovulation. All the averages coincide the morning after the surge is detected, making it the most logical time to perform the IUI. Alternatives to using the urinary ovulation predictor kit to time intercourse or insemination are ultrasound or a variety of fertility monitors. In fact if at the time of the insemination, an ultrasound shows that the follicle is still present, we recommend doing a second insemination the next day as well.