Tag: ivf

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Couple’s struggle to have a child leads to surrogacy

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Dawn Kornstein felt the pain again.

The medication wasn’t working. There was nothing more the doctors could do. The contractions kept coming.

Dawn was 5½ months pregnant with twins, and the pain intensified with every breath. Her skin took on a gray pallor. The alarms hooked up to her monitors screamed every 15 minutes or so.

The doctor gave Dawn and her husband, Mike, the grim news: Baby Alex wasn’t going to make it. But if they delivered Alex and tied off the cord, maybe they could save Ben.

Maybe.

Dawn and Mike said goodbye to one son and willed the other to wait just a few more weeks before being born. Those weeks could make all the difference in whether he would live.

Ben died the day after his brother.

Devastated, the couple clung to this mantra: We can try again. We can have other children.

The dream is simple: To have a baby.

In generations past, couples faced with infertility had two choices: adopt a child or accept life without one.

Advances in medicine and science have provided more options: Fertility drugs. Artificial insemination. In vitro fertilization. Sperm donors. Egg donors. Surrogate mothers.

Approximately 2.7 million American couples put their faith in one or more of these options every year.

Still, not everyone who begins the quest ends with a baby. Only about 65% of women who seek fertility treatment ultimately give birth.

There are limits to what science can do, what government allows and what society supports.

Laws have not kept pace with medical innovations, leaving judges to make important decisions about the intersection of biology and parenthood with little or no guidance. What is rewarded as innovation in one state can be outlawed in another.

For some couples, the financial costs climb too high. For others, the personal costs become insurmountable.

This was the new world Dawn and Mike were entering. For them, the key to parenthood lay in Wisconsin – 1,000 miles from their Connecticut home.

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Emotional aid important when facing infertility

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Mara Kofoed was not always hopeful about having kids. When she first started trying for children in 2004, and learned that she had fertility issues, her life seemed full of fear and anxiety. She worried she’d never have children.

Kofoed is one of the 7.4 percent — 2.1 million — of married women aged 15-44 who are infertile, according to the Center for Disease Control. Infertility is defined as trying for pregnancy for 12 consecutive months without success. The study also shows 7.3 million women in this age bracket, or 11.8 percent, struggle with impaired fecundity, or the diminished ability to have children. While there are multiple medical options and remedies for women and men struggling with infertility, there is also a nationwide push toward often neglected emotional and spiritual treatments.

Become Informed

Effective treatments vary for intertility, said Corey Whelan, program director for The American Fertility Association. Because of this, she said, couples who have not been able to have children should become informed about their specific condition and find a specialist to meet their needs.

“It’s very, very important to tell yourself the truth and find out what works,” Whelan said. “Don’t sit in the anxiety for too long. The emotional toll for infertility is really extreme.”

Whelan has seen how lack of education and the perpetuation of inaccurate facts can close doors for women trying to have children. For instance, Whelan said she has known of many women who assume they can prolong their fertility with a healthy lifestyle. While the converse is true — obesity and unhealthy lifestyles will hurt someone’s chance for pregnancy ?— healthy habits will not lengthen the biological clock. Since 20 percent of women have their first child after the age of 35, according to the CDC’s National Survey of Family Growth, Whelen said it is important for them to realize their decreased chances of impregnation, even in spite of good health. Whelan also said women who are older than 35 should consult a specialist after six months of unsuccessfully trying for pregnancy.

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Noninvasive Embryo Selection Forecast for IVF

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SANTA BARBARA, CALIF. – Unique protein signatures in the media surrounding embryos may soon provide a noninvasive means of identifying viability and aneuploidy, Dr. William B. Schoolcraft predicted at a conference on in vitro fertilization and embryo transfer sponsored by the University of California, Los Angeles.

Biopsies performed during preimplantation genetic diagnosis or comprehensive chromosome screening are “very invasive procedures” that are comparable to surgery or a forceps delivery, said Dr. Schoolcraft.

Removal of the embryo from an incubator, exposure to the heat of a laser, and traumatic manipulation may cause subtle harm, resulting in short- or long-term complications, he added.

But fascinating developments in the laboratory have confirmed dynamic, day-by-day evolutions in the pattern of proteins that are taken up – and secreted – by embryos in culture, providing evidence of distinctive signatures indicating viability, gene expression, and prospects for implantation, Dr. Schoolcraft noted.

To date, his group has identified more than 250 proteins in spent media from embryos, 74 of which are uniquely expressed in that environment.

“Some are excreted only by early embryos, some by embryos throughout preimplantation development, and most interestingly, some proteins are just excreted by embryos on day 3 to day 5, suggesting they might be markers for viability,” said Dr. Schoolcraft, medical director of the Colorado Center for Reproductive Medicine, Lone Tree.

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Conversion leads fertility doctor down new path

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Ex-Chicago physician wants to open reproductive center faithful to Catholic doctrine.

The first time Dr. Anthony Caruso saw life created in a petri dish, it brought tears to his eyes. Once one of Chicago’s leading reproductive endocrinologists, he guesses that he helped more than 1,000 children come into the world.

But two years ago, he walked away from his practice and into a confessional at St. John Cantius Roman Catholic Church to repent. Reproductive technology had gone too far, he said, and he could not practice the same kind of medicine anymore.
“We see babies in our Catholic faith as children of God,” said Caruso, 48, of Lombard. “What doesn’t get thought about is the process that brought the babies to be.”

Caruso, now a doctor at Alexian Brothers Medical Center in Elk Grove Village, has proposed opening the St. Anne Center for Reproductive Health.

It would be one of a handful of clinics in the U.S. that helps couples struggling to have children within the Ethical and Religious Directives for Catholic Health Care Services. It would not offer in vitro fertilization (IVF), artificial insemination or certain medicines often prescribed as a course of treatment. It also would be the only center in the nation run by a board-certified reproductive endocrinologist.

Caruso acknowledges that the success rates of measures compatible with church teachings are lower than what advanced reproductive technology can offer. Furthermore, doctors almost always try to accommodate a patient’s religious convictions. But Caruso and other proponents of natural family planning say many fertility practices tend to treat infertility rather than treat the underlying condition of which infertility is a symptom.

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Happy Birthday IVF

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Carolyn Savage knows more than most about the moral and ethical quandaries of in-vitro fertilization. An IVF clinic mistake left her impregnated with another couple’s child; she carried that child to term and gave him up to his biological parents, knowing that would have to be her last pregnancy for medical reasons. Later, she became the mother of twins through a surrogate. The mom of five reflects on how much has changed, and how much hasn’t, since the first “test tube baby” was born 34 years ago today.

By Carolyn Savage

I remember when the first “test tube baby” was born on July 25, 1978. Even though I was only 9 years old at the time and didn’t know a thing about the “birds and the bees,” I knew enough about where babies came from to understand that the birth of Louise Brown in Oldham, England, was a big deal.

When TODAY Moms asked me to watch the original story of the first child conceived through in-vitro fertilization, I was curious to see how the technology was viewed. I expected the first IVF to be reported with a science fiction aura, but aside from the use of the term “test tube baby,” I was pleasantly surprised to see how accurate and thorough Tom Brokaw’s story was. Surprisingly, it was not the tone of the 34-year-old TODAY report that struck me but, instead, the realization that some of the thornier moral, ethical and religious issues surrounding IVF in 1978 still exist today.

Since the birth of the first IVF child, the field of assisted reproductive technology has made remarkable advances. In-vitro fertilization has been proven to be safe and long-term studies have determined that children conceived through IVF live physically and emotionally healthy lives. Meanwhile, the advancement of embryonic cryopreservation allows pro-life infertile couples to give all of their embryos an eventual chance at life.

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What Are Fertility Drugs?

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There are a variety of drugs used for fertility treatment. Some are used to produce more ovarian egg follicles. Some are also used to suppress the pituitary gland and prevent ovulation. Others are used to support the uterine lining and early pregnancy.

Medications That Affect Follicles:

Eggs are housed in a protective sac called a follicle. To promote the growth of ovarian egg follicles, the pituitary gland naturally secretes the hormone Follicle Stimulating Hormone (FSH) into the blood stream. Typically only enough FSH is secreted each month to promote the growth of one egg follicle despite there being many follicles available in each ovary.  A tablet form of fertility medication called clomiphene citrate (Clomid) can be taken to increase the amount of FSH being secreted by the ovary. In this manner clomiphene citrate induces the growth of multiple egg follicles, typically 2-4 in number.

Alternatively, injections of FSH (called gonadotropins, Follistim, Gonal-F, Menopur, and Bravelle) can be used to induce the growth of even more follicles. These injections are given subcutaneously (under the skin) for 8-12 days. Once the follicles are ready, an injection of the hormone hCG (Ovidrel, Pregnyl) is used to ovulate the follicles. At this point eggs are either combined with artificial insemination or harvested and fertilized in the lab (in-vitro-fertilization) to create embryos which can then be transferred directly to the uterus.

Medications That Affect Ovulation:

During in-vitro fertilization treatment, drugs are used to turn off the natural pituitary hormones in order to synchronize egg follicles and prevent premature ovulation. The most common drug used for this purpose are oral contraceptive pills. During in-vitro treatment, injections of gonadotropin help eggs to develop better. However, during this stage eggs become vulnerable to premature ovulation. A second medication called leuprolide acetate (Lupron) can be used, in conjunction with oral contraceptive pills or alone, in order to prevent premature ovulation. Interestingly, leuprolide acetate actually belongs to a class of drugs called GnRH agonists- which, when injected, initially cause the pituitary gland to produce more FSH. However, with continued use, the drug eventually overwhelms the pituitary gland resulting in the opposite effect – pituitary suppression. For women who make a low number of eggs, leuprolide acetate in sometimes administered in micro-dose amounts to promote higher pituitary FSH production in order to yield more eggs. Instead of administering leuprolide acetate for a prolonged period of time to achieve pituitary suppression, a similar medication called a “GnRH antagonist” (Ganirelix, Cetrorelix), can be injected when egg follicles begin to grow. The use of this additional drug prevents the pituitary gland from causing premature ovulation. The “antagonist” provides instant pituitary suppression unlike that of leuprolide acetate which requires prolonged use to achieve suppression.

Medications That Support The Uterine Lining:

During a normal menstrual cycle, one egg follicle is recruited under the influence of pituitary FSH and subsequently ovulates as a result of the pituitary LH surge. The egg follicle makes a potent hormone called estradiol during the first two weeks of the egg’s development (pre-ovulation). After the egg is ovulated the remaining part of the egg follicle then begins to produce progesterone in addition to estradiol. These hormones together cause the uterine lining (the endometrium) to thicken and begin to secrete molecules which help the embryo develop into a pregnancy. In some forms of fertility treatment such as frozen embryo transfer, egg donation and surrogacy, tablets or patches of estradiol and suppositories or injections of progesterone are given to artificially prepare the endometrium to be able to support the early pregnancy.

By Dr. John Jain

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Ubiquitous exposure to two common toxins may diminish IVF success

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New research conducted at the University of Albany indicate that daily, commonly-occurring exposure to two toxic metals – mercury and cadmium – diminish pregnancy rates for women who have undergone in vitro fertilization (IVF). Mercury and cadmium are a constant presence in our air, water and food, at levels considered safe by the EPA (Environmental Protection Agency).

The UAlbany study, led by Michael S. Bloom and Dr. Victor Fujimoto, asserts that even at currently acceptable levels, these two toxins appear to have devastating effects on a significant percentage of clinical and biochemical pregnancies resulting from IVF, a widely utilized form of reproductive technology. Clinical pregnancies are those in which a gestational sac is present; biochemical pregnancies are defined as very early pregnancies diagnosed through a blood test.
While mercury and cadmium are natural elements found within the earth’s environment, levels of both toxic metals have become increasingly elevated over several decades. Attributing to the increased rate of mercury in fish for example, is coal-generated electricity, smelting, and incineration of factory waste products that find their way into our atmosphere, oceans and food chain.

Cadmium is secreted by cigarette smoke, certain types of fertilizers and organ meats such as liver. Waste products discarded from steel and iron factories are also a contributing factor; factory workers may be particularly vulnerable to cadmium exposure.

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Three Birthdays One Day of Conception

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For Joyce Mallon, the births of her three children are “a miracle.” Conceived on October, 26, 2007, in a lab by in vitro fertilization, the embryos were implanted into her uterus at two-year intervals, giving her and her husband three children conceived on the same day but born years apart.

“They are my Tripblings!! Triplets via conception, siblings by actual birth,” she wrote in an e-mail sent to CNN. “I believe our story to be an exciting and intriguing one, that NO ONE in the U.S. (to my knowledge), has any claim to.”

Fertility experts say while the Mallon births are exciting, they’re not a first. With better freezing techniques, many babies have been born by doing what the Mallons did: creating a group of embryos, using some to start one pregnancy, and then freezing the rest for future pregnancies. Three babies born this way aren’t triplets, but rather three genetically unique siblings conceived on the same day and born years apart.

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High Doses of Hormones Faulted in Fertility Care

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Two days after Debra Demidon underwent in vitro fertilization, she gained more than 30 pounds in fluid and suddenly was struggling to breathe.

Doctors diagnosed severe ovarian hyperstimulation syndrome (OHSS), a complication seen in some women who undergo fertility treatment. It landed Ms. Demidon in the hospital for five days; doctors ultimately drained 6.5 liters of fluid from her body. She missed three weeks of work, and by the time it was over, she and her husband had spent all of their savings.

“It was my first time doing IVF, and I’ll never do it again,” said Ms. Demidon, 28, a quality assurance specialist in Cayuga, N.Y. “It was awful. When you have that much fluid in you, it puts pressure on everything.”

OHSS is a little-known complication of fertility treatments that rely on high doses of hormones, which are standard in the United States and the United Kingdom; the syndrome is not the only health problem to be linked to in vitro fertilization. Fertility clinics in Europe and Japan have turned to a safer, low-dose form of IVF, but clinics here have largely resisted on the grounds that the success rates for low-dose IVF are not as high.

“Pregnancy rates are lower, and more cycles of IVF are necessary” with low-dose IVF, said Dr. Glenn L. Schattman, a fertility doctor at NewYork-Presbyterian/Weill Cornell Medical Center and president of the Society for Assisted Reproductive Technology.

But some critics are urging the industry to reconsider.

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What is Minimal Stimulation IVF?

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Minimal Stimulation IVF differs from traditional IVF in the type and amount of fertility medications used to stimulate the growth of egg follicles.

Traditional IVF uses injections of the hormone FSH (follicle stimulating hormone) to stimulate the growth of multiple eggs which are then harvested from the ovary and fertilized in the laboratory (in-vitro fertilization) before being transferred to the uterus as embryos.

With Mini Stim IVF, a tablet form of fertility medication called clomiphene citrate is taken for 5 days to increase the natural production of FSH in order to recruit multiple egg follicles. Hormonal injections may be used for a few days but at much lower doses than used in traditional IVF.

Although fewer eggs are recruited with Mini Stim IVF, the ones that do grow are believed to be highest in quality. Other benefits include less injections, shorter treatment times and lower cost. Mini Stim IVF is a good alternative for women who respond poorly to traditional hormonal stimulation or have failed traditional IVF.