Genesis Fertility Clinic Blog
February 23, 2010 | 0 CommentsThyroid hormone, Cows and IVF
A recent study from the Ontario Veterinary College found that adding thyroid hormone to the culture media in which IVF cow embryos develop might improve the embryo quality. In general, better quality embryos are associated with a higher pregnancy rate with IVF. See the Globe and Mail — Fertility research: Thyroid hormone may boost in-vitro conception.
Potentially, human IVF success rates could be improved by the addition of thyroid hormone to the culture media. Before we can conclude this, however, we need to determine if the better quality embryos created in the study mean higher pregnancy rates. Then the same study needs to be done in humans. If there is a benefit, then we would incorporate this practice into our embryo media.
At present, we require that women undergoing IVF at Genesis have normal thyroid hormone levels. Thyroid hormone is known to affect egg development and uterine lining (endometrium) quality. As a result, women with abnormal (high or low) thyroid hormone levels have lower success with spontaneous conception and conception with IVF.
It is so important that we explore human and non-human models of IVF as we work to optimize IVF pregnancy rates and the health of the children created by IVF.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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February 18, 2010 | 0 CommentsHome-made twins
Of the 30 people you in Canada one of them is likely to have a twin brother or sister. The lowest chance of meeting a twin is in Asia, where 1 in 70 persons is a twin and the highest chance in Nigeria where 1 in 12 persons is a twin.
There are two types of twins, dizygotic (DZ) and monozygotic (MZ) twins. DZ twinning occurs when two separate eggs are released during the same menstrual cycle and are fertilized by two sperm, creating “fraternal twins.” MZ twinning occurs when a single egg is fertilized by a single sperm and the resulting embryo splits a few days later creating “identical twins.”
DZ twins can occur spontaneously (i.e. home-made!) or as a consequence of fertility treatments. Patients will sometimes ask me about their risk of having twins; “my mother was a twin so am I more likely to have twins?” If you are undergoing fertility treatments the major increase in twin risk is due to the treatment. The minor influence of family history is washed away by the large fertility treatment effect. For example, if a woman’s mother is a DZ twin the woman is about twice as likely to have a DZ twin pregnancy (to about 1:15). If that woman does fertility treatment she has up to a 40% chance of having a DZ twin pregnancy (depending on the type of treatment of course).
It is known that your mother’s family history of twinning effects your chances as does your age (older women have a higher chance of conceiving DZ twins). A study published this month in Fertility & Sterility observed that a woman’s height and body mass index also affected her chances of having DZ twins. Specifically tall women and overweight women have more DZ twins. Current thinking is not that being tall or overweight increase your risk, per se, but are related to a gene that causes multiple ovulations.
Other factors that increase your risk of conceiving DZ twins include increasing female age, conceiving in the summer or autumn, cigarette smoking, recent use of the oral contraceptive pill, and folic acid consumption (controversial).
Understanding factors that influence DZ twinning can help shed light on the mechanism of multiple and single ovulations. The more we know….
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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February 10, 2010 | 0 CommentsOlympics
Just a note about the Olympics…. Our hours have changed to make life a little easier for patients. From February 12 to 28, 2010, our hours will be:
Monday to Friday
6:30 am – 3:00 pm
Pharmacy will close at 3:00 pm
Saturday and Sunday
7:30 am – 1:00 pm
Pharmacy will close at 1:00 pm
This is an hour earlier than we are usually open. We hope it helps! Go Canada Go!
Dr. Beth Taylor, MD, FRCSC
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January 29, 2010 | 0 CommentsPreimplantation Genetic Screening (PGS)
There are so many factors that determine whether IVF will work, that is achieve a pregnancy. On the surface it might seem simple. After all, we are taking eggs and sperm, making embryos and putting the best looking (grade) embryos back into the uterus.
One reason is that many embryos that look normal are genetically abnormal. For example, we cannot tell if the embryo has an extra chromosome 21 which results in a child that would have Down Syndrome. Presently, we only examine the chromosomes of embryos if the couple is undergoing preimplantation genetic diagnosis for a known genetic disorder.
Why don’t we test every embryo to ensure we only transfer genetically normal embryos? Because it does not increase the chance that the woman will have a healthy child. This might seem surprising. After all, if you put only genetically “normal” embryos into a women, shouldn’t you have higher pregnancy rates because genetically abnormal embryos don’t implant as often? No, and the reason you don’t is that the process of testing an embryo’s genetic material can damage the embryo, thereby reducing the pregnancy rate.
Suppose a 33-year-old woman and her husband have 8 embryos. Currently, the best 1-2 embryos would be transferred into the woman, and she would have about a 65% pregnancy rate, about a 50% chance of a live birth, and a 0.002% chance of carrying a genetically abnormal fetus (because nearly all the genetically abnormal embryos will not implant or be lost at some point in the pregnancy). If we took those 8 embryos, tested their genetic maternal (called preimplantation genetic screening – PGS) and transferred only normal embryos, we would reduce the success rate by 25% (depending on the embryo biopsy technique) giving her a live birth rate of about 40%. Please note these numbers are for illustration only – different studies have shown different results. Some studies have shown a reduction in the success rate with PGS and some have shown no difference.
There have been just a few randomized trials examining the effect of PGS of embryos on pregnancy outcome and none have shown a benefit. In time, as the technique of embryo testing improves, I think PGS will be proven beneficial in improving pregnancy rates and the success of IVF, but for now it should not be performed routinely.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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January 19, 2010Exercise and Female Fertility
When I talk to my mother about infertility, she always asks me to tell my patients to “go on a vacation and stop exercising so much.” Very lucid, and there is some evidence she is right, at least about exercise.
There have been two notable, large studies supporting her belief. One by Morris et al. (2006) found that women who had enrolled in a fertility treatment programme and reported exercising 4 hours or more per week for 1–9 years previously were 40% less likely to have a live birth, almost three times more likely to experience IVF cycle
cancellation, and twice as likely to have an implantation failure or pregnancy loss.
More recently (2009), a Norwegian study by Gudmundsdottir et al. found that women who exercised for more than 60 minutes or to “exhaustion” every day were more likely to be infertile. Women who exercised to be “sweating and out of breath” for 15-30 minutes 1-3 times per week had improved fertility compared to women who didn’t exercise at all. So, moderation seems to be the key – just like our mothers have always told us.
So if your new year’s resolution was to exercise more, don’t go overboard or it might lessen your fertility.
Happy New Year!
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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January 3, 2010Public Vs. Private Health Care
Nearly every week either a patient or someone I meet socially will ask me whether Genesis is a “private health care clinic.” The short answer is “no.”
According to Health Canada, private health care clinics in Canada are “facilities that receive no government funding: the physicians are not reimbursed by the provincial health care insurance plan and their patients must pay the full cost of the services rendered to them.”
At Genesis, we are fully within the public health care system, i.e. MSP. The catch is that not all the services we provide are covered by MSP.
I admit that the public versus private health care issue is a bit confusing as there are gray areas. The health care system in Canada is publicly funded but mostly privately delivered. Most people are treated by physicians who are in their own private practice (including your GP). This means that they are not paid a salary by the government, but they bill MSP for your medical treatment rather than charging you directly.
We are just like any other physicians or medical clinic in this regard: we see you at Genesis and bill MSP for treatments they cover. This includes your consultation with us, surgery, ultrasounds to monitor menstrual cycles, and emergency room treatment. Even your fertility tests are covered by MSP. There are a number of treatments that are not covered by MSP and these include IVF, some sperm tests and artificial/intrauterine insemination. The reason for this is that Health Canada has decided that:
… a number of services provided by hospitals and physicians are not considered medically necessary [including vitro fertilization and artificial/intrauterine insemination] and, thus, are not insured under provincial and territorial health insurance legislation. Uninsured physician services for which patients may be charged differ from province to province.
At the moment, Quebec is the only province that plans to covers IVF (likely starting in the spring 2010). However, there has been some promising progress in Ontario as a report released in August 2009 by the The Ontario Expert Panel on Infertility and Adoption proposed that Ontario health care should fund up to three treatment cycles and one session of counseling. The report argues that health care costs would be reduced by funding and regulating IVF. Currently, these recommendations are being reviewed by Ontario healthcare (OHIP), and if they were adopted that would put pressure on other provinces to follow suit.
At Genesis, we have been long-time advocates for IVF to be funded by public health care, and Dr. Albert Yuzpe sits on a national board that is lobbying the government.
We are committed to promoting reproductive health and advancing fertility treatments. In addition to caring for our patients at Genesis, we work at VGH and BC Women’s providing gynecology services and teaching medical students and residents.
And while it doesn’t help you if you are trying to conceive with IVF or other uncovered treatments now, we do hope that our efforts are going have an impact on the delivery of fertility treatment in the future.
Because the decision to fund or not to fund fertility treatments is largely political, public pressure on both your MLA and on the BC’s health minister Kevin Falcon may help bring about change. If you want to express your views on the need for public funding for fertility treatments like IVF, you can e-mail Kevin Falcon at Kevin.falcon.mla@leg.bc.ca
Dr. Beth Taylor
Reproductive Endocrinology & Infertility
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December 18, 2009Building Babies - A Cautionary Tale
Surrogacy seems straightforward. A woman (called the intended mother) who cannot carry a pregnancy in her uterus has another woman carry the pregnancy for her. At the end of the pregnancy, the surrogate hands over the baby to the intended parents.
This is how the process works 99% of the time, and it works well. I coordinate the surrogacy program at Genesis, and it is wonderful to see people come together to help each other create their families. The surrogate is supremely generous, and the intended parents are immensely grateful.
Things can go wrong, however, as illustrated in a case reported in the New York Times this week. You can read the New York Times article here. There are five people involved in this complex case: the intended parents, the egg donor, the sperm donor and the surrogate (called a gestational carrier in this context). Briefly, a couple used donor eggs and donor sperm to create embryos. They put two embryos into a gestational carrier who carried the pregnancy and delivered twins. The carrier gave the twins to the intended parents, but a month later learned that the intended mother has schizophrenia. The carrier, fearing the twins will not be well cared for, goes to court and wins custody of the twins. It’s a messy, heart-wrenching story.
Why did things fall apart? In some jurisdictions, surrogacy contracts do not hold up in court. So, although the gestational carrier had a written agreement to give the children to the intended parents, the agreement wasn’t recognized by the courts (in Michigan).
Could this happen in BC? Perhaps, but we go to great lengths to prevent such a disaster. There have been no challenges to surrogacy law in BC to my knowledge. At Genesis, we try to protect all parties as best we can. We require psychological counseling and a report of the appropriateness of all parties before we will embarking on surrogacy (this was not done in the NY Times case). We also require a legal contract, and we interview all parties prior to commencing surrogacy care. This is an expensive and intensive process, but it aims to protect all parties from such problems as the NY Times case highlights.
It’s not easy to engage in surrogacy, but perhaps it shouldn’t be. Clinics should be thoughtful in who they help with surrogacy. After all, we have to protect not just our patients but also their potential children.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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December 3, 2009Letting Go
We’ve all heard of infertile couples who “give up” after years of fertility treatments and then conceive on their own. Another seemingly common story is of the couple who spends years trying to conceive, who then adopts a child, and shortly thereafter conceives on their own.
Is this just random luck? Is this just background fertility demographics? Or is there something therapeutic about “giving up” or “letting go” of the stress of infertility that can help you conceive?
A study published in Fertility & Sterility in October, 2009, suggests that women who “let go” during IVF treatment are more likely to conceive than those who do not. The IVF process involves many steps beyond a woman’s control – hormone response to medications and procedures to remove eggs and replace embryos. In such low-control situations, women can respond by either trying to alter or take control of the events (called problem-focused coping; PFC) or by letting go of control and regulating their emotional response to the event (called emotion-focused coping; EFC).
In this study, the authors examined 88 women undergoing IVF for various causes of infertility and explored how they coped with the stress of IVF. Those women who employed EFC were almost twice as likely to conceive than those who employed PFC.
Why? Perhaps high levels of stress, worry, rumination, etc. cause physiological changes that affect eggs or uterine health. There have been several small studies looking at this, but no clear explanation of the association between stress and IVF outcome is available yet.
This study suggests that no matter what the explanation is, though, if a woman can “let go” during IVF (meditation? Chinese medicine? deep breathing? other relaxation techniques?), she might be more likely to conceive.
It’s hard to “let go,” but figuring out how to do it might pay off in IVF success.
Dr. Beth Taylor
Reproductive Endocrinology & Infertility
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November 18, 2009After embryo transfer
During the IVF process, we transfer embryos into a woman’s uterus. There is an approximately two-week interval from the time of embryo transfer until a woman knows whether she is pregnant or not. This is a nerve-wracking two weeks, and couples search for advice on what they can do to improve the chances of success after embryo transfer.
A lot of people worry that standing up after embryo transfer reduces the success of IVF because they fear the embryo will “fall out” or be dislodged. A recent review of all the world literature on bedrest after embryo transfer (be it for 1 hour or 2 weeks) reveals there is no benefit to bedrest on the pregnancy rate after IVF.
The full article can be read on the Wiley InterScience site.
The review also looked at mechanically closing the cervix after embryo transfer and using a fibrin sealant. None of these interventions seemed to help either. There were no newly reported interventions that helped.
So, we’ll continue to do what we do – we have excellent pregnancy rates. We’ll also continue to look for ways we can improve our rates.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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November 15, 2009Declining Fertility
I don’t usually read “The Economist.” After all, I am pretty busy trying to keep up with fertility research, and I don’t really understand why a rising yuan affects farmers in Africa and other such economic nuances; but last week’s cover story was “Fertility Declining: Go forth and multiply a lot less,” and so I thought I’d give it a read.
The article discussed the decline in (voluntary) fertility in the world. They state that sometime soon “half of humanity will be having only enough children to replace itself. That is, the fertility rate of half the world will be 2.1 or below. This is the “replacement level of fertility,” the magic number that causes a country’s population to slow down and, eventually, to stabilise.”
The article then goes on to detail how positive the decline to replacement levels is for the environment, women’s rights, living standards in the developing world, and the economy. It is certainly interesting from a population health viewpoint but neglects those who are “involuntarily infertile” – i.e. my patients.
As the rates of involuntarily infertility climb (predominantly due to women delaying childbearing), we could see less than replacement levels of fertility which can also have a very negative effect on these same domains: the economy (fewer taxpayers), women’s rights (in China when only <=1 child is permitted female infanticide is not uncommon), the environment (there are no greater consumers/CO2 producers than affluent, small families in the developed world), etc.
Ok, I am simplifying things and should not pretend to understand the complexities of demography, fertility and the economy, but the article got me thinking about this trend in declining world fertility. It purports to show how positive it is, but what if the pendulum swings too far below replacement levels? Then, perhaps, we’ll see more interest in increasing fertility and a greater focus on fertility treatment and public awareness of the issue. This has started in Japan and Australia, which have both seen fertility rates below 2.1 and have seen changes in public policy to promote fertility.
It’s a very interesting topic, but change is slow. In the meantime: go forth and multiply.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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