Genesis Fertility Clinic Blog
searching: “ivf”
January 29, 2012
Caffeine
My colleagues and I will sometimes joke that we went to university for 13+ years and now that we are in practice we get asked “can I dye my hair in pregnancy?” and we can’t answer it! We were never taught the answer! We learned about molecular mechanisms of disease, spent hours in the histology lab reviewing cell structures, sat through many lectures on metabolism and pharmacology, etc. but we were never taught the answers to many everyday questions.
One such question I get asked often is “how much caffeine is safe when trying to conceive?”
To answer that a few researchers have followed women who were trying to conceive though their attempts and early pregnancy and had them record how much caffeine (in coffee, tea, soft drinks and chocolate) they consumed. While there were some conflicting results, the bottom line is that more than 200mg of caffeine per day slightly increases the risk of miscarriage. There was no suggestion that caffeine caused infertility.
A study referenced in the NY times recently looked at how caffeine consumption effected non-pregnant women’s estrogen levels. Interestingly, caffeine was found to increase estrogen levels in white women but decrease estrogen levels in Asian women. This is probably due to genetics. The change in level, up or down, wasn’t enough to effect ovulation or fertility, that they could tell. I wonder what it means for mood and libido in the short term, and breast cancer and bone health in the long term. It will be interesting to follow this research.
Part of my job is to translate this kind of science to patients; and it’s the most fun part. Now that I have been in practice for a few years I find myself reading much less basic science research and much more of the patient-centred research. It makes the job more fun and allows me to answer the questions patients actually want answered. Rarely do I get asked about the expression of steriodogenic proteins by mouse syncytiotrophoblasts. hehe….
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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January 15, 2012What happens to infertile couples?
I saw a patient today whose husband left her because their infertility is due to a problem with her. How often does a person leave their spouse because of infertility?
There have been a few large European studies that attempt to answer that question. You can read a recent article that includes a summary of past studies here.
The summary is that when couples are followed for up to 20 years after IVF treatment (successful or not) about 70% of them are still together. The chance they are still together is the same whether or not they have children.
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January 13, 2012Dragon Baby
The year of the Dragon in the Chinese zodiac calendar begins January 23rd. Babies born in the year of the dragon are meant to bring luck to a family and according to Chinese tradition are high-spirited, fearless and destined for success.
More Chinese women are expected to try to time their pregnancies to deliver this year. This phenomenon of astrological influence on birth rates has been noted in the past with slightly lower Asian birth rates documented in years of the tiger (headstrong and difficult) and horse (rebellious).
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January 7, 2012Building a Better Baby?
The cover of the Globe and Mail today featured an article on Preimplantation Genetic Diagnosis (PGD). The article is titled Building a Better Baby.
In my opinion the article tries to create a big concern where there is a small one.
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December 15, 2011Varicocele
There are lots of grey areas in reproductive medicine. Sometimes being unclear what the best treatment is makes my job interesting, and other times it makes it frustrating. One frustrating grey area is the management of varicoceles.
A varicocele is an abnormal dilatation of a vein in the scrotum that drains blood from the testicles. Varicoceles can cause pain or aching in the testicles and can effect sperm count and quality. There is little doubt that (at least large) varicoceles can impact sperm, but it is unclear whether fixing them meaningfully improves sperm counts.
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December 8, 2011Gets people talking
Infertility is generally not talked about. People feel ashamed or embarrassed that they can’t conceive – something that should be easy to do. However, the more people talk about infertility, the better, as it will normalize the problem and help couples realize they are not alone.
Recently a famous Bollywood couple, Aamir Khan and Kiran Rao, conceived using IVF and a surrogate.
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November 29, 2011New year's resolution
Every year I resolve to eat better, exercise more, say “yes” instead of “yeah” and be a better listener. I’ve had variable success: some years I run a marathon and eat fewer potato chips, and other years I sloth about and gain 10lbs in chip and chocolate. I keep trying to listen more, but haven’t stopped saying “yeah.” How well people follow through on their new year’s resolutions depends on the significance of the outcome. If getting pregnant is your “outcome” for 2012, then it’s time to resolve to eat better and stick to it.
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November 12, 2011Older Moms
We spend our time trying to help women conceive healthy babies. The health of the mother is also of paramount importance. As physicians, when we see a patient, we ask ourselves “…is she healthy enough to support a pregnancy? …what are the risks of a pregnancy to this patient?” Medical conditions (e.g. lupus, diabetes, etc.) can make pregnancies difficult, and so can increasing female age.
I recently came across a ‘nice paper’ that describes the risks of pregnancy to Canadian women of different age groups.
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October 29, 2011IVF and ovarian cancer
The Globe and Mail reported on a study suggesting an increased risk of borderline ovarian tumors in women who undergo IVF.
Firstly, borderline ovarian tumors are NOT cancer and the study of 25,000 women found no increase risk of ovarian cancer in women who undergo IVF.
Secondly, the increase in borderline ovarian tumors was from 5 in 1000 women to 7 in 1000 women. This is a very small risk. To help put this risk into perspective the risk of heart disease is 1 in 5, the risk of being injured in a motor vehicle accident is 1 in 100, and the risk of breast cancer is 1 in 9.
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October 24, 2011Procrastination
I just finished watching what is perhaps the most ridiculous show on television: Dancing with the Stars. I like TV, but I really do not have time to watch it. I have a job to do, a family to care for, food to cook, email to write, research to consider, and a “to do” list longer than I care to consider – just like most people my age – and one item that has been my “to do” list for weeks is “work on talk for D.A. Boyes.”
Well, the D.A. Boyes Conference is now just 3 days away, and I have only 2 slides out of the 20-30 I need. I should be working on my talk, but instead I am watching terrible TV.
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October 16, 2011Doing the wrong thing
Saturday’s Vancouver Sun ran a story about traditional surrogacy gone terribly wrong. (Traditional surrogacy means that the surrogate mother conceived using her own eggs and the intended father’s sperm by insemination – at home in this case.)
After reading it, I blurted “what were they thinking?” The case illustrates the necessity for the reproductive laws in Canada to be implemented.
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September 28, 2011Coenzyme Q10
At last week’s Canadian Fertility and Andrology Society (CFAS) meeting, Dr. Robert Casper, a Canadian researcher, presented a very interesting research paper. Casper’s team gave half of a group of middle-aged mice co-enzyme Q10 (CoQ10), and the other half a placebo. Next, they compared eggs retrieved from both groups of mice with eggs from young mice. The middle-aged mice that received CoQ10 had more eggs and better quality eggs than those that received a placebo. If it works in humans as it did in mice, it’s possible to slow down the effects of age on fertility.
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September 24, 2011Busy week for journalists covering fertility conference
This week the annual Canadian Fertility and Andrology Society meeting was held in Toronto. A wide range of topics were discussed, but a couple were picked up by the media as topical. One topic was the treatment, or refusal to treatment for obese infertile women. Another topic covered was the problem of too many multiple births.
The media sometimes polarizes issues, but I think we all know most of life is rarely dichotomous – most of the time there is a gray zone. My opinion?
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September 16, 2011Delaying parenthood
As a fertility doctor, I focus on getting women pregnant, but I also have a responsibility to tell women the risks of being pregnant at “older” ages.
A recent study by the Canadian Institute for Health Information (CIHI), referenced in a Globe and Mail article today, helps quantify the risks for Canadian women.
The study examined pregnancy outcomes of over one million births in Canada.
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September 13, 2011NSAIDS + pregnancy = bad
If the amount of shelf space a pharmacy dedicates to a particular drug class is proportional to it’s sales, then non-steroidal anti-inflammatories (e.g. Advil, Motrin, Midol, Aleve) are big sellers. Pharmacy shelves are stocked with several different brands of these medications commonly used for pain. NSAIDS are also included in several cough and cold remedies. As North Americans over half of us have used an NSAID for pain in our lifetimes. When you are pregnant, though, you should reach for something different on your pharmacy’s shelf for pain.
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August 28, 2011Choosing who is right
I don’t know why I read Ian Brown, a Globe and Mail writer. Every time he writes about his son Walker, or how Walker’s disease relates to some topical issue, I cry. Last year when exerts from his book, The Boy in the Moon, were published by the Globe, I read, unable to hold back tears. Walker, who is now 15, has an impossibly rare genetic disorder that leaves him profoundly disabled.
This week, Mr. Brown wrote about his son in the Globe again. The article was about the new at-home fetal-DNA tests available in the USA.
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August 20, 2011Early Bird Gets the Sperm
If you are a couple trying to conceive you might enjoy this YouTube video. Click here.
It was good for a few laughs.
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July 20, 2011Grading embryos
IVF involves the creation of embryos which are then put into a woman’s uterus. Embryos start as one cell, divide and become two cells, four cells, etc. We grade embryos prior to putting them into the uterus to give us a sense of the chance a pregnancy will result.
So a high grade embryo is more likely to result in a pregnancy than a low grade, but it does not tell us about the health of the child who results. We have hundreds of healthy children from low grade embryos!
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July 12, 2011Genetic Testing in Pregnancy
Once you fall pregnant, many people want to have testing to determine whether the fetus (or fetuses) have Down syndrome, trisomy 18 or neural tube defects and other abnormalities. In BC this testing takes three main forms: Serum Integrated Prenatal Screening (SIPS), Integrated Prenatal Screening (IPS) and amniocentesis.
SIPS and IPS need a blood testing and ultrasound done very early in pregnancy, so once you are pregnant you should contact your midwife, GP or obstetrician soon to set up the testing.
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July 11, 2011Receptionists matter
On-line there are many websites dedicated to rating physicians. Some are good and some are bad. Such is life. As physicians we are used to being judged: by our college, by our peers, by our hospitals, by our university, and importantly, by our patients. But, as Genesis patients know, seeing a physician isn’t just about that one person: each of the staff members you encounter must be respectful, caring and knowledgable. It’s essential.
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May 7, 2011Mother's Day
Mother’s Day brings up lots of mixed feelings for women who are infertile. I was at dinner on Thursday night with 5 girlfriends, four of them have their children because of IVF. We were talking about our plans for Mother’s Day. When I told them I am working at Genesis, two gasped and said “Genesis should be closed on Mother’s Day!” They had both struggled with infertility and found Mother’s Day the cruelest day of all.
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April 14, 2011Multiple births are risky
Today’s Vancouver Sun had an article discussing the risk of multiple births and highlighting that many of the country’s multiple births (twins, triplets, more) are due to IVF.
We sometimes put more than one embryo back in hopes of increasing a couple’s chance of successful pregnancy. The cost of this practice is that multiple births can occur.
So, we shouldn’t put more than one embryo back, right? If it was only that simple! Genesis has always lead the way in putting the fewest embryos back in young women, yet….
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April 7, 2011Antagonist supply issue
Due to an unexpected manufacturer shortage, there is currently a worldwide shortage of gonadotropin-releasing hormone (GnRH) antagonist injections that are used in many IVF cycles to control the timing of ovulation.
Fortunately, we are a large IVF program and we have a considerable stock in our pharmacy, so our patients will not be affected….
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April 7, 2011New Study at Genesis
The only way we improve is by studying interventions and outcomes. This month we’ve started recruiting patients into a new study at Genesis. There have been a few small studies published since 2003 that have suggested endometrial biopsy or sampling in the menstrual cycle prior to IVF might improve pregnancy rates in patients who have have several unsuccessful IVF embryo transfers.
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March 26, 2011Fertility drug worries?
There are two types of fertility drugs: synthetic and those derived from urine. A recent study, lead by a UBC team, documented that prions can be found in urine-derived fertility drugs.
Should you worry if you have taken or will be taking these drugs? For now, no.
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March 1, 2011Global TV this week...
Global TV BC (channel 11 for those in the lower mainland) is doing a five part series this week on fertility. Every night on their 6 o’clock new hour they are doing a 5 minute segment on fertility. Last night was IVF. The rest of the week will include PGD, donor egg, funding and egg freezing.
Tune in!
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February 26, 2011First World Care
Until fertility treatments like IVF are publicly funded by our provincial medical service plan, many couples will continue to struggle to find the money to help them pay for treatments to have conceive.
When medical treatments are expensive, some look to other countries to find less expensive treatment. People go abroad for hip replacements, gall bladder surgery, cosmetic surgery and the like.
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February 26, 2011Male Fertility Blog
One excellent website, written by a urologist in California, is The Turek Clinic’s site. It’s worth reading as it authoritatively discusses the emotional and medical side of male fertility problems.
At Genesis, all five of our doctors are gynecologists with additional fellowship training in infertility. We also have urologists on staff who help with complex male fertility patients.
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January 30, 2011Scrotal Hyperthermia
The article I just finished is on laptop computers and scrotal hyperthermia. It is known that testicles function best at a temperature 2-4 ℃ less than core body temperature. If the testicles/scrotum are heated, sperm quantity and quality drops. In this study the effect of laptop computers on scrotal temperature was examined. They also examined whether a laptop shield and whether sitting with your legs together or apart (70°) influences scrotal temperature.
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January 15, 2011Laughter and IVF
A few patients sent me a link to a very funny article.
The study suggests that when a medical clown visited their clinic after embryo transfer, the IVF pregnancy rate increased. Is this a real effect?
It’s certainly tempting to follow every little study…
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January 10, 2011TED
Tonight I watched the creators of Babble.com, Rufus Griscom and Alisa Volkman, speak about four taboos of parenting. One of the taboos is that you must not talk about your miscarriage. For anyone who has miscarried, I think the message will resonate. It is a profoundly lonely and isolating experience well articulated by the speakers.
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December 1, 2010Accreditation
Accreditation is a rather boring topic, I admit, but for a clinic it’s a very, very important process. In Canada fertility clinics are accredited by two main bodies: their provincial college of physicians and Accreditation Canada. We were accredited by the BC College of Physicians in 2009 and this fall underwent the rigorous Accreditation Canada inspection.
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November 27, 2010The IVF Lifecycle
Louise Brown, the first IVF conceived child, is now a healthy woman who two years ago naturally conceived and delivered her own child, Callum. This is reassuring for all involved in IVF as fertility is a marker of the health of IVF conceived children.
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November 24, 2010Sheffield, UK
IVF centres in Europe have lower pregnancy rates than those in North America. This is for a variety of reasons but largely because IVF is government funded in many countries. Even though these programs have lower per cycle IVF pregnancy rates than we do at Genesis, there are always a few tricks to take away from a clinical meeting.
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November 3, 2010CTV News - Starting November 8
CTV British Columbia News is airing a 5-part series by Mi Jung Lee on reproduction. Each night at 6pm from Monday to Friday they will be discussing surrogacy, PGD, IVF and other issues related to fertility.
Click here for the CTV ‘Making Babies’ News page.
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October 26, 2010All over the news...
In my drive to work today Olivia Pratten, 28, was being interviewing on CBC Radio One. Olivia found out 5 years ago that she was conceived using donor sperm. Since then she has tried to gain access to the sperm donor’s personal and medical records.
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October 20, 2010Gulf Oil Spill
The recent British Petroleum oil spill in the Gulf of Mexico has devastated the ecosystem and destroyed wildlife in the region. Events like this affect each of us uniquely. Many studies have examined the effect of exposure to petroleum hydrocarbons on female and male fertility.
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October 18, 2010One versus two inseminations
Patients will sometimes ask me whether two inseminations are better than one. The short answer is “no” and a meta-analysis (analysis of all of the currently published “good” studies on a topic) published in September 2010 supports this answer.
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October 5, 2010The 2010 Nobel Prize
This is an exciting week for those involved in IVF treatment. The 2010 Nobel Prize in Medicine was awarded to Professor Robert Edwards. Edwards, a scientist, along with Patrick Steptoe, a physician, developed the technique of IVF.
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September 27, 2010Donor Egg Information Session
On Saturday, October 2, 2010 Dr. Robert Stillman from Shady Grove Fertility will be speaking about anonymous egg donation. Shady Grove Fertility, which has locations in Maryland and Washington, DC, has one of North America’s largest donor egg programs.
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September 25, 2010Horrible
The past week has been filled with stories of families in Ottawa who have come to learn that their children where not created with the sperm they believed they were. Several patients of Dr. Bernard Norman Barwin in Ottawa, Ontario were inseminated with the husband’s sperm or anonymous donor sperm to conceive their child. They have now discovered someone else’s sperm was used. So children are not a genetic match to their fathers or their donor.
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September 21, 2010Canadian Fertility Meeting
Next week the Canadian Fertility and Andrology Society’s annual meeting is being held in Vancouver. The CFAS is the national organization of fertility doctors, nurses, laboratory scientists and other affiliated professions in the field of fertility. The CFAS establishes best practice guidelines and collects data on the practice patterns and success rates of fertility treatments, like IVF, across Canada.
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September 14, 2010A long, long time ago
Today is my birthday. So, nearly 40 years ago (I said “nearly”) today my mother was in labour. She would eventually deliver me by vaginal breech delivery. I was breech because my mother has a bicornuate uterus.
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August 30, 2010Baby Beat
A lot of people know Amy Beeman a morning radio DJ from the Beat 94.5 FM in Vancouver. She was my patient and conceived her twins by IVF. She discusses her fertility journey and recent delivery in her blog.
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August 30, 2010Baby Beat
A lot of people know Amy Beeman a morning radio DJ from the Beat 94.5 FM in Vancouver. She was my patient and conceived her twins by IVF. She discusses her fertility journey and recent delivery in her blog.
No patient confidentially is breached here – Amy mentioned that she came to Genesis and was my patient in her blog
It might be a fun read for those struggling like Amy did….
Congratulations to Amy and her husband and thanks for sharing your story!
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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August 25, 2010Dr. Kashyap
Dr. Kashyap has started at Genesis, and has already has an introduction to Vancouver as her car was towed last night. I told her she needs to do the Grouse Grind, eat at White Spot, swim in Kits pool, take the Canada Line and walk the SeaWall. Oh, and she needs to be accosted by a squeegie kid to have had the full Vancouver introduction!
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August 22, 2010More on stress
For some couples the trick to conceiving is reducing stress. Of course, if you have severe endometriosis, damaged tubes, poor sperm quality or quantity, stress isn’t the whole story.
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August 3, 2010If at first you don't succeed...
A very relevant study out of the Netherlands was published in the July 2010 issue of Fertility & Sterility that assessed the time to a successful pregnancy after a miscarriage in infertile couples.
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July 20, 2010Quebec IVF Funding
As of August 5, 2010 the Quebec Provincial Health Plan will cover the cost, including medications, of three IVF cycles. There remains much to be sorted out, for example whether there will be an age limit, whether additional IVF cycles will be funded if a child is born from IVF, how will a wait list be managed?
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July 10, 2010New Doctor Joining Genesis!
Dr. Sonya Kashyap is joining Genesis! She will be the fifth member of the physician team. To say I am excited that she is coming is an understatement. Dr. Kashyup is energetic, well educated, kind and experienced. She has already published more research papers than most REIs publish in their careers.
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July 5, 2010Home inseminations
Two patients in one day is not a pattern. It might just be a fluke, but it does make me wonder. Today two of my patients had a positive pregnancy test who had been trying to conceive with a known donor at home for at least a year. Single women, women whose husband’s have poor or no sperm, and lesbians will sometimes use sperm from men the know, at home, to conceive. We call the men “known donors.”
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July 3, 2010Health and relationships
With the HST, school-board funding cuts, and numerous other political bad news stories many of us are disillusioned with government these days. There is a small good news story, however. The provincial government is introducing a new initiative that focuses on the relationship between health care providers (e.g. family doctors) and patients.
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June 16, 2010AMH
Fertility declines with age because egg number and quality decrease over time. This happens to all of us (unless you are a celebrity it seems! Ok, that’s a donor egg discussion I’ll leave for another entry).
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June 8, 2010How do people choose a clinic?
Driving down the strip in Las Vegas this past weekend while on vacation I heard an advertisement on the radio for a fertility clinic. My gut reaction was “ugh.” It sounded like they were announcing a mattress sale or deeply discounted used cars. It just didn’t feel right, and it made me wonder how many people choose a fertility clinic based on similar advertising.
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May 28, 2010Pregnant at 47
John Travolta’s wife is pregnant at the age of 47. I bring this up because daily since the news broke a patient who is aged 43-50 has asked me how they could get pregnant yet she can’t.
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May 16, 2010Infertility Awareness Week
May 16th to 22nd is Canadian Infertility Awareness Week. There are several events to raise awareness of infertility, including a webcast and public forum here in Vancouver.
The Infertility Awareness Association of Canada’s (IAAC) website is a valuable resource for information about this important week and infertility issues in Canada.
I am speaking at a public forum along with IAAC’s Executive Director Beverly Hanck, Lorne Brown, a Chinese Medicine specialist, and Sue Dumais, a mind-body specialist, about infertility on Wednesday, May 19th. The event is at the Vancouver Public Library, downtown from 6:30 to 9:00pm. It’s free to attend and will be webcast. More information is available at the Family Passages website.
Raising awareness can help couples access care, help remove the stigma of infertility, and promote infertility as an important disease to government.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 4, 2010IVF Pregnancies: As healthy as the rest?
It remains unclear if pregnancies that follow IVF have the same risks for preterm birth, stillbirth, growth restriction, and other pregnancy complications as those conceived without fertility treatment (spontaneously conceived pregnancies). I think it’s reassuring that the answer is unclear. If pregnancies following IVF were significantly more complex or risky, we’d know by now as there have been over 3 million such pregnancies in the world to date.
A Japanese study published in 2010 examining over 53,000 singleton IVF pregnancies found no significant increase in perinatal risk (including stillbirth) to the pregnancy or fetus. In contrast a study published this year of over 20,000 women with singleton pregnancies in Denmark found that risk of stillbirth in women who conceived on their own (spontaneously) was 0.4% compared to 1.6% for those who conceived with IVF. When big studies like this contradict each other, it’s hard to know just what to say to infertile couples.
Twin pregnancies are riskier than singletons whether they are IVF or spontaneously conceived. A recent review suggests that IVF twin pregnancies have a higher risk of premature birth and low birth weight than spontaneously conceived twins.
My belief is that IVF pregnancies may have more risk than spontaneously conceived pregnancies, particularly twin pregnancies, but the increased risk is small. Whether an increased risk is a product of fertility treatment or possible reproductive problems in the couple (i.e. is it the treatment or the couple?) is unknown.
In my opinion and experience, few couples decide not to pursue treatment because of small, unclear pregnancy risks.
Hopefully, in time the picture will be clearer and even more reassuring.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 2, 2010Soy consumption and male fertility
If soy products contain phytoestrogens and phytoestrogens could potentially reduce sperm count in males, should males with infertility stop consuming soy products?
No. This month in “Fertility & Sterility” a comprehensive review of the world literature on soy consumption and fertility was published. Soy products are an excellent source of protein and contain isoflavones which act like estrogen and are classified as phytoestrogens (plant source estrogen). There have been a few small reports of men consuming large quantities of soy products experiencing breast development, erectile dysfunction and reduced sperm counts.
A recent, large study from Massachusetts examined the soy intake of approximately 100 men at an infertility clinic. They found that the highest soy intake category of men had an average of 41 million/mL lower sperm count than men who did not eat soy foods. They also observed that obese men were more likely to consume soy. This might be the explanation why men in Asian countries who consume large amounts of soy their whole lives have normal fertility. The thinking is that obese men (i.e. North American men) are more susceptible to the negative effects of soy on sperm count than thin men (i.e Asian). This study concludes that, for North American men, consuming large amounts of soy can reduce sperm count. It does not seem to effect motility or sperm morphology.
This Massachusetts study is interesting but contradicts the four other smaller studies looking at soy and sperm. If all the studies are assessed together, as this review article does, it seems soy has little to no meaningful effect on sperm count. That is, soy consumption might reduce sperm count marginally but not enough to have a significant effect on fertility.
More studies are needed. For now it seems soy is fine for infertile men to consume. Everything in moderation, I suppose.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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April 18, 2010Funding for IVF
Quebec seems to be on track to fund IVF through their provincial health plan sometime this year. It’s unclear just how much of the cost of IVF will be funded and whether other services (e.g. insemination) will also be covered. We’re watching closely. We’re also continuing to push for IVF and other fertility services to be funded for our patients in BC.
If you believe that fertility treatments should be funded provincially in BC, please email BC’s Minister of Health, Honourable Kevin Falcon, at: kevin.falcon.mla@leg.bc.ca
Everyone, rich or poor, should have access to fertility care in BC. Fertility is a disease like any other.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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April 14, 2010Robitussin to the rescue?
Some remedies go in and out of fashion. Flat ginger ale for nausea, lemon & honey tea for a sore throat, beer for limp hair, vitamin E for wound healing, tea tree oil for warts, etc. They all have a plausible relationship to their believed effect and they have all been reported to help their ailment.
But did they really help or was it coincidence? That’s where science comes in. It’s the difference between anecdotal-based medicine and evidence-based medicine. Evidence-based medicine has been what has defined “good medicine” for the past 40 years; prove that a treatment is better than luck and physicians will support it.
I do my best to practice evidence-based medicine, and I know I would want evidence-based medicine practiced on me. If I had a cancer I’d like to know that the treatment I was given was tested on X number of people and found to be the best possible treatment, compared to all others.
Recently, the Globe and Mail published an article on the use of Robitussin for fertility. This is anecdotal medicine. Let me explain. About 2% of couples with infertility are infertile because of a problem with the woman’s cervix, mostly thick mucus that is “hostile” to sperm. In the 1960s and 70s physicians would perform a post-coital test to examine the mucus to see how the sperm were faring. “Hostile” mucus was thick and had few motile sperm. While interesting, it did not seem to be a very valuable test as women got pregnant on their own just as often if their mucus was “hostile” or not. So, the test was pretty much abandoned. (I still have a few patients see me with post-coital test reports from fertility clinics, mostly clinics in the developing world.)
So the test doesn’t help. What about treatments that thin the mucus making it less “hostile?” This is where Robitussin comes in… the active ingredient does a half-decent job at increasing the water content (thereby thinning) mucus in our lungs when we have a cold. This thinner mucus is easier to cough out so Robitussin’s active ingredient, guaifenesin, is an expectorant. If it works on lung/airway mucus, perhaps it works on cervical mucus? Well it probably does, but does that make you more likely to get pregnant? No. Firstly, if you are infertile there is a 98% chance that you have another explanation besides your cervix. If you are in that 2% it could help, but the science to date (I will admit it’s limited) indicates that making your cervical mucus less hostile doesn’t matter.
I believe the best place to conceive is at home in your own bedroom, so I am very supportive of treatments and strategies that can help at home. I just don’t think this is one of them.
So, what do I suggest? If there is no other explanation for your infertility and you are young (i.e. you have some time to spend trying), you might chose to try this for a month or two, understanding that what you are doing it is similar to drinking a can of flat ginger ale to settle your stomach. Sometimes your stomach feels better afterwards, but it probably would have felt better anyway.
If you are infertile, here’s hoping you find success whether it comes from modern medicine or good luck. Robitussin is in the “good luck” category.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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April 12, 2010Cupcake Girls
One of my patients owns the Cupcake stores here in Vancouver. It might seem that I am breaching our patient-physician confidentiality, but I am not. Lori Kliman has decided to share her story with the world on her new show, Cupcake Girls.
The show is on the W Network and follows Lori and her friend Heather as they run and expand their cupcakes business. The show also documents a personal side of these two entrepreneurs, and for Lori that’s infertility. During the 13-episode series her care at Genesis is featured.
I truly commend Lori for being open about her journey (the ups and downs) on TV. She is a brave woman.
You can watch the show online or on the W Network Sunday and Wednesday nights.
Enjoy!
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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March 24, 2010World's Oldest Moms
The CBC program, the Passionate Eye, has a rather interesting documentary titled “World’s Oldest Moms.”
It explores the very controversial journey of post-menopausal women (up to age 72!) to achieve a pregnancy. This is the extreme of fertility treatment in the world. In general, Canadian clinics will not help a women conceive after age 51.
It is fascinating to see just how far people and their doctors will go.
Just because we can, should we?
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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March 20, 2010Embryology
We all started out as one cell. That one cell was formed after a sperm fertilized an egg. That one cell, called a zygote, then divided and divided, and divided becoming an embryo. Then the embryo implanted into our mother’s uterus.
As infertility specialists and embryologist we spend a huge amount of time studying those first few cell divisions – watching, supporting and waiting for the right time to put embryos back into a woman’s uterus. I thought I’d outline those first few amazing days after eggs are retrieved from a woman during IVF treatment until an embryo is placed back into her uterus.
Day 0 – eggs are retrieved. The eggs are cleaned up (dead cells and blood from around them are removed) and 50,000-100,000 sperm are put into the dish with each egg. Fertilization hopefully occurs.
Day 1 – the next morning we check to see if fertilization occurs. On average, 80% of eggs will fertilize.
Day 2 – the single cell embryo will have cleaved/divided twice (once about 35 hours after fertilization and again about 45 hours later). We check the embryos in the morning, and typically each embryo is 2-4 cells. They don’t always follow the clock precisely!
Day 3 – this is the day embryos are often put back in the uterus. From day 2 to 3 they will usually have divided again and are 8 cells. Not all cells divide at the same rate, so we can see embryos with 5 to 12 cells (and more or less) on the morning of day 3.
Day 4 – if we haven’t put the embryos into the uterus on day 3, we keep watching them. This is when embryos start to become complex structures. On this day we see further division, compaction of the cells and the start of formation of a fluid cavity in the centre of the embryo. These embryos are called morulas.
Day 5 – the blastocyst day. On this day the fluid cavity is well defined, the embryos have enlarged and are now 100-200 cells in size. They are beautiful! Many patients will have blastocysts transfer into their uterus on this day.
That’s a simplified schedule of embryo development. It’s an exciting few days in our lives, and our parents lives!
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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March 12, 20103D and 4D ultrasound
I want to thank our patients for their patience this morning! We are testing a new ultrasound machine that scans ovaries in 3 dimensions (we currently scan in 2 dimensions, which is standard) to see if it can enhance our IVF follicle monitoring.
The machine arrived this morning, and I used it on a few of our morning patients. Learning a new technology takes time…. Thanks for waiting longer than usual for your scans!
Dr. Beth Taylor, MD, FRCSC
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March 10, 2010Does race affect IVF outcome?
According to a Statistics Canada report released this week, by 2031 visible minorities will be the majority in Vancouver. What does this mean for fertility care?
Differences in reproductive outcomes across racial groups have been reported. It is controversial, however, just how significant the differences are and how to apply studies of racial differences to our patients. We have mixed race couples, mixed race patients, and patients who have lived for variable amounts of time in Canada (e.g. some just arrived from another country this year while others’ families have lived in Canada for generations). No studies to date have examined these categories of patients; instead, we have information on women whose race can be “accurately” categorized.
What do we know about the influence of race on IVF outcome?
Black women have lower pregnancy rates from IVF compared to white women. Hispanic women have similar IVF pregnancy rates as white women but have higher miscarriage rates. Asian women have lower pregnancy rates than white women but higher than black women.
Once pregnant, black and Hispanic women are more likely to deliver preterm. White and Asian women have the same risk of a preterm delivery.
There are many possible reasons: differences in obesity rates, causes of infertility, socioeconomic status, environmental exposures, and behavioural factors.
At Genesis we adjust treatment protocols based on many patient factors. Going forward we look for trends in IVF outcomes of different racial groups to continue to try to optimize pregnancy rates.
Click here to read more about race and reproduction.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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February 23, 2010Thyroid 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, 2010Home-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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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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November 12, 2009Making eggs and sperm
In the National Post last week, there was an story titled “Scientists make cells that form eggs, sperm in lab.” Like so many medical headlines, it sounds much more promising and simple than the reality. Nevertheless, researchers out of the UK were able to make germ cell precursors (the cells from which eggs and sperm arise) out of embryonic stem cells.
You can read the full article in the National Post.
What’s important is that we are inching closer to understanding how eggs and sperm are produced in humans. This understanding can help us determine why some people don’t produce adequate numbers of eggs or sperm to be fertile, or why some people produce poor quality eggs or sperm which can also render them infertile. After that, then we can hopefully treat the underlying problem and help infertile couples. We are years away from such treatments, but it’s exciting to see progress being made in the right direction.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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November 10, 2009Science of Twins
This weekend (Nov 14-15th) Science World is having a program called “Seeing Double.” It’s about the science of twinning. From what I can gather, it’s about identical twins – and most twins created from assisted reproduction are fraternal (not identical genetically) – but it still might be interesting to attend. Twins get in free!
For more information see Science World Events & Programs.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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October 19, 2009DHA and pregnancy
Once we help a couple get pregnant one of the most common question I get asked is “what supplements should I take?” Seems there’s lots of advice given out at health food stores, pharmacies and by our friends about all sorts of things like raspberry tea, coenzyme Q10, fish oil, ginger, vitamin B6, etc.
What have large studies of women in the developed world shown that pregnant woman should be taking? A multivitamin containing folic acid (0.4mg to 1.0mg unless you are in a high risk group for a neural tube defect) and perhaps DHA. That’s it. We need iodine to prevent thyroid disease in the newborn but we get enough in our salt in Canada. So, if you have a reasonable diet and take a multivitamin with folic acid (the best studied are Materna and Pregvit) and perhaps some DHA you are doing everything right from a evidence-based nutrition perspective.
Sure, some people swear you should take extra B6 or a miriad of different herbs, but until a big studies suggests there is a benefit, and most importantly no harm, I’d stick with the basics. DHA is an interesting one…. there is some evidence that it helps with an infant’s gross motor control and visual acuity if taken in pregnancy. When to take it and how much isn’t clear. So, what do I take (I am 38 weeks pregnant now)? I take a DHA supplement daily that has been purified from fish oil (NOT fish oil as many preparations have too much vitamin A) that has 900mg of DHA and 180mg of EPA. The Institute of Medicine in the USA recommends 300mg/day while a similar European regulatory body suggests much more. So I take somewhere between the two. When to take it? Probably the last half of pregnancy – that’s when it’s been most widely studied.
I hope this helps… and if you are reading this I hope you have to decide on what supplements to take in pregnancy soon!
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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October 12, 2009NY Times Debate
Today in the NY Times there is a debate on the issue of multiple births, their risks and whether the number of embryos transferred during IVF in the USA should be regulated and how.
It’s interesting as they have infertility doctors (REIs), ethicists, high risk pregnancy specialists and a lawyer weighing in. No patients, though which I consider an mistake.
Otherwise I think it’s excellent. Check it out by clicking here.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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October 6, 2009Bisphenol-A and sperm
Driving to work today I was listening to CBC radio one. The host was interviewing a professor at SFU who authored a study that observed an association with high bisphenol-A (BPA) exposure in pregnancy and hyperactivity in girls at 2 years of age. BPA is used as a stabilizer in many plastics and we are exposed mostly from food (as it leeches from packaging) and drinking water (that comes through plastic pipes or from water bottles).
BPA is apparently be found in the urine of many of us (95% in a random sample according to a 2005 study), in our amniotic fluid, and breast milk. It’s everywhere and is described as the most ubiquitous environmental hormone disruptor in humans.
BPA has been linked to lots of terrible things like breast cancer, brain tumors in children, testicular cancer, etc. I think many of us have become worried about how much BPA we might be consuming since these links started to be reported in 2006. Most recently I returned by SIGG bottle when I found out the liner contains BPA. Are we over reacting? Who knows, but as a consumer I feel fairly helpless in determining what the real risk of BPA exposure is, I am losing faith in Health Canada’s ability to provide timely guidance about the risk and I am skeptical of many media reports as I believe corporations can manipulate the messages we receive about products.
What I do look to for answers is studies that come out of universities or reputable institutions. So, I did a little literature search looking as the issue of BPA exposure and sperm count. Most people are aware that over the past 60 years sperm counts have been declining. Could it be that an estrogen-mimicking compound like BPA is contributing?
There have been just over 40 studies published and all in non-humans: carp, trout, mice, rats. There does seem to be an association between exposure both as a fetus and after birth between decreased sperm count and BPA exposure. Also observed is an increase in prostate size, a decrease in testicle size, and abnormalities of the urethra. So at least in these animals BPA exposure might have a negative effect on their fertility.
It will likely take a generation and years of study for any definitive conclusions to be drawn about human male fertility and BPA exposure. Indeed it might be concluded that there is no connection. Who knows? Common sense would suggest that avoiding foreign chemicals that can mimic hormones that affect our health is probably a good idea. So, I’d suggest men (all of us really) minimize their exposure to BPA just in case… no time to wait for the definitive human study to be performed.
My 2 cents.
Dr. Beth Taylor MD, FRCSC
Reproductive Endocrinology & Infertility
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September 23, 2009Infertility Brochure
The government agency Assisted Human Reproduction Canada is working on several information brochures for people navigating infertility and it’s treatments. I am on the editorial committee and one of brochures we are currently working on contains basic infertility information, like it’s definition, incidence and causes.
What strikes me is that people who work in fertility might not actually know everything that the public needs/wants to know. Like an automechanic who assumes everyone can change their own oil so doesn’t explain it well.
What would you like to see in such a brochure? There are many other brochures the committee is working on, like genetic testing, donor egg, donor sperm. I’d like to get a sense of what people actually want to learn, not just what I (and committee members) think people should learn.
Drop me an email at btaylor@genesis-fertility.com if you would like to offer suggestions for the brochure, or have any other thoughts on what the misconceptions are about infertility and it’s treatment.
Thank you!
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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September 6, 2009Pregnant at a Fertility Clinic
When you are struggling to get pregnant it seems everyone around you is pregnant or pushing a baby stroller. Friends volunteer their conception story hoping to help but it often makes you feel worse. Stories like “we weren’t even trying,” or “I’m so fertile I got pregnant on the pill,” or “if I even look at my husband I get pregnant.” It’s hard. At least at a fertility clinic nearly everyone is either struggling like you or is pretty sensitive to your cause because they work here.
Currently at Genesis we have 4 pregnant staff and I am one of them. I’m not sure how my patients feel about seeing a pregnant fertility doctor but I’m guessing for some it’s not easy. My due date is in early November so it’s just been the past few weeks that my pregnancy has been obvious. A couple of our nurses are a little farther along in their pregnancy, so for the next couple of months when you come to Genesis you’ll likely see a pregnant woman…. we know that can bring up mixed feelings.
Interestingly, most of us didn’t get pregnant easily. We’ve all taken a path to get there – some of us needed surgery, some needed IVF, some needed clomiphene, some needed a combination. On some cosmic level I wonder if we ended up working at a fertility clinic because we had our own fertility issues?
So take heart that we empathize with your struggle and truly do appreciate that’s not easy to see a pregnant belly when you would really like one of your own. We’ll work hard to give you one!
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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August 27, 2009Ontario to fund IVF?
There is a buzz around the clinic. Is Ontario going to fund IVF? Will BC follow?
In 2008 the Government of Ontario appointed an expert panel on fertility and adoption in Ontario. Their report was released this week and it recommends significantly expanded government support for fertility and adoption services. Having just finished reading it I’m struck by how accurate they have assessed the barriers to fertility treatment that exist in Ontario (and most other provinces). Barriers like cost, lack of information, work constraints, and the negative stigma of infertility prevent countless couples from building the families they desire.
The panel’s recommendations, if implemented, would go along way to ensure more people can build their families and would certainly put Ontario at the forefront of public fertility policy in North America. Some highlighted recommendations:
The Government of Ontario should fund up to three IVF cycles for women ages 41 + 12 months and younger.
The Government of Ontario should fund frozen embryo transfers and up to 4 cycles if intrauterine insemination for women ages 41 + 12 months and younger.
The Government of Ontario should introduce a 50% refundable tax credit up to $20,000 to offset the cost of fertility medications.
The Government of Ontario should fund the mandatory counseling required under the Assisted Human Reproduction Act (e.g. donor egg, surrogacy, donor sperm).
The report also supports the creation of an altruistic province-wide sperm, egg and embryo bank. It supports ensuring that fertility doctors are adequately trained, that clinics are accredited (we are already by a few governing bodies) and that work places provide personal emergency leave for employees undergoing fertility treatments.
There are many more recommendations all of which support couples and individuals hoping to grow their families either through adoption or fertility treatments. This is a really important report. The next step is for the government to act on the panel’s recommendations. I am skeptical because of the dismal history of government support for fertility services in Canada, but this is a positive step.
If Ontario leads will other provinces follow? We’ll keep pushing in BC.
The full report is available at www.ontario.ca/creatingfamilies.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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August 18, 2009The Olympics & Genesis
At Genesis we are trying to figure out how to manage the clinic during the 2010 Olympic Games in about six months. Although it will be a bit of a challenge, we are determined not to close and, of course, not to compromise patient care.
Closing is a huge inconvenience for our patients. We know this because every year we close at Christmas to give our staff holidays, perform necessary maintenance, and to update the laboratory with new technology. Because of the nature of fertility treatments, this blip of a closure ends up affecting a lot of patients. Believe it or not, I am already discussing the Christmas closure with patients in the office because it may impact when they decide to start a cycle of IVF or even IUI. We realize the inconvenience BUT the Christmas closure is a necessity that maintains our excellence in the field. A closure during the Olympics, however, would have nothing to do with maintenance and excellence so we will not close.
Staying open during the Olympics will require some significant planning on our part. One of the issues is making sure that patients and staff can get the clinic. We have checked the roads and things should be just fine for most people. It may involve weaving around the back roads, but getting to the clinic and getting access to the parking lot should work out.
We toyed with the idea of being open extra early or extra late during the Games but haven’t settled on either. We had thought about providing more care out at our Surrey office but again, that plan is just in the works now. We certainly are thinking about it. We are also currently handing out a survey to our patients hoping to get some advice and suggestions as to how to make the clinic function well for them during the Olympics- hey, we are in this together!
When I initially thought about Vancouver winning the right to host the Games I really had no idea how it could impact people’s access to medical care. Although it will offer challenges, we are determined to provide continued excellence in fertility care to our patients right through the Olympic Games.
(As a side note, we are pleased to have Dr.Taylor and Dr.Fluker as official Gynecologists for the 2010 Olympic Games.)
Dr. Jason Hitkari, MD, FRCSC
Reproductive Endocrinology & Infertility
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August 7, 2009Eliminating Disease
Eliminating disease… that’s a lofty goal. There are a few diseases we can potentially eliminate in families, though, using an IVF technology called Preimplantation Genetic Diagnosis (PGD). Huntington’s Disease is an example. At an international Huntington’s Disease Research meeting this year we are presenting our experience (one of the largest in Canada) in using PGD to eliminate Huntington’s Disease from families.
PGD involves a couple with a known genetic disease going through IVF to create embryos. Embryos are made up of cells and we remove one of the embryo’s cells and test for the defective gene, e.g. that causes Huntington’s Disease. If the embryo does NOT have the gene we put it back into the women’s uterus. If she conceives from the embryo placement the child will not have that genetic disease.
You can imagine how significant this is for families who suffer with a terrible disease they they risk passing on to their children. They can undergo PGD and if they conceive remove that disease from their family.
So far PGD works only for diseases caused by a single abnormal gene. Diseases like diabetes, autism, heart disease, etc. are thought to be caused by many genes interacting with the environment so, for now, PGD can’t eliminate those diseases from families. One day I believe they will… one day.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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August 1, 2009Happy Pride!
It’s Gay Pride weekend in Vancouver. Well, at a fertility clinic we really don’t have a big party this weekend but we do stop and think about all the families – gay or straight – we’ve helped to create. We were the first clinic in BC, indeed western Canada, to help gay couples conceive. Since we opened our doors 14 years ago we’ve helped lots of gay couples have children. Mostly we help lesbians as we just don’t get many requests from gay male couples as the process is much more complicated because they require a someone to donate use of their uterus and eggs. Sometimes both the uterus and eggs come from the same woman and sometimes it comes from two separate women. Plus Health Canada requires the gay partner whose sperm we are using to have it quarantined in a lab in Toronto for 6 months before we can use it. So, it’s not an simple process but it’s doable.
Helping lesbians is less complex as sperm is easier to obtain. We get it from a few different (reputable!) sperm banks. After the lesbian couple has some basic fertility testing and a counseling session we get going – putting sperm into the uterus (insemination) at the time of ovulation. For more info click here.
To all those families we’ve helped grow we hope you enjoy the weekend with your little ones a foot. For those we haven’t helped… come on over!
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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July 28, 2009Child-free
August 3rd MacLean’s Magazine’s cover story is titled “No Kids, No Grief.” It examines the societal shift in attitude toward childlessness. Childlessness, now called “child-free,” has been stigmatized by western society as a word conveying void or handicap, in the author’s words. The article examines the reasons some people choose not to have children – financial, biologic, lifestyle, etc.
It seems that Canadian women are choosing not to have children more often. Ok, not that much more often, but since 1982 the number who choose to be child-free rose from 4.9% to 6.2% in 2002. Why? Are people just more comfortable admitting that they don’t want the work, stress or physical demands of having a child or are they listening to their own impulses to have children or not. There is some evidence that this impulse to procreate is genetic – not everyone is programmed to want children.
The article falls short in addressing fertility as a reason that couples are child-free. This is why I never ask people socially if they plan to have children or why they haven’t had children yet. Some people who are child-free will say they have chosen to be child-free but are infertile – the article forgets about this group.
This seems like a funny blog topic on an infertility clinic’s website, after all most people seek treatment at Genesis because they want children. I do observe that not all couples who see me are equally as motivated to have children – adopted or biologic. Some say they just want to know if they could conceive naturally, some say they would stop at fertility pills or insemination, some want to try all possible treatments. Perhaps there is genetic variation in how strong people’s impulses to conceive are, or perhaps there is just discomfort in the nature of fertility treatments.
It’s complex. It’s interesting. I’d just like to be apart of helping couples come to find whatever version of family feels right for them. As fertility doctors we are pretty good, but not perfect, at helping couples get pregnant, we no doubt could be better at helping them explore their impulses, motivations and dreams around living life with children or without.
To read some of the article and the comment stream it has generated click here.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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July 16, 2009Tubal Ligation Regret
Most of the time I am helping infertile couples conceive, but I also help fertile women who have had their tubes tied and later regret it. About 7% of women who have their tubes tied (i.e., tubal ligation) will wish they hadn’t tied them. The typical patient is a woman who had children with an ex-husband and had her tubes tied during that relationship thinking she was done having children. Then that relationship ends and the woman meets a new man and decides to have children with him.
Women who have had their tubes tied can either do IVF or have a surgical procedure to reverse the tubal ligation (aka tubal ligation reversal or tubal reanastomosis). I do this surgery for Genesis patients and it’s perhaps one of the most enjoyable surgeries I do. It’s enjoyable because I get to sit down, use a microscope and slowly and carefully sew tubes back together. I come from a long line of women who sew, knit and crochet so I guess I am just carrying on the family tradition in some way!
How likely is it that a woman will conceive after this surgery? Like everything the answer is “it depends.” Mostly it depends on the age of the woman, length and health of the tubes I am sewing, and the quality of her partner’s sperm. Rough pregnancy rates are: 70% for women < 36, 60% for women 36-40, 50% for women 40-43 and 10% for women > 43.
The surgery involves a ~8cm cut in the abdomen – similar to a c-section cut. Some centres in the world do it laparoscopically (i.e. through 4-5 tiny cuts in the abdomen) but it takes much, much longer and there isn’t any evidence that pregnancy rates are higher and some argue they are lower.
Unfortunately the provincial health plan will not pay for tubal ligation reversal and the total cost (which covers all hospital fees, and anesthetisia, nursing, surgeon and assistant costs) is $4500 and I perform them at BC Women’s Hospital here in Vancouver.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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July 13, 2009Stem Cells And Sperm
Fertility is in the media spot light more and more these last few years. Most recently, an article published in Stem Cells and Development started a small media frenzy that even had me roped in. The story was that a group of researchers in the UK had reported that they had found a way of converting embryonic stem cells into sperm.
Some of you might have seen me interviewed on CTV about this research. The media was looking for a local fertility expert’s opinion and I was glad to have the chance to give a perspective on what this research means for men with sperm issues-now.
Some people wonder whether all this work will eventually make men obsolete! Well, we are quite a few years away from this technology being useful in that regard. First of all, the sperm that were made have not been used to make a human being. Also, it appears that the male Y chromosome is still critical to sperm development as stem cells from “female” embryos weren’t able to be converted to sperm.
So while this research is very interesting it is still in the early stages. In summary, what the researchers did was take an egg and a sperm and make an embryo in the laboratory – something we do here every day at Genesis. They then took that embryo and divided out the stem cells. Stem cells are cells that have not decided what they want to “be” yet and they therefore, are not committed to being a muscle or bone or sperm cell. They then cultured these embryos in the laboratory and in the right environment were able to turn these cells into sperm.
There are a couple of problems with this, though. Notice that they needed a sperm to MAKE the embryo in the first place. What would be more interesting is if they took a stem cell from an adult male who doesn’t make sperm for some reason and turn one of his stem cells into sperm – now that would have more applications in the clinic! Stem cells from adults like you and me are very different than embryonic stem cells and so this research isn’t easily transferable to adults who want to reproduce.
The second issue is that there is some debate as to whether the sperm that we made are actually “sperm”. The cells look like sperm in that they have a tail and move and they have some “markers” of sperm but they haven’t been used to make an embryo yet.
It is clear that a lot of people are uncomfortable with some of the ethical issues that arise with this type of work. Some people are upset that embryos and stem cells are being used for research at all. It is important to realize that reproductive technologies in Canada are regulated by the Assisted Human Reproduction Agency located here in Vancouver. The agency’s mandate it to ensure that the regulations included in the Assisted Human Reproduction Act are being adhered to. Practically, that means that although this research may shed light into how sperm is made, it would not be legal to use such derived sperm to make a human being.
Dr. Jason Hitkari, MD, FRCSC
Reproductive Endocrinology & Infertility
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July 7, 2009Is daily intercourse best?
Since the Globe and Mail ran an article last weekend referencing a recent study that suggested daily ejaculation improves sperm quality I’ve been getting lots of questions from my patients.
Most infertility doctors recommend that couples have intercourse every second day to optimize fertility. This is because daily ejaculation/intercourse can reduce semen volume and sperm count. So, if you have intercourse for 3-4 days leading up to the day of egg release (ovulation), by the time ovulation occurs the count might be too low to be adequate for egg fertilization.
At the European Society for Human Reproduction (ESHRE) meeting in Amsterdam two weeks ago a study was reported that suggested men who have intercourse/ejaculate daily for seven days had less DNA damaged after the 7 days. DNA damage was measured as a percentage of DNA fragmentation (less fragmentation is good). The Australian authors of this study found that 81% of men had a lower percentage of DNA fragmentation after daily ejaculation for 7 days.
Does this mean more pregnancies? We don’t know, and further research is required but some previous studies have shown the relationship between sperm DNA fragmentation and pregnancy rates. So, it’s certainly possible.
Now, the study did find a reduction in semen volume and sperm concentration after 7 days of ejaculation which is a concern for men who have low or borderline semen volumes or sperm counts.
So, what do I recommend in light of this research? Men with normal sperm parameters should try to have intercourse daily for up to a week before the ovulation date. Those with abnormal semen volumes or sperm counts to start should continue with every second day intercourse, if appropriate. My advice is different for each couple, but these are my general guidelines.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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June 28, 2009How much folic acid?
How much folic acid should I be taking when I am trying to get pregnant or pregnant? This is a really common question and the answer is pretty straightforward.
MOST women should take a multivitamin with 0.4mg to 1.0mg of folic acid daily for 2-3 months before they conceive and throughout pregnancy. Taking folic acid alone is not enough – it should be folic acid in a multivitamin. Folic acid along reduces the risk of neural tube defects (NTDs), but folic acid and a multivitamin reduces other defects like heart defects, urinary tract abnormalities, limb defects and pyloric stenosis (a narrowing of a segment of the stomach).
SOME women should take more folic acid. These women are diabetics, epileptics, obese women (BMI >35 kg/m2), women with a family history of neural tube defect, and women belonging to a high-risk ethnic group (e.g., Sikh). These women should take 5mg of folic acid total. So if they are taking a multivitamin with 1mg of folic acid in it, they need to take an additional 4mg daily. To get your 5mg of folic acid you can buy a bottle of 1mg tablets of folic acid (and take 4 of them along with your multivitamin) or get a prescription for something called Pregvit Folic 5 – it’s a multivitamin with 5mg of folic acid in it.
What’s the harm in taking more? There is probably no harm. Excess folic acid in your body is removed in your urine. There’s lots of controversy about whether there is a risk or benefit of extra folic acid in people who don’t need extra. One day perhaps we’ll be advising all women to take 5mg of folic acid daily. Until then I’d just suggest following the guidelines above, which for most women means just taking a multivitamin that has 0.4mg to 5mg of folic acid in it daily. The most common vitamin women take is called Materna – you can buy it over the counter at any pharmacy.
Please don’t take too many vitamins in pregnancy – remember too much of a good thing can be bad. A great example is vitamin A – too much can cause blindness in a fetus. So, more isn’t always better. Just take a multivitamin like Materna daily and you are doing the best thing for your pregnancy.
For more info:
Society of Obstetrics & Gynecology Guidelines
Motherisk
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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June 22, 2009Picking gender
I get asked quite often if we can select a male or female embryo in IVF. In the interest of balancing sex in families or for cultural reasons there is a desire by many couples not just to get pregnant but to get pregnant with a child of a certain sex.
In Canada, since the Assisted Human Reproduction Act was passed by federal parliament in 2004 we cannot select sex, so the conversation about sex selection is generally a brief one!
In the USA most states do not have a similar law so sex selection can be done at many fertility clinics. It’s certainly very controversial but I cannot deny that couples can feel tremendous pressure to have children of a certain sex, for themselves or to please their relatives. In 2009 in Canada I would hope these pressures didn’t exist but they do. Honestly, I am happy that we cannot select sex as it takes the option away from us.
There is one situation in which we will select sex. If a couple carries a serious genetic disease that affects one sex and not another we will perform preimplantation genetic diagnosis or PGD and select the healthy sex. This is an expensive and complicated process (about $16,000!).
Selecting sex, for whatever reason, really isn’t that easy. Some clinics will try to wash away (typically) female sperm to leave the faster swimming male sperm for insemination. This works, at best, 80% of the time. The only real way to select gender with ~100% certainty is by the process of PGD – where a cell of an embryo is biopsied and then tested for it’s genetic complement: XX vs. XY. Then the embryo of the desired sex is put in to a woman’s uterus.
So, for most Canadian’s seeking fertility treatment they will have a child whose gender is a random act of nature: 50% female 50% male is about as good as we can guarantee.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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June 12, 2009Changes to the Age for an Amnio
Recently, there have been significant changes in the choices patients have for prenatal screening here in BC. When women are pregnant, we are always worried about identifying abnormalities in the fetus early so that we can provide women with choices and information about the pregnancy. One of the largest concerns that women have is the concern about the risk of having a baby affected with Down Syndrome.
Over the years, there have been many changes to the guidelines as to what is available in terms of testing for chromosome abnormalities (usually Down Syndrome) in their fetus. For example, it used to be that women over the age of 35 at the time of delivery had access to an amniocentesis if they wanted this. An amnio, unlike blood tests and ultrasounds, will give a woman a definitive answer about whether her baby has Down Syndrome. This sounds really appealing – why not get a definitive answer when you can?? The problem is that amniocentesis has some risk associated with it, albeit small, that includes the risk of losing the whole pregnancy.
Because of this risk of amnio, doctors and researchers have tried to find blood markers and ultrasound markers that may indicate that a baby is at increased risk of being affected with Down Syndrome. It is not as “good” as an amnio but remember that blood tests and ultrasounds have no risks. Over the years, we have been able to refine the blood tests and ultrasound indicators to a point where we are getting really very good at finding babies at risk of having Down Syndrome and sending ONLY those patients for an amnio.
So, as it stands now with the new changes, it is only women who are 40 years of age or over who can get an amnio on demand here in BC. Women under 40 have access to blood tests publically and nuchal translucency scanning privately (including here at Genesis) as their first round of tests. If the first round of tests comes back worrisome, it is only THEN that women under 40 can get an amnio done.
I think that these changes are good because it means that, as a province, we will be doing fewer unnecessary amnios which is safer. It does mean that some a woman may be unhappy because she won’t be able to get an amnio now when she may have qualified in the past. I think that once women understand that there are tests that can be done BEFORE to help see if an amnio is needed, that might ease some of the tension.
Dr.Hitkari, MD, FRCSC
Reproductive Endocrinology & Infertility
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June 6, 2009Body weight and fertility
It seems that from the time of puberty most women think about their weight. Nearly all of my girlfriends are trying to lose at least 5 lbs. Statistically more and more of us are overweight or obese. There is a long list of reasons to maintain a normal body weight and fertility is on that list.
When we talk about weight, the easiest way to compare women is by BMI – a function of your height and weight (weight/height x height). To calculate your BMI click here.
A normal BMI is between 18 and 24 kg/m2. From 25-30 kg/m2 you are considered overweight and about 30 kg/m2 you are considered obese.
A large US study indicated that women whose BMI is > 24 kg/m2 took longer to conceive and were more likely to miscarry. Several other studies have observed that if an overweight or obese woman does conceive she is also at higher risk to have high blood pressure, diabetes, premature labor, need a c-section, stillbirth, neonatal death, and postpartum complications like infections than women who are of a normal BMI.
To add to the bad news fertility treatments like IVF don’t work as well in women who are overweight or obese. Pregnancy rates with IVF are lower and miscarriage rates are higher. It seems that the number of embryos and their quality is not affected by obesity but the implantation (embryo sticking) rate is much lower. In a recent large study (> 6000 women) the live birth rate for women of normal BMI was 31%, 29% for overweight women and 24% for obese women. To read this study click here.
So, keep yourself in a normal BMI range for optimal fertility and treatment success.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 30, 2009Marijuana and fertility
From time to time I get asked whether men should stop smoking marijuana to improve their fertility. Answer: yes. Marijuana reduces sperm count, how well sperm swim (motility) and their shape (morphology). A study published this month looked at sperm respiration or oxygen use and demonstrated that the two main active cannabinoids of the marijuana plant, D9- and D8-tetrahydrocannabinoid (THC), are potent inhibitors of oxygen consumption in human sperm. This might influence the ability of the sperm to fertilize and egg, or affect fertility in some other unknown way.
The good news is that the negative effects of marijuana on sperm don’t seem to be permanent (more studies are needed to answer this definitively, though). Once you stop using marijuana new sperm that are made will not be exposed the THC and therefore should be of better quality and number. It takes about 3 months for a new “batch” of sperm to be completely formed. So, if you have been using marijuana it will take about 3 months for beneficial effect of stopping it to be seen.
It’s pretty clear marijuana isn’t good for male fertility. Your instincts probably already told you this, huh?
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 26, 2009The Two Week Wait
Your final procedure is complete: Whether you have been trying to conceive at home, with intrauterine insemination or with an embryo transfer, the proactive part of achieving a pregnancy is over and the long wait to the pregnancy test begins.
Fertilization occurs approximately two days after the start of your ovulation process. The resulting embryo will take about five to six days to be gently propelled along the fallopian tube and become embedded in the lining of the uterus. If you have had an IVF then the embryo is transferred directly into the uterus.three to five days after fertilization. Approximately six days after fertilization, no matter which process, an embryo, due to continual cell multiplication, will “hatch” out if it’s protective covering and under ideal circumstances, start implanting (growing) into the lining of the uterine wall.
There are several factors that determine whether or not your hatched embryo will be accepted into your uterine lining. Some of these factors like ensuring a sufficiently thickened lining, selecting one or two of the better quality embryos can be controlled by your physician if you are having IVF. Other factors are completely out of your or your physician’s control.
At the end of the day the ‘genetically perfect’ embryo will result in a normal healthy baby for you. Laboratory Scientist’s have sophisticated means of evaluating embryos under their microscope, but they are still not able to look into the full genetic structure of your embryos before transfer. Not all human embryos are perfect. For that reason when conceiving naturally you have no more than a 20-25% success rate in that month of trying and even this figure is affected by many other factors such as female age which could bring the chance much lower.. The success rates are higher where there is medical intervention such as intrauterine insemination or invitro fertilization but the rate will never be 100%.
It is therefore important to prepare yourself sufficiently to help manage this waiting period and cope with the pregnancy outcome. It is important that you are aware of t the pregnancy and live birth success rates that specifically apply to your age group before starting fertility treatment. It is important to realize that the pregnancy hormone begins to be released into your blood stream 8 days after the start of your ovulation process, so it will take the full two weeks after fertilization before a pregnancy test can accurately pick up the pregnancy hormone in the blood or urine test.
Pregnant woman are considered healthy women and therefore you can continue your normal activities within moderation. Sometimes it helps to keep relatively busy to keep you mind off the impending pregnancy test result. You probably will be experiencing inner conflicts as you desperately want to be pregnant, but during this stage you have no control whatsoever over the outcome. No control and not knowing the outcome creates frustration and stress which is compounded by you coping with the side effects of elevated hormone levels. It is difficult to ‘appear and behave normally’, to all those around you.
During this time negative thoughts that go through your head will not change the outcome of whether you are pregnant or not. The decision has already been made by nature. It might help you to think about that outcome a few days before the test. Do a little “what if” thinking, in the event of a negative test. You might like to have a break, a holiday or research a little more about moving onto alternate fertility promoting procedures. . Clinical Psychologists or counselors, experienced in the field of fertility, can often help you cope during this period. The negative outcome will always be devastating. Allow yourself time to morn the loss before you move on to the next steps you have contemplated.
Biddy Collings BA, RN
Nursing Department
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May 19, 2009Covering the cost of IVF
On Mother’s Day about 200 women pushing empty strollers protested on the Ontario provincial legislature building demanding funding for IVF. Protests demanding attention or funding of fertility treatments are always small – the voice of infertile couples is soft for many reasons. Infertility is still rarely disclosed to family and friends, let alone to the public. So, unlike diseases like breast cancer, couples suffer in silence. Couples scrape together enough money for fertility treatments and quietly live their lives, with or without children.
I wish things were different. We are seeing some progress though. Quebec has announced it will fund 3 IVF cycles for couples. This is the only province in Canada who has made such a committment. As Genesis we try out best to advocate for provincial funding but it’s an uphill battle. Ethicists argue that being a parent is not a right and that when health resources are limited fertility treatments should not be covered. I would suggest that we need not debate whether a person has the right to be a parent. I believe that couples should have the right to access widely available, effective medical treatments that can treat a defined illness, that illness is infertility with all it’s causes.
Not everyone agrees but not everyone has to see of patients every day who are denied the ability to have a biological child for financial reasons.
To read more about the Mother’s Day protest please read:
http://www.thestar.com/article/629535
This is infertility awareness week. Hopefully this week, and other, people and governments will notice our cause. I have some patients who are willing to speak up. On the CBC National this Wednesday one of them will bravely tell her story. I know not everyone is willing or interested speaking out, but if you are please do so knowing their are thousands of couples who thank you!
One day hopefully we’ll see fertility treatments covered by all provincial health plans. Here’s hoping that day comes soon!
I’ll step off the soap box now…
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 17, 2009CTV Interview
As mentioned in a previous blog, one of the things that Genesis is known for is our work in the area of elective single embryo transfer (eSET). The idea behind eSET is that there are women whose embryos are terrific and whose chance of getting pregnant by putting back a single embryo during IVF is almost as good as putting back two embryos. Why this is so great is that by putting back one embryo, the chance of having twins drops significantly from around 30% to <1%.
I know that many of my patients actually come to see me overtly or secretly wanting twins. My role is to make sure that my patients are informed about the risks of having a multiple gestation and also to discuss with them the option of putting a single embryo back if it is appropriate.
eSET is such an important advancement in infertility that CTV was very interested in covering the story in conjunction with IAAC’s Infertility Awareness Week (which starts next week). The story will be on the Dr.Rhonda Low section of the Wednesday, May 20th news broadcast. The crew from CTV came out to Genesis last week to film some footage with me and our lab staff talking about the pertinent issues around eSET.
The CTV crew came into the clinic on Wednesday and set up the camera in our andrology lab. I think that I was a little stiff but I hope that I got the information I wanted to out – I hope that the editing is generous to me! It was fun to do the “background” shot as well as it involved me and our andrologists looking and acting rather serious. It was a little nerve wracking to be filmed but it was worth it as I think that increasing the public’s knowledge of eSET and the choice women have to increase the likelihood of a healthy term pregnancy by reducing multiples.
I have always believed that women should be fully informed about their fertility choices and I spend a lot of time educating my patients and the public about fertility. In this vein, as part of infertility awareness week, I am participating in a forum called “Taking Charge of Your Fertility, this Wednesday, May 20th. The details can be seen in our “Events” section here on the website. Hope to see some of you there!
Dr. Jason Hitkari, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 16, 2009Brain development and IVF
Almost everyday a couple asks me whether IVF or ICSI create abnormal children. Of course infertile couples want to conceive, but they also want a healthy, “normal” baby.
While there remains controversy with ICSI, in general IVF and ICSI produce normal babies just like babies conceived naturally. A recent study reviewed all published reports on the brain development of children born from IVF and ICSI as compared to naturally conceived children. They asked the very question couples as me, “does IVF and/or ICSI negatively affect the human brain?”
Fifty nine studied were reviewed. Over 40000 children conceived with IVF or ICSI were studied from birth for as long as 20 years (though most were studied in infancy). They examined children for neurodevelopment, cognition, behaviour and speech/language problems. The good news is that IVF and ICSI conceived children were no different than children conceived naturally.
This is certainly very reassuring. This kind of rigiour research can help reassure doctors, scientist and patients that they are giving couples their best chance of having a healthy, neurologically normal baby.
To read the full paper click here.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 16, 2009At the end of the day
At the end of a day, one of the things that we doctors at Genesis like to do is to sit down together and talk about the day. We talk about difficult cases and great success stories and everything in between. It is a great opportunity to bounce ideas off each other. Often, someone will have read a medical article that he or she feels should be shared and discussed. We also talk about cases from the past that may shed more light on what is going on with a particular patient now.
These kinds of informal discussions are really important for both us and our patients. For our patients, this kind of communication makes sure that all heads are being put together to try to optimize their care and treatment cycle. For us, it allows for a forum of discussion and keeps the work interesting and challenging.
As our computer software improves, what we are finding is that it gets easier and easier to access patient information quickly. What we docs have been doing at the end of the day lately is reviewing the pregnancy test results that have come in that day. It is tremendously exciting to see a positive pregnancy test result in patients but it is also very important to know whose result was negative.
Being a fertility doctor is incredibly satisfying work for many reasons – most of which is helping our patients with their fertility journey. Some patients get pregnant relatively easily and they are thrilled, sending cards and thank-you’s with pictures of their new babies. Many patients struggle and get frustrated and angry with their journey. Believe me, we get frustrated too. Sometimes we have no answers or we have found problems that are insurmountable. These can be frustrating conversations but they are conversations that must be had.
It is in these little meetings at the end of the day that we docs can talk about our patients and spend some time reflecting on the work that we do and the things we have yet to know.
Dr. Jason Hitkari, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 7, 2009Success of IVF
The best part of my job is when a couple gets pregnant. The worst part is when they don’t. Fortunately most patients, at least those less than 40 years old, do get pregnant with fertility treatment. I think all fertility doctors wish they had a crystal ball to be able to know who will conceive, who won’t conceive, and how many treatments a couple might need in order to conceive.
Will you conceive in your first IVF cycle? Will it take 2, 3, 4, never? Our years of training, experience and dialogue with colleagues help us to a great extent but there are still unknowns in infertility care. Why do couples who have tried to conceive for many years get pregnant as soon as their adopted child arrives home? Why do couples do IVF, not conceive and then conceive on their own 4 months later? Why does a healthy young couple with perfect embryos not get pregnant when they are put back into the woman? Why can a “perfect” egg and perfect make an abnormal embryo? The list is long…
At Genesis we are always asking questions and trying to find answers. We do more research than most IVF clinics. It’s still not enough, we still have lots of questions to answer. That’s what makes the field of fertility so exciting, but also what brings frustration. We don’t have all the answers but we try. Does anyone have a crystal ball?
My thoughts for the day.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 4, 2009HIV and us
I was recently asked to be a part of a committee whose goal is to develop pregnancy guidelines for people living with HIV/AIDS. The reason why a few of us fertility doctors were asked to participate is because these guidelines are also going to outline how patients with HIV can or should get access to fertility services and they wanted our advice about this.
With current treatments, people who are HIV positive are living much longer and healthier lives. Also, with current obstetric practices in Canada, the chance of a baby of an HIV positive mother having the disease after birth is extremely small. So people are looking to start families and they want not only information, but in some cases they want access to fertility treatments.
Some people may wonder why fertility clinics are needed since patients with HIV aren’t necessarily having trouble conceiving. The issue is that for a heterosexual couple where one partner is HIV positive and the other is negative, it is possible for the virus to be transmitted during intercourse. An option for this couple then is to do artificial inseminations with washed sperm as reduces the chance of transmission. It is thought that the “safest” way to prevent transmission to the partner is actually to do an IVF cycle with ICSI (intracytoplasmic sperm injection) where one sperm is directly injected into each egg.
I have to admit that currently at Genesis we don’t offer treatment to patients who are HIV positive. In fact, a recent survey looking at nationwide access to fertility treatments demonstrated how few places there are to seek treatment in Canada.
There are several reasons why fertility clinics have been slow and sometimes reluctant to offer treatment to patients who are HIV positive. These include:
- one needs the services and cooperation of an infectious disease specialist
- the concerns of the staff of the clinic need to be addressed
- the public perceptions have to managed so that patients who are not HIV positive feel that their sperm and eggs and embryo are safe
- some duplication of expensive laboratory equipment would be needed
- issues around counseling and making sure that patients understand the consent process
All of this is surmountable but takes some oomph on the part of fertility clinics. This is really the purpose of the guidelines, to outline what should be available for people living with HIV/AIDS so that we as fertility clinics can aim higher.
Dr. Jason Hitkari, MD, FRCSC
Reproductive Endocrinology & Infertility
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April 17, 2009Octomom
What are the risks of a multiple pregnancy?
The issue of multiple births has grabbed the headlines ever since the 33 year old “Octomum” gave birth to octuplets as a result of IVF. With the media frenzy over this event, reality TV shows like Jon and Kate Plus Eight, and ever more triplet strollers swerving down our streets it seems there is an epidemic of multiple pregnancies.
For many of the couples I meet in my practice a multiple pregnancy seems desirable. Often they have been struggling for years to get pregnant and the possibility of having more than one child at a time looks like the ideal way to get the family they have been longing for.
I understand this desire, but my goal is not just to help my patient get pregnant but to do everything possible to ensure that she has a healthy pregnancy and a healthy baby to take home.
While multiple pregnancies seem like the new normal in fact Mother Nature has created women to have just one baby at a time: any more than that poses a significant risk to mom and babies.
For the mom there is an increase chance of high blood pressure, diabetes, premature birth, need for hospitalization in pregnancy, heavy bleeding at the time of delivery and more. For the babies, even twins, there is a higher risk of premature birth, cerebral palsy, respiratory diseases, blindness, deafness and death as compared to singleton pregnancies.
We’ve made advances in IVF/ICSI that allow us to transfer fewer embryos (thus avoiding the risks of multiple pregnancy) with an ever greater success rate. Using these protocols and procedures in our new lab, we are seeing success rates of 70% and higher in certain patient groups.
Of course there is no one size fits all formula for how many embryo’s to transfer —each woman’s situation is different. I encourage every woman to talk this over with her doctor.
In response to the health risks posed by multiple pregnancies governments in Canada, several European countries and several states in the USA are developing legislation that will legally limit the number of embryos clinics can put into a woman. This will hopefully mean fewer sick moms and sick babies from multiple pregnancies in the future.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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April 16, 2009How long can you freeze sperm?
People often ask “how long can sperm or embryos be frozen?” and “do sperm or embryos go bad if they are frozen too long?” Well, the good news is it seems that sperm and embryos can be frozen for many years without any deterioration. They are frozen in liquid nitrogen (-196 C) which is so cold that all cell processes stop – cells don’t change at this temperature.
In March of this year a healthy baby girl was born in the US using sperm that was frozen 21 years earlier. The father had frozen sperm at age 16 before undergoing chemotherapy for leukemia. His wife underwent the IVF process and, using ICSI, her eggs were fertilized with his frozen sperm. There have been other cases of prolonged sperm freezing with excellent outcomes like this one. The longest successful sperm freeze to my knowledge was 28 years.
Embryos typically don’t get the chance to be frozen for very long as couples typically don’t do IVF, freeze embryos and then wait more than a decade to use them. There have been a half-a-dozen case reports of couples who have used embryos frozen for more than a decade and the outcomes was just as good as for embryos frozen for less time.
A nice study of over 11,000 embryos frozen between 1986 and 2007 published in 2008 concluded “Cryostorage duration did not adversely affect postthaw survival or pregnancy outcome in IVF or oocyte donation patients.” Further, the children born from frozen sperm and embryos seem to be just as healthy as those that were created with IVF/ICSI and transferred fresh, not frozen, into women.
So, overall freezing sperm and embryos doesn’t seem to harm them and they can be frozen for many years. Sperm and egg freezing gives couples options for creating their families over time.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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April 16, 2009Misconceptions
I am currently reading Naomi Wolf’s book “Misconceptions.” The book is an exploration of her and her friend’s experiences getting pregnant, being pregnant and delivering. It’s a very honest look at the fears, values, and the misconceptions we, as women, have about pregnancy and child birth that our often paternalistic society supports. It is terribly cynical of the US health care system and I believe much of it doesn’t apply to Canadian’s (e.g. greedy US hospitals pushing amniocentesis as it is apparently profitable, or obstetricians motivated not by patient best interest but by medical-legal factors) as we fortunately have a public health system and doctor’s medical-legal risk is low. Nevertheless there are some lessons to be learned from these women’s journey’s and the section on infertility really struck a chord with me.
The women paint a picture of very dismissive, impersonal and incomplete fertility care. Some of the women had to wait 2 hours for their appointment, were ill informed of what to expect after fertility surgery (e.g. laparoscopy), were given limited information on the cause of their problems, etc. The most disturbing part for me was that women were left feeling that they had failed. That their doctor allowed them to be “…primed for self-hatred.., or at least a sense of being defective.” It made me rethink some of the diagnoses we give couple’s like “premature ovarian failure,” “failed fertilization,” etc. I think it’s easy to forget how powerful words can be and how important the patient’s emotional well being is to the success of fertility care. The connection between a couple and their doctor, even the whole clinic, probably influences the outcome of treatment . The words we use, the time we spend with each other and how we all feel about the treatment plan probably matter as much as the medical intervention itself. I spent 14 years in training (not because I am slow, it just took that long!!) and I think I am pretty good at the medical interventions of fertility care. “Misconceptions” reminds me that the medical aspect is just a part of what I do. Now to keep working on the rest of fertility care….
I encourage women, mostly pregnant women, to read “Misconceptions.” Actually most of Naomi Wolf’s work is interesting, in my opinion, to the post-feminist 30-40-ish woman.
Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility