My husband and I never thought having a family would be a struggle.  His siblings and my cousins were all VERY fertile… why shouldn’t we be the same?  Little did we know, as we said our “I Do’s”, that a condition called endometriosis was wreaking havoc on my reproductive organs.

Such was its devastation, that our 1^st pregnancy was an ectopic, resulting in the rupture of one of my fallopian tubes.  Had we not gotten to surgery in time I could have died.  My husband still reels from the memory of me handing him my wedding ring as they wheeled me into surgery. 

My doctor at the time didn’t see my other symptoms, (missed menses, constipation, heavy menses) and the ectopic as a problem.  The solution therefore was to put me on Clomid.  After a year of trying, a family member recommended finding a new doctor. 

My new doctor stated that my symptoms were consistent with endometriosis but could not be certain without “going in” to make sure.  Thus began the 1^st of 8 laparoscopies (over 6 years) to “clean me up”.  I had 2 surgeries in one month. My endometriosis was so bad that I had organs being pulled together.  After the 1^st surgery my doctor had me begin the Clomid regimen. After 4 cycles of treatment she said that I would need IVF to get pregnant.  Here is where the true shock began.   

My husband and I live modest lives… I’m a Kindergarten teacher and he works in construction.  Although we lived comfortably, the cost of IVF seemed unattainable.  We discussed our options.  IVF meant no more vacations, no more upgrades to our home, and no more “let’s buy it” spending.  It also meant facing the dark reality that we may never have children.  After getting our finances in order we visited the Pacific Fertility Center in San Francisco, which our doctor had recommended.  It was a good visit and was our first step.  We made our plans to undergo IVF that summer, when I would be off from school. 

When the medications arrived we were in awe at the number of needles we had.  We were ready to begin this process… I had but one condition… since I was the receiving the injections, my husband had to give them.  I felt it only fair and would enable him to be very involved in the whole process.  He cried before giving me the first shot in my stomach.  He said he didn’t want to hurt me.  So I cupped his head in my hands and said, “If we want to have a baby, you have to give me the shot”.  He did.  I really didn’t have that many side effects.  What was more bothersome was the bruising and pain at the injection sites.  Of course as blood work and ultrasounds were done along the way, more meds were needed, bye- bye money.  Unfortunately, round 1 was unsuccessful and we discovered that I was not a top egg producer.  Of course my hubby had no problems with his soldiers… it was all me.  Ugh!  I think we had some extra embryos and did a frozen cycle right after… but to no avail.  Since we were committed to not only sticking to IVF but, also only doing it during the summers we had time not only to regroup, but save money.  Sadly, round 2 was also a dud.

For round 3 we had 3 embryos implanted.  And on 7-7-07 we discovered I was pregnant.  My husband said the date was a sign of good luck.  We were so happy and relieved.  We were finally going to expand our family.  Each month went by with no problems.  We had some stress… my work life was getting chaotic and my father was being a difficult patient recovering after heart surgery.  But my pregnancy was flawless.  On week 20 we discovered we were having a boy and by the end of the evening we had named him Lucius. 

However, one week later, while talking with some parents at school about the Halloween Parade guidelines, my water broke.  Even now I weep remembering that very moment.  The hospital sent me home to wait it out, hoping the hole would close.  However, by the third day I developed a fever and was going septic.  I had to deliver my little boy.  I begged with the doctor for a way to save my baby.  She said the waiting 4 more weeks until his lungs might be mature enough for survival was not possible since now I was also in danger.  There I was in the maternity ward waiting to deliver a dead baby. 

All I could think of was that I had failed my husband again.  In the months that followed I wished I had died with my baby.  I felt it was the only way I would feel less of a failure and the pain from my loss would be gone.  My husband would hold me and remind me that if he’d lost both of us he would be all alone.  I even offered to let him divorce me so he could find a wife that would be able to give him children.  I don’t think I’ve ever seen him as angry as when I said that.  He was willing to keep trying if I was.  And he felt that if we couldn’t have a child, then that’s just the way it would be.

So along came rounds 4 and 5, both of which failed.  The strain of infertility on our marriage was slight… but was there.  We were lucky to be able to talk it out.  What was difficult was the loss of Lucius.  There was pain there that lingered in each of us in different ways.  My husband started drinking more than usual and I found myself very resentful of others that had children/babies.  Amazingly, we made it through, pulling each other out of it.

When round 6 came along, with all we had been through, neither of us really expected it to succeed.  But amazingly we struck gold and were on our way to a family again.  However, this time we were on pins and needles.  I honestly don’t think I would have mentally survived another loss.  So we took every precaution possible, my mom even went to work with me 2-3 days a week to help out.  After the first trimester I decided that to be afraid was unfair to my unborn child.  Therefore, we started planning for this baby.  Registering and decorating.  Once we discovered we were having a girl… OMG!  Our joy could not be contained.  Every doctor visit that pronounced us healthy was fantastic.

Other than gestational diabetes, everything was great. Our little Lyra was born March 13, 2011 weighing 7lbs. 8 oz. and 20.5 in. long.  She was perfect!  We were perfect!

So after 10 years of trying, 6 years being IVF, 3 acupuncturists, body talk therapy, an ectopic pregnancy, and our Angel Baby Lucius, our family is now complete.  When I gaze into Lyra’s eyes and see her in awe of me I know she was worth all the sacrifices and tears.    

- Martina & Leandro

A statistic that we follow closely at PFC is our cumulative pregnancy rate in a given year.  This is defined as a patient’s chance of taking home a baby after one IVF cycle, but it includes the fresh embryo transfer and any frozen embryo transfers resulting from that one cycle.  These rates are shown in the table and are broken down into maternal age groups.  The numbers are calculated by looking at how many patients delivered a baby from their fresh transfer (43% of patients under age 35) and then adding in pregnancies achieved from the frozen embryos for patients that did not get pregnant in the fresh cycle (totals 64% of patients in this group).  So in this age group, 2 out of every 3 patients had a baby from just one IVF cycle.  Similarly, for patients doing a single cycle with donor oocytes, 74% had a baby.

Cumulative pregnancy rates have special importance since PFC is a national leader in reducing the number of embryos transferred at one time while still maintaining exceptionally high overall pregnancy rates.  One healthy baby at a time is the goal of fertility treatment at PFC and for every patient, a singleton pregnancy is the safest and most likely way to have a healthy baby.  At PFC we work carefully with every patient to reduce their exposure to a multiple pregnancy and all its risks for mother and baby.  And a big part of our strategy involves freezing embryos successfully so that we can use embryos conservatively and efficiently to generate more singleton pregnancies, and fewer multiples. Multiple pregnancies are a complication of IVF treatment, and we strive to avoid them. 

Patients with the highest risk for multiple pregnancy are those where maternal age is <35, doing their 1^st or 2^nd IVF cycle or those patients using donor eggs.  We encourage these individuals to transfer just a single embryo during their IVF cycle and to freeze their surplus embryos for use later.  The frozen embryo program has been so successful here at PFC that it provides very high pregnancy rates for those patients that need to use their embryos from the freezer.  It also means that we don’t have to risk transferring many embryos in the fresh IVF cycle because we have the frozen embryos as a back-up. And most patients that are doing elective single embryo transfer qualify for one of PFC’s financial plans (e.g. the refund plan) that include the cost of frozen embryo transfer cycles in the original price.

We believe that using embryos conservatively is the safest treatment.  And we don’t see big differences in pregnancy rates between patients that transferred just one embryo vs. those that transferred 2.  In fact, patients that received donor eggs and transferred 1 or 2 embryos had the same delivery rates, but those transferring 2 had a 35% twin rate.  In our efforts to reduce this twin rate, we are now transferring 1 embryo 60% of the time in the donor egg program, and 40% of the time in patients aged less than 35.

We want our patients to have healthy babies and we are working to make this possible while still maintaining high success rates.  Our goal is one healthy baby at a time.

 - Joe Conaghan, Ph.D., HCLD & Embryologist Erin Fischer

Tune in and watch PFC’s Dr. Liyun Li on KTVU Channel 2 News tonight at 10p.m!  She will be talking about fertility treatment and twin births.  Don’t miss it!

Growing up in a small town in New England, where the population of dairy cows outnumbered townspeople and the nearest neighbors were miles away, gave me the desire to work with people. As an Amherst College student in Massachusetts, my anthropology studies led me to an economic development project in eastern Africa. Upon my return the social and economic needs of people right here in the United States became more clear to me. My honors thesis included field work with homeless populations in southern California documenting their remarkably savvy ways of engaging in local politics and with the media to meet their basic needs and improve their quality of life.

As a graduate student at the University of Southern California I studied visual anthropology and media production in the schools of Anthropology and Film and Television. I received a Masters Degree in Film Production with an emphasis on ethnographic film.  My focus then shifted to interactive communications. I spent several years working for companies in Northern California that were developing low-cost and easy to use interactive technologies that would enable increased communication among distributed populations. I worked in usability and market research, which meant discovering how people interacted with these products in order to improve their usability and user experience.

After my experience in communications, I returned to a more anthropology focused career.  I joined a UCSF research team studying fertility decision-making.  For the next 8 years I worked in the field of medical anthropology with an incredible team of experts that included a distinguished Reproductive Endocrinologist and a pioneering Medical Anthropologist conducting research into patient experiences and decision-making with reproductive technologies and third-party reproduction. I worked with scores of patients who had experienced infertility and benefited from reproductive technologies to build their families. This turned out to be a great synthesis of my interest in people in their personal and social contexts and my love for technology which has continuously motivated me to better understand how social and technological innovation can be used to improve the quality of peoples’ lives.

I am privileged to now work with the amazing talent at Pacific Fertility, where as a Research Analyst on Cynthia Willson’s team, I shepherd clinical studies that continue to increase our understanding of human reproduction and the ways in which new and old technologies may improve fertility outcomes and patient experiences. One of our current studies investigates how the use of Traditional Chinese Medicine such as Acupuncture may affect birth outcomes and patient quality of life during treatment. Patients enrolling in this study may have the opportunity to receive acupuncture treatments before and during IVF at our in-house acupuncture clinic as well as having some IVF medications donated while they are in the study. I also have the honor to be helping conduct a trial of a ground-breaking imaging technology that is designed to predict which embryos at early stages of development will be most likely to result in viable blastocysts and subsequent pregnancies and births. Patients enrolling in this study are helping future IVF patients improve their chances for success while they also may be eligible to receive some reimbursement of IVF expenses. New studies are in the works that will be expanding our knowledge about the role of genetics in treatment as well as aspects of patient decision-making. Stay tuned for updates as research opportunities become available.  I am incredibly excited to be at the crossroads between the highest standards of treatment and patient care and new technological innovation that will continue to allow more people to create their treasured families.

ASRM 2011 Updates

In addition to the magical wonders of Disney, Orlando welcomed reproductive endocrinologists from around the world this October to attend the annual meeting of The American Society for Reproductive Medicine (ASRM).  Several members of Pacific Fertility Center were among the participants. 

Preimplantation Genetic Screening (PGS)

PGS was again a hot topic of discussion.  Multiple presentations showcased the recent technological advances in this field.  The ability to perform comprehensive chromosome analysis using microarray technology instead of the first generation method of FISH (fluorescent in situ hydridization), which could only test a selected number of chromosomes at a time, has increased the accuracy and the detection rate of embryonic aneuploidy (abnormal number of chromosomes).  Laboratory advances such as biopsy of the trophectoderm (the outer cell layer of a day 5 embryo) and vitrification (a method of rapid cooling of embryos that minimizes ice crystal formation) have further improved success.  As the result of the above-mentioned technical breakthroughs, we have seen a measurable increase in the pregnancy rate and a decrease in the miscarriage rate from IVF using PGS.  Additionally, two respected groups independently presented data supporting the use of PGS as a successful embryo selection tool to promote elective single embryo transfer (the process of transferring one embryo at a time into the uterus to reduce the risks of multiple gestation).  The pregnancy rates from a single PGS-selected euploid embryo were 58% and 60.7% compared to 42% and 40.7%, respectively, from a morphologically comparable but non-PGS-selected embryo.  Moreover, the miscarriage rates decreased to 6% and 6.3% from 12% and 12.5%, respectively.  The risk of multiple gestation was essentially eliminated (1-2% monozygotic twining).

We were excited to note the parallels between the data presented and our own work at PFC.  Several years ago, we made the commitment towards decreasing our multiple pregnancy rates by adopting a policy of encouraging elective single embryo transfer in qualified patients.  We have found that 24-chromosome aneuploidy screening (via informatics-based single nucleotide polymorphism microarray technology by Gene Security Network) of trophectoderm biopsy has significantly enhanced our ability to select the embryo with the best implantation potential.  Our improved vitrification program has also allowed us to reassure our patients that their unused embryos can be safely stored for future use, thus removing the pressure to transfer more embryos at one setting.  We are very proud of our success so far in achieving our goal as we are currently the number one ranked program in the nation of the fewest number of embryos transferred in donor cycles (1.4 embryos per fresh cycle) while maintaining a high pregnancy rate of 57% (of all programs with more than 20 donor cycles per year, 2009 SART).  For more details on our experience with single embryo transfer and its pregnancy rates, please read “What are my chances of having a baby from a single IVF cycle” by our embryologist, Erin Fischer, and laboratory director, Dr. Joe Conaghan, in this issue of Fertility Flash.

Fertility Preservation

Another interesting topic that deserves attention is fertility preservation using oocyte cryopreservation. Two centers with extensive experience in this area shared their outcome data from both methods of cryopreservation, slow freeze and vitrification.  A center in Atlanta vitrified over 2000 oocytes from donors with an average age of 26 years.  Of the 1772 oocytes rewarmed, 88% survived, 75% fertilized, and 51% resulted in viable cleavage stage (day 3) embryos.  Live birth rate per cryopreserved oocyte was 11%.  The other presentation by a group in New York reported their experience of rewarming 536 cryopreserved oocytes using both slow freeze and vitrification from non-donors with an average age of 32 years.  The overall live birth rate per rewarmed oocyte was 5.5%.  Study is ongoing to compare the efficacies of slow freeze and vitrification.     

PFC’s own data with vitrification of oocytes is comparable to, if not better than, the results presented at our national meeting by various groups across the US.  A 5-10% live birth rate per oocyte in women under the age of 35 years translates to a respectable chance of having a baby in the future from one to two treatment cycles in the present (10-20 oocytes can be expected to be cryopreserved per cycle).   As we further perfect our own techniques of vitrification, we will be increasingly more confident in our ability to offer young women with a viable option for future family planning in addition to embryo freezing and donor gametes.  Future research is needed to achieve the same type of success rates in older women.   

Participating at ASRM is always an educational experience.  We enjoyed sharing our own clinical and research endeavors with our colleagues across the US and all over the world.  Our position as the nation’s leader in many of the most cutting-edge technologies in our field is a validation of our commitment to excellence and to provide our patients with the highest quality care available.

According to Resolve, Rep. John Lewis (GA) introduced a bill in the U.S. House of Representatives on November 30 that would provide eligible taxpayers a tax credit for the out-of-pocket expenses associated with infertility medical treatment. 

The “Family Act of 2011,” HR 3522, is a companion bill to S 965 which was introduced in the U.S. Senate in May 2011.  Advocates can now push for action on the two bills including bipartisan co-sponsorship, Committee hearings, and a vote in both chambers.

If you would like to support this bill, contact your U.S. Representative and ask them to co-sponsor HR 3522.  According to Resolve, you can do this by completing the following:

Contact your Representative right now.  It takes 3 minutes through RESOLVE’s Action Alert System. PLEASE review the online letter and personalize it with your story.  Personal content is far more impactful than a form letter.

To learn more about The Family Act 2011, visit the Resolve website today! 

How does metabolism affect fertility? PFC’s Dr. Liyun Li may be able to shed some light on this interesting question. She has studied extensively a key hormone regulater of body weight and appetite called ghrelin, and found that its levels in the ovaries may affect egg and embryo quality.  Her work has just been published in the peer-reviewed and the highly respected journal Fertility and Sterility.

For abstract, see here.

Tune in for a Channel 5 news special! The story shares the journey of Dino, a single restaurant owner, and his quest to have his own son. The special also features PFC’s Dr. Carl Herbert.

The two part special will air on Channel 5 on Wednesday, November 16th at 11pm and Thursday, November 17th at 6pm.

You won’t want to miss it!

PFC is proud to announce that all 5 Pacific Fertility Center Partner physicians have been named top reproductive endocrinologits on the U.S. News Top Doctors list.  Drs. Philip Chenette, Carolyn Givens, Carl Herbert, Isabelle Ryan, and Eldon Schriock were selected as top doctors based on a peer nomination process by U.S. News Top Doctors and Castle Connolly Medical Ltd.

Congratulations to each of you for this incredible honor!

In case you missed Dr. Carl Herbert on the Fertility Forum radio show, you can download the Podcast on iTunes or the MP3 version from the Fertility Forum website.  Hear Dr. Herbert talk about the History of ART, Genetics, Fertility Preservation, Egg Banking, and other topics in the field of Assisted Reproductive Technologies. 

We hope you enjoy!