Empowering a woman’s choice using fertility preservation

Protecting and preserving fertility is a new way of empowering reproductive choice. The fertility of youth is no longer a limited resource, constrained by age.  Women can now pursue their reproductive lives at their own pace, rather than according to the obligations of biology.  Reproductive choice means having children when you want them, rather than when you must have them.

Fertility preservation, specifically egg freezing, is changing the way we think about building families.  Through fertility preservation, eggs can be stored and saved for use a later. 

The potential of fertility preservation replaces the tick of the biological clock

The tick-tock of the biological clock influenced reproductive choice in the last decades.  The sacrifice of delaying family while assembling a career, home, and relationship worked in an economic sense.  It did not, however, fit well with the designs of biology. 

Eggs work best at a young age, when there are more of them, and they are more vital. The best pregnancy rates occur in women ages 18-30.  With declining egg numbers and egg quality, pregnancy rates are lower in older age groups, while miscarriage rates and chromosome defects become more common.

Biology wastes eggs

The limit of egg quantity and quality is a consequence of our biology. From mid-gestation through menopause, there is a continuous stream of egg follicles that grow to a certain stage and then are lost.  This pool of eggs is never replenished. Each woman is born with a set number of eggs (over a million), and by puberty perhaps 300,000 remain. Ovulation will happen only 500 times in a woman’s reproductive years. and will result in a child less than 1% of the time.  From start (gestation) to finish (menopause), 1 in a million eggs results in a child.  This constant and dynamic process of decline continues through the reproductive years, uninterrupted by birth control pills, pregnancy or ovulation.

Fertility preservation provides the potential for protection against future infertility

Fertility preservation is a relatively simple process.  The first step is for a woman to see her fertility doctor for an ultrasound and physical exam.  On ultrasound the ovaries are measured and the number of follicles determined.  A treatment calendar with a schedule of injectable fertility drugs is initiated.

Using fertility medications for approximately ten days, multiple eggs begin to mature in the ovaries.  Under sedation, the eggs are retrieved, a process that takes about 10-15 minutes.  The eggs are then cryopreserved and placed in frozen storage.

At a later time, the eggs can be thawed, inseminated with sperm (ICSI is recommended), and the embryo(s) created transferred back into the uterus to develop into a pregnancy.

Technology of Fertility Preservation is improving

We are continuing to optimize the outcomes of oocyte cryopreservation.  In a series of women under age 30 where eggs were cryopreserved, egg survival was 88%.  Over half of the eggs fertilized, and two thirds of transfers resulted in pregnancy.  As of January 2011 Pacific Fertility Center has 8 delivered babies from cryopreserved eggs.

The limits of biology continue to constrain outcomes of those eggs that survive.  Not all eggs have the capacity to produce a viable embryo.  This variable is very age dependent.  In a healthy woman under the age of 30, approximately one third of her eggs(33%) are capable of producing a viable embryo.  In women over the age 40, this ratio changes to one in twenty (5%).

Fertility Preservation:  reproductive choice

The message is this:  Fertility is optimal in your youth.  If you have not started your family, you should consider freezing your eggs for use in the future.

-Philip Chenette, M.D.

Advances in research & development bring a deeper understanding of infertility:

Modern fertility science is changing treatment, enabling better pregnancy rates.  A healthy child for every person suffering from fertility problems remains Pacific Fertility Center’s goal.  Through a better understanding of the egg and embryo we are  closer to delivering on that promise of one healthy baby at a time.

The problem of the aging egg:

The aging egg remains a very basic problem in fertility.  As a woman ages, her eggs do not work as well, resulting in embryos that do not develop or implant.  Mistakes in early cell division, chromosomes, and development become common.  With an aging egg, pregnancy rates are lower and miscarriage risk higher.

Finding that healthy egg can be a problem.  For a twenty year old, roughly 1 in 3 of her eggs will be healthy.  For a woman over forty, less than 1 in 20.  This continues to be a real and ongoing challenge for our patients.

One way to work around this problem is to increase the number of eggs.  Starting with more eggs gives a better chance of finding at least one that is healthy.  Once we have a batch of eggs, the problem emerges of trying to choose the best out of the group.  Which egg is most likely to achieve pregnancy?

Research of early egg and embryo development:

We are excited to share that we are currently working with a privately held medical technology company, along with several other centers in the Bay Area, on a new investigational imaging device in the early stages of development.  We can now observe, using a video microscope, the early stages of embryo development.

Knowledge of the way an embryo develops, the early cell division, when and how, promises to improve selection of embryos.  Over a several year period at Stanford Institute for Stem Cell Biology & Regenerative Medicine, Dr. Renee Pera, in collaboration with Stanford colleagues, Dr. Barry Behr (Associate Professor and IVF Lab Director), Dr. Thomas Baer (Executive Director of the Stanford Photonics Research Center), and post-doctoral fellows Dr. Connie Wong and Dr. Kevin Loewke, conducted ground-breaking research into early human embryo development.  Looking at embryos in their first few days of development, the team identified an elegant set of imaging parameters by day 2 that accurately identified embryos that develop to the blastocyst stage.

Through the use of precision imaging technology coupled with novel measurements, embryologists may be able to choose the best embryos more accurately and consistently.  Published last year in Nature Biotechnology, Time magazine named the discovery one of the 10 medical breakthroughs of 2010.

Dr. Renee Reijo Pera, Ph.D.

Dr. Renee Reijo Pera, a leader of the team that published this study, understands these problems, working with them in a research lab for the last twenty years.  She is now bringing that knowledge to clinical medicine.

Dr. Pera received her PhD from Cornell University, and later worked in David Page’s lab at the Whitehead Institute.  While working with Dr. Page, she discovered a gene on the Y chromosome that was involved in male fertility called the DAZ (Deleted in AZospermia) gene.  As it turns out, the gene accounts for a significant proportion of male infertility and tests for this gene are now routine for men with low sperm counts.

Now, as Director of Stanford University’s Center for Human Embryonic Stem Cell Research and Education, Dr. Pera’s focus is on understanding issues related to human reproductive failure.  The questions she and her team are addressing encompass issues such as Egg formation and development, as well as what triggers cell division and formation of a healthy embryo

Fertility care will change based on Dr. Pera’s research on early development of eggs and embryos.  This work has vast implications for the future of treatment and prevention of infertility.  In her exploration, she is finding new ways of thinking about old fertility problems.  Dr. Pera’s work will strongly influence medicine and clinical realm for years to come.

At Pacific Fertility Center we are committed to bringing advanced science to the clinic.  We are finding major changes in our understanding of early egg and embryo development and anticipate continuing to lead the way in bringing these advances to help our patients have one healthy baby at a time.

-Philip Chenette, M.D.

Born into a musical family, some of my earliest memories are of visiting musicians and musical instrument makers.  I was fortunate to meet Carl Geyer in Chicago, who built some of the world’s finest French horns.  His shop was full of raw materials, the valves, tubes, and bells associated with a French horn.  I watched as Mr. Geyer shaped them into beautiful instruments, ones that professional musicians from all over the world came to play.  For me, these visits became early lessons in craftsmanship, quality and personal responsibility.

My father, a conductor and horn player, expected each of his five children to play an instrument.  I turned to Oboe.  There are many stories about oboe players, mostly revolving around the fact that playing the oboe is a real challenge; the oboe being “an ill wind that nobody blows good”. 

However, I pursued the art and craft of the oboe and learned from some of the top master oboists and conductors of the day.  My instructors came from major symphony orchestras in Indianapolis, Cleveland and Chicago.  I met and was influenced by world renowned conductors and composers;  Leonard Bernstein, Aaron Copland, Dika Newlin, and Peter Shickele.  Working with masters you learn that, while there are many ways to accomplish a task, the path chosen must be done correctly and pursued with passion.

Many years have passed since I played in an orchestra, but those early experiences are still with me each day I practice medicine.  The symphony is a wonderful analogy to describe the work in our practice.   In an orchestra there are nearly a hundred individuals of diverse backgrounds, origins, and personalities. There’s a conductor at the helm, working the notes placed on paper by a master of composition.  The mastery and craftsmanship, performed by a unified team devoted to a single goal, using all the skills available to them, creates a performance of great beauty and power.

Similarly, at Pacific Fertility Center, the doctors compose a treatment plan and direct the team.  We give our staff the best of class tools.  Our staff orchestrates the performance; a highly talented group of people applying their best skills to the unique problems of each individual patient.  It is an honor to work with the patients that entrust us with their care. We continue to pursue the best in fertility technology and pregnancy rates.

On reflection, perhaps I became interested in fertility medicine because it gave me the same sense of structure, purpose and wonder as playing the oboe as a young student.  I was inspired by the announcement of the first pregnancy from in vitro fertilization. The application of medical technology to help a family achieve their dreams was a landmark event.  Controversy and hoopla ensued, but the truth stood clear, that a small baby – a new child – was held in its parents’ arms as a result.   For me, this was a momentous event that inspired me to attend medical school at Indiana University, residency in obstetrics and gynecology at the University of Pittsburgh’s Magee-Womens’ Hospital, and ultimately a fellowship in reproductive endocrinology and infertility at USC.

USC was a crucible of fertility technology.  Roger Lobo was performing extraordinary work on ovulation induction and PCOS.  Some of the pioneers of IVF and oocyte donation were rewriting the book on fertility care.  Lobo, Rick Paulson and Mark Sauer published the first report of oocyte donation in women over 40 years of age (New England Journal of Medicine, 1990).  The protocol diagram in that paper is my design.

After completing fellowship, I returned to Chicago to join Anne Wentz in developing the program for in vitro fertilization at Northwestern University.  Anne came from the Gerogeanna and Howard Jones Institute tradition, and was a real master of the embryo transfer.  We established a successful program synthesizing the best of East and West coast protocols, advancing the theory and practice of embryo transfer, developing new techniques for male fertility problems, and developing fertility preservation for endangered species. 

California called me back, and I joined Pacific Fertility Center (PFC) in San Francisco in 1991.  At PFC, I was fortunate to meet Dr. Herbert who later established The San Francisco Center for Reproductive Medicine.  Dr. Herbert’s vision of patient-centric fertility care was pioneering and contemplated my own interests in quality care.  In 1999, we carried this vision forward joining with Drs. Schriock, Givens, and Ryan from the University of California to form Pacific Fertility Center as we know it today.

Being an early member of the profession, I have been blessed with many opportunities to apply technology to patient care.  I developed an embryo transfer system with Danforth Biomedical and was awarded a patent, “Methods for endometrial implantation of embryos”.  We were early adopters of networking technologies in the early 1990s and developed one of the first fertility support websites, PacificFertilityCenter.com (at that time sfivf.com) in 1993.  My wife was responsible for the early work leading to FertilityWire.com, which continues today as an educational resource for patients.  Ongoing interests in genetics, fertility preservation, and imaging are leading to new developments that we will apply to clinical care in the near future.

Today I am a husband to a remarkable wife and three wonderful girls.  I have many outside interests in skiing, music, bicycling, and aviation.  I was pleased to receive a “Best Doctors in America” award and recognition in “America’s Guide to Top Obstetricians and Gynecologists”. Our entire family went to New York for the American Fertility Association’s Kokopelli Ball, where I received the AFA’s Family Building Award. 

One of my interests includes teaching young doctors that are contemplating their roles in the field, and I was asked to join the faculty at UCSF where I teach these bright young minds.  I am reminded of how unique our profession really is, seeing  it again through their eyes.  Reproductive Medicine has grown much since that first IVF pregnancy and I am proud to be part of its continuance into the future.

-Philip Chenette, M.D.

The award of the 2010 Nobel Prize for Medicine to Robert Edwards was a mark of recognition for development of the first successful in vitro fertilization.  The award, though, goes far beyond a mark of personal accomplishment.  The real significance of the Nobel Prize is the immense impact of Dr. Edwards’ work on medicine.

The growth of research, education, and clinical care that emerged from this work continues to echo to this day, and the pace of this advancement shows no signs of slowing.  Pacific Fertility Center exists as a result of these efforts; however reproduction is not the only field that has been affected by Dr. Edwards work. All fields of medicine have benefitted from the outgrowths of technology that show their origins in Dr. Edwards’ work.

His work arose during a time of sparse knowledge concerning reproduction.  Little was known about the early steps of egg, sperm, and embryo development, and even less about the implantation of an embryo into the uterus that establishes pregnancy.  Dr. Edwards worked through many of the early details of IVF technology, such as ovulation induction, sperm capacitation, and embryo culture. Each stage of egg development and maturation, sperm management and fertilization, and embryo transfer, had to be studied, modeled, and attempted in the clinic.  When a technique did not work, it was back to the drawing board to try again.

The work was never easy.  In the beginning, success was difficult to achieve and the worries were high.  One of the earliest in vitro fertilization pregnancies ended in miscarriage.  A second ended in the fallopian tube, as an ectopic pregnancy.  Professional associates often, and loudly, doubted that in vitro fertilization was possible or safe. 

In the midst of these doubts, a normal child, Louise Brown, was born in 1978 after in vitro fertilization.  It was a pregnancy much like any other, except born after conception assisted by technology.  Concern and worry were replaced with the simple beauty of a newborn child in its mother’s arms.

All of us clearly remember the day we heard of Dr. Edwards’ work.  The ideas were startling at first, but soon created a newly opened door to a vast area of possibilities.  New techniques for fertility treatment, avenues for treatment of genetic illness, and new ways of thinking about medicine became possible.  For me, a young man in college, deciding on a career path, it was a call to learn and resulted in medical school and fellowship.  For researchers, educators, and clinicians already in the field, suddenly there was a new way to help patients, and an array of interesting pathways for research.

There began a massive change in medicine, with the development of a network of research, education, and clinical care.  Educational programs were established at most major medical institutions for training new practitioners and researchers.  Funding, mostly private, was established for research into fertility.  Professional journals, like Fertility and Sterility, and Human Reproduction, emerged to document the research findings.  A network of clinical care grew applying research findings.

Pacific Fertility Center was established in the midst of this development, in the late 1980s, as a center of excellence in fertility care, by a group of doctors at Pacific Presbyterian Hospital (now California Pacific Medical Center) in San Francisco.  A small program in the midst of a very busy medical care system, the Pacific Fertility rapidly established success as a leading private practice for in vitro fertilization and ovulation induction.   The five doctors that run the program today were true innovators in the field of IVF.

Pacific Fertility Center sought to improve a high standard of care from its early days, seeking the best proven technologies for patient-focused fertility care.  Early innovations included the move from laparoscopic to ultrasound-guided procedures, requiring less anesthesia and less risk to patients.  Intracytoplasmic Sperm Injection (ICSI) for male factor introduced in the mid 1990s, and methods to reduce multiple pregnancy rates and chromosomal testing of embryos (preimplantation genetic diagnosis and screening) were all mastered and introduced to Pacific Fertility Center within the last decade.  We continue these efforts today with innovations in fertility medications, vitrification, and fertility preservation.

Today, some 4 million children have been born worldwide through in vitro fertilization technology.  Pregnancy rates have steadily improved, while the risk of multiple pregnancy has declined.  Treatments have emerged for specific problems such as male factor infertility, and diminished ovarian reserve.  Fertility preservation, oocyte donation, and the prevention of genetic illness all are growing areas of reproductive medicine.  All of this came from the birth of one child three decades ago.

We are pleased at the recognition of Dr. Edwards’ work by the Nobel Prize committee. We are honored to have been able to participate in the development of these technologies, and we look forward to helping patients at Pacific Fertility Center benefit from this work, one healthy baby at a time.

-Philip E. Chenette, M.D.

At the birth of the first baby from in vitro fertilization (IVF) I was in college studying music, but intensely curious about science and medicine.  The reports from Dr. Patrick Steptoe and Dr. Robert Edwards demonstrating that conception in a test tube worked changed my life, triggering renewed enthusiasm about biology and chemistry.  Controversy aside, this event marked a new way of thinking about technology.

The Nobel Prize for Medicine this year was awarded to Robert Edwards for his work on in vitro fertilization (IVF).  Along with Patrick Steptoe, Dr Edwards developed many of the methods for growing embryos in the lab, but more than that, creatively used science to develop novel solutions to real people’s problems and illuminated a new pathway in medicine.  Dr.  Edwards is not only the father of IVF, but also of modern cell culture techniques, stem cell derivation, and the medical therapies that will result.  He stimulated many creative minds at a pivot point of changing technology.

Rare are the events that mark a new pathway in human history.  Each time I have spoken with Dr. Edwards I have been impressed with his curiosity and gentle nature, and realized again that he brought his unique experience, education, and training to bear on important clinical problems.  He was a creative and thoughtful man at exactly the right time in history, opening a new pathway for medical science, and changing future generations in the process.  This is of what great men are made.

- Philip E. Chenette, MD

Nobel Prize For Medicine

Title: The Fertile Kitchen Cookbook

Can diet influence fertility? Can altering your diet help you conceive? Is it true that you are what you eat (and so is your baby)?

At age 40 and after trying to conceive for over a year, Cindy Bailey and her husband Pierre Giauque were told that they were unlikely to conceive. With disconcerting medical test results and failure in conven tional treatment, alternative therapies seemed the best option. After trying a fertility-friendly diet, to their surprise, their son was conceived four months later.

The Fertile Kitchen is one couple’s story of overcoming the odds against conception while using common sense and easily executed measures to optimize health. Using fresh, high quality, organic ingredients, and reducing wheat and dairy; the couple developed a nutritional plan that they feel contributed to their success. These authors found that optimizing the basic ingredients for life, adjusting calories, carbohydrates, fats, and proteins into a regimen that has the potential to optimize pregnancy rates, should be considered in a given fertility plan.

Science is still catching up to medical concerns about fertility and diet. As an example of this emerging science, it is known that women with abnormal body fat levels, either high or low, suffer from lower pregnancy rates, and that improvement in body weight and body fat levels improves fertility rates…Certain types of animal protein are potentially problematic for fertility, whereas vegetable protein sources seem to carry less risk. Calorie source, simple sugar versus protein, makes a difference in treating anovulatory women. Irregular menstrual cycles can be optimized by changing diet. Omega-3 fatty acids are related to uterine artery perfusion pressures, and supplementation seems to provide some clinical improvement in these parameters. Studies are showing a role for B-complex vitamins, folic acid, and dietary fat in regulating ovulation.

It is unfortunate that some people have serious challenges to fertility that cannot be addressed with a change in diet. Diminished ovarian reserve, male factor, and tubal occlusion are problems that go beyond what can be remedied with diet alone. With that said, fertility treatment programs, regardless of the health issues, should include a healthy diet, as a good preventative measure for already healthy women wishing to conceive. The recipes in this book are easy to follow and the ingredients are amply available at most grocery stores.

Fertile Kitchen Media Kit (pdf)

— Philip Chenette, M.D.

These tests can be done by your primary care physician or gynecologist prior to consulting your Reproductive Endocrinologist:

• Day 3 FSH (follicle stimulating hormone) and Estradiol (Day 2-3 is acceptable)
• TSH (thyroid stimulating hormone)
• Prolactin
• Progesterone: 7 days prior to menses, this test is occasionally helpful
• Semen analysis

These tests may be useful based on each patient’s particular needs:

• Hysterosalpingogram (HSG) or documentation of tubal status
• Hysteroscopy
• Laparoscopy: The surgeon should be able to treat during this procedure, not just diagnosis.

The following treatments may be done, if indicated, for a limited number of cycles:

• IUI (intrauterine insemination)
• Clomiphene citrate (Clomid, Serophene)

At Pacific Fertility Center, we bring a complete team of specialists together to focus on your fertility situation. With extensive backgrounds as REI specialists, embryologists, nurses, marriage and family therapists and financial counselors, we develop a single, integrated solution to your medical, psychological and financial needs.

Please use our Ask the Experts resource if you have further questions.

– Philip Chenette, MD

These tests are best done through your Reproductive Endocrinologist (fertility specialist):

• Strict sperm morphology
  Strict morphology is a very specific method of evaluating the shape of sperm. Most laboratories do not use strict criteria thus potentially missing a sperm problem. Our laboratory is staffed with embryologists trained to analyze sperm with these strict criteria.
• Evaluation of ovarian reserve
  Evaluation of ovarian reserve includes family history, ultrasound to detect the antral follicle count (AFC), a cycle day 2-3 FSH and estradiol level (both must be done at the same time), Anti-mullerian Hormone AMH, and clinical and family history.  An REI can bring all of these assessments together into one consistent picture of a woman’s ovarian reserve.
• Ultrasound
  A pelvic ultrasound is a very useful test when it is done at the appropriate time in the menstrual cycle. A few days prior to ovulation an ultrasound can evaluate ovulation, follicle growth, endometrial thickness and pattern, polyps, and fibroids. During menses is the best time to evaluate the ovary for cysts and endometriosis.
• Genetic testing
  Genetic testing is important in women with premature menopause and multiple miscarriages and men with very low sperm counts.  Patients with a family history of a genetic disease can use genetic testing to determine if they are carriers of the disease.  Universal genetic testing (Counsyl, www.counsyl.com) can be used to assess risk for certain genetic illnesses that run in families. If detected, Preimplantation Genetic Diagnosis (PGD) can help prevent genetic illness in your child.
• Insulin
  Women who have irregular periods and have been told they have Polycystic Ovary Syndrome (PCOS) should be evaluated by an REI.  Testing can lead to more effective treatment.

Treatments by a fertility specialist

The advanced training of an REI is helpful to provide the most successful treatments for infertility.

Some of these treatments include:

• In vitro fertilization with embryo transfer (IVF, or IVF/ET),
• Fertility preservation
• Egg freezing
• Intracytoplasmic sperm injection (ICSI)
• Preimplantation genetic diagnosis (PGD)
• Ovulation induction
• Intrauterine insemination

A specialist is able to evaluate simpler treatments and finely tune them to make them more effective. For example, a specialist can monitor ovulation induction with clomiphene (Clomid) with ultrasound and blood tests. The vaginal ultrasound can be used to assess follicle development and endometrial pattern and thickness. Intrauterine inseminations can be done to bypass hostile mucus caused by clomiphene. The specialist can also help decide when to stop a particular treatment and/or proceed with more.

Alternative medications like letrozole (Femara) are just as effective as clomiphene but have fewer side effects.  Since letrozole is not approved by the FDA for marketing for fertility use, its use is generally restricted to specialty clinics, that is, REIs.

Gonadotropins, the injectable drugs, for example Follistim, Gonal-F, Bravelle, and Menopur, are potent stimulants to the ovary.  They are designed to produce multiple follicles, in order to improve pregnancy rates.  Due to the risk of multiple pregnancy and overstimulation of the ovaries, the medications should be used only by experts in the field.  Most of these treatments are performed by REIs in the United States.

At Pacific Fertility Center, we bring a complete team of specialists together to focus on your fertility situation. With extensive backgrounds as REI specialists, embryologists, nurses, marriage and family therapists and financial counselors, we develop a single, integrated solution to your medical, psychological and financial needs.

Please use our Ask the Experts resource if you have further questions.

– Philip Chenette, MD

A Reproductive Endocrinologist (REI) is a specialist in Reproductive Endocrinology and Infertility, a medical doctor with advanced training in the science of fertility and its evaluation and treatment.  An REI focuses on the hormones and mechanics of conception with advanced knowledge of sperm, eggs, male anatomy, female anatomy, and the complex interactions between pituitary and reproductive hormones.  An REI will be trained in evaluating the problems that can interfere with conception, and has in depth knowledge of the treatments for fixing these problems.

An REI starts training after medical school in a 4 or 5 year residency in obstetrics and gynecology.  Specialty training in reproduction after residency requires 2-3 years at an advanced educational and research institute.  The fellow in REI works side-by-side with experts in the field, developing clinical expertise in evaluation and treatment of fertility, and researching new areas of reproduction.  The REI will be trained in laboratory and clinical research techniques, the mechanics and hormones of fertility, and in maintaining a lifelong love of the pursuit of advancing knowledge of fertility.

After completing the fellowship, an REI is “board eligible”. To be “board certified,” an REI must publish a thesis in a peer-reviewed journal. The REI must pass an in-depth written exam and then appear before experts in the field for an oral exam to test their depth of knowledge, defend their thesis, and demonstrate reasoning in solving fertility problems.  If they pass the exams, they are then “board certified”. This certification is the highest level of achievement in the field of infertility.

All REIs certified since 1990 are required to maintain their certification every year (a few are grandfathered in).  This involves reading and evaluating peer-reviewed journal articles on current advances in the field, and a written exam every year.  New standards require demonstration of clinical knowledge and a commitment to advancing standards of clinical care, the Maintenance of Certification (MOC) process.

While there is no formal requirement, most REIs will maintain membership in national and international fertility societies, such as the Society for Reproductive Endocrinology and Infertility (SREI).  The Society for Assisted Reproduction (SART), devoted to in vitro fertilization and its variants, does not require REI certification.  The American Society for Reproductive Medicine (ASRM) is the umbrella organization supervising these specialized societies.  Most anyone with a professional interest in fertility can join ASRM, but SREI requires board certification.

At Pacific Fertility Center, we bring a complete team of specialists together to focus on your fertility situation. With extensive backgrounds as REI specialists, embryologists, nurses, marriage and family therapists and financial counselors, we develop a single, integrated solution to your medical, psychological and financial needs.

Please use our Ask the Experts resource if you have further questions.

– Philip Chenette, MD

Stillbirth, loss of a baby at delivery, is a painful challenge.  The suffering associated with the loss of a child, even before birth, can be overwhelming.  Especially acute for women that have conceived utilizing assisted reproduction, the loss of a pregnancy fought through reproductive technology can overwhelm a couple.  Stillbirth is a rare risk of pregnancy; the challenge facing us as reproductive medicine experts and obstetricians is how to reduce that risk.

The technologies of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) have enabled pregnancy for thousands of families with sperm, egg, and uterine problems.  With IVF, egg quality can be optimized using fertility drugs to produce more eggs.  Blocked fallopian tubes can be bypassed.  Weak sperm can achieve pregnancy by ICSI, where, using a microscopic needle, the sperm cell can be introduced into the egg.

No-one should expect these techniques to be foolproof.  While mechanical problems can be improved, other weaknesses in the reproductive system cannot.  Small deviations in the genetic code of the sperm or egg, missing chromosomes, aging, uterine defects, etc cannot be fixed by treating the sperm cell or embryo.

Thus the problem – these pregnancies established by high technology, are at higher risk.

A recent study from Denmark looked at stillbirth in children born after IVF/ICSI  and found that the risk was higher in children born after IVF/ICSI than natural pregnancy.  Out of 16,525 births to fertile women the chance of stillbirth was 0.37%, that is, 3.7 out of 1000 births.  Out of 742 babies born to women after IVF/ICSI there were 12 stillbirths, 1.62%, that is 16.2 out of 1000 births.

But more importantly to our patients, the liveborn baby rate after a successful IVF/ICSI treatment  and pregnancy is 98.4%.  The liveborn baby rate after a successful natural conception and pregnancy is 99.6%.  Almost all of the successful pregnancies after IVF/ICSI are liveborn.

Reproductive technologies, like IVF and ICSI, are enabling pregnancy and family building where it was not possible before.  All of our patients must be informed of and recognize the risks associated with fertility treatment.  These risks should not, however, dissuade anyone from considering these therapies.  On the contrary, the overwhelming likelihood is that, once a pregnancy is established, it will progress successfully to delivery and a healthy child.

We need to recognize these risks to provide help understand and take measures to reduce the risks to all children.  We will continue to watch these studies carefully in our ongoing effort to assure our patients of excellent pregnancy rates, at low risk.

Footnote:

1. K. Wisborg, H.J. Ingerslev, and T.B. Henriksen  IVF and stillbirth: a prospective follow-up study  Hum. Reprod. Advance Access published on February 23, 2010.