2012 is the Year of the Dragon (January 23, 2012 to February 10, 2013) in the Chinese Zodiac, thus making this an auspicious year to have a baby.  The Chinese people have a long-held belief that we are descendants of the mythical Dragon who is benevolent and all powerful.  The Dragon is said to be a deliverer of good fortune and a master of authority, and those born in Dragon years are to be honored and respected. 

One may have believed that younger generations of Asian Americans no longer live by ancient superstitions.  Perhaps that explains our initial surprise when we noticed an influx of Asian couples, mostly from the Bay Area but also from Asia, who have rushed to PFC for fertility treatment to have their Dragon baby. 

PFC is not alone in this observation.  Nationwide, news headlines have described similar trends in fertility centers that service a demographic with a large Asian population and whose clinics are geographically more accessible to Asia.  In Hong Kong and other major cities in China, maternity wards are already overbooked for elective labor inductions and cesarean sections for the end of the Dragon Year.  Pregnant women who have not been able to secure a hospital bed around their due dates are panicking about where to deliver their babies.

All of the patients we have seen and treated so far at PFC have confirmed diagnosis of infertility.  However, the impetus behind their seeking treatment at this point in time is their common and resounding desire to capture that rare dose of good luck associated with the Year of the Dragon and to pay homage to their cultural roots.  Many presented with an accompanying sense of urgency that is often foreign and perhaps incomprehensible to our mostly Western staff.  As a medical facility that takes pride in our ability to deliver high quality patient-centered care, we have learned to become more culturally aware and sensitive. 

There is a very popular song in China, known by every child growing up.  Perhaps it captures the essence of why the Dragon is so important to people of Chinese heritage.  It’s called the Descendants of the Dragon:

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.

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.