Infertility & Reproductive News featured Pacific Fertility Center and interviewed Dr. Herbert for their August newsletter issue. 

Click here to read the article in Infertility & Reproductive News.

Dr. Chenette was honored as Fertility Doctor of the Month by FertilityAuthority.com!  Below is the story they featured.

Philip E. Chenette, MD, Pacific Fertility Center, San Francisco, CA

July 2011

FertilityAuthority.com is pleased to honor Philip Chenette, MD, as Fertility Doctor of the Month.  We recognize San Francisco fertility doctor Philip Chenette for his progressive and patient-focused practice at Pacific Fertility Center in San Francisco, CA, and his philosophy of individualized care for the fertility patients he treats.

“Our focus in on the individual patient,” says Dr. Chenette.

From the diagnostic regimen to fertility treatment to holistic services such as acupuncture, mind-body and nutritional support, the entire process is tailored to the patient’s specific needs. “My 9 a.m. patient, she’s my boss, and I have to get the job done with her,” Dr. Chenette adds.

Involved from Beginning to End

At Pacific Fertility Center, the fertility doctors are the ones who do their patients’ ultrasounds, egg retrievals and embryo transfers for IVF cycles. “It makes a real difference in outcomes,” Chenette says. “I’m the one who knows you the best and I can see things my partners may not see.

“There are so many details in fertility — all the pieces of the puzzle that have to come together,” he continues. “And those things don’t happen by themselves. As a doctor, you can’t entrust that to chance. I have to be there in the mix — guiding things, lending my 20-plus years of experience to keep things on a good path.”

Age-Related Infertility

From a clinical perspective, Dr. Chenette’s emphasis is on age-related infertility, including diminished ovarian reserve and aneuploidy (chromosomal abnormalities). He has seen improved success rates and reduced multiples in those patients.

“We’re now working on fertility preservation,” Dr. Chenette says. He is a champion of egg freezing and says that randomized control studies indicate that it’s a viable option for preserving fertility.

“Fertility preservation is a route to reproductive choice,” Dr. Chenette says. “Not everyone gets married young and can have children young.”

One of his goals is to drive some critical mass around fertility preservation. That includes contacting and building relationships with Ob/Gyns and other physicians who see patients with diminished ovarian reserve to encourage them to talk with their female patients about fertility preservation. He’s currently involved with putting together a program at a local hospital where an advisory group will help guide best practices in the area.

Inspiration in New Technology

For Dr. Chenette, the new technology involved with fertility treatment was what sparked his interest in a career in the field early on — and it is what continues to drive him today. He talks about the important insights we’re starting to gain about the genetics of eggs and embryos, and early embryo diagnostics.

“For the first time we’re starting to understand what makes a healthy egg — and that’s such wonderful information,” he says.

Nominate Your Fertility Doctor

FertilityAuthority.com features a dedicated fertility doctor (reproductive endocrinologist) each month. You can nominate your favorite fertility doctor by clicking here. We will contact you if your fertility doctor is chosen to be our Fertility Doctor of the Month.

Senator Kirsten Gillibrand (D-NY) introduced The Family Act of 2011, S 965 to the U.S. Senate just 2 weeks ago.  This bill will provide a tax credit to offset the high costs of some infertility treatment for those trying to have a family. There is a significant financial burden associated with  infertility because of the lack of insurance coverage.   This bill would help thousands of people diagnosed with infertility overcome the financial burdens of family building. 

According to RESOLVE, they are now working to secure Senate co-sponsors for this legislation.  This does not happen unless members of Congress hear from their constituents. A letter from you to your Senators is critical.

What YOU can do

1. Contact your two U.S. Senators 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.  You can add as much or as little information as you want in the body of the letter. The RESOLVE Action Alert System will do the rest!

2. Ask your friends and family to send letters too! Forward this link so they can take action today.  www.resolve.org/taxcredit

3. Share the information about the tax credit on your Blog or Facebook page! 

To learn more about The Family Act of 2011, S 965, visit RESOLVE now!

A 42 year old woman has given birth to a healthy baby boy by using embryos which had been cryopreserved (frozen and stored) for nearly 20 years.  Dr. Sergio Oehninger, Director of the Jones Institute for Reproductive Medicine at the Eastern Virginia Medical School, treated the woman who had been unable to conceive due to problems with egg production.  She had undergone almost ten years of fertility treatments without success when she was given five frozen embryos anonymously donated by another couple.  The donating couple had delivered a child in 1990 using an IVF treatment and had stored these additional embryos for over 19 years.  Of the five embryos, two survived after thawing and were grown in the laboratory for two additional days. Both embryos were transferred into the woman’s uterus but ultimately only one attached and grew.  In May 2010 a healthy baby boy weighing 6lb 15ozs was born.   

It is exciting to hear of cases like this one as it provides hope for other couples who might be able to use donated frozen embryos. The success of freezing and thawing embryos continues to improve with such new techniques as vitrification, embryo collapse before freezing or embryo assisted-hatching after thawing. Fortunately, there is also significant research data confirming the health of babies born after embryo cryopreservation. However, the majority of the cases used in the research to date have been frozen for less than five years. Therefore, we will need to gather more information on cases such as this one where the embryo storage has been for an extended time period. Happily, at least so far, there does not seem to be any “freezer burn” for embryos stored in liquid nitrogen.

-Carl M. Herbert, 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

It’s looking to be another typically busy week at the Center. Although the overall patient volume at PFC in 2009 was down about 10% from 2008, 2008 was a record year, so 2009 was more typical of the volume in the last 10 years. So far in 2010, we are up over this time in 2009. Many clinics in California and around the country are seeing decreased demand for IVF services, likely due to the poor economy. I heard on the radio the other day that the number of vasectomy procedures was up sharply in 2009 as well. A sign of the tough economic times, I suppose.

In 2007, the last year for which U.S. IVF clinics have official results tabulated from mandatory reporting to the CDC, the total number of  fresh IVF cycles performed in 430 reporting clinics was 142,435 resulting in 43,412 live births and 57,569 infants*. It is estimated that in western countries, about 1% of babies born are now from assisted reproductive technologies. Overall, about 36% of embryo transfers resulted in a live birth. This number continues to climb nationwide, at the same time the number of triplets and more is dropping (now at only 1.8% of live births, which is excellent). The twin percentage is still too high at 30% but we hope to also see this number declining in the coming years as overall success rates improve and we continue to emphasize to our patients the  much better outcomes of singleton pregnancy as compared to twin pregnancy.

Delayed childbearing still continues to be the biggest issue for human reproduction and fertility in the post-industrial world. This is especially true in the San Francisco Bay Area. The median age for women doing IVF in the U.S. was less than 35 but at PFC it is age 39. This may partly to do with the fact that in California, insurance coverage for fertility treatment is not mandatory, like it is in some states like Massachusetts and Illinois. Therefore, couples wait longer before availing themselves of the most effective treatment for infertility. This is also why the proportion of women undergoing IVF nationwide diagnosed with decreased ovarian reserve (i.e. diminished egg quality, a diagnosis that tracks with female age) is 10.3% but this diagnosis represents 31% of the patients at PFC.

*2007 Assisted Reproductive Technology Success Rates National Summary and Fertility Clinic Reports U.S. Dept. of Health and Human Services Centers for Disease Control and Prevention www.cdc.gov/ART/

Imagine a website that allows you to search for the very latest information on fertility. Well, it’s here and it’s called fertilitywire.com.

PFC is proud to present fertilitywire.com as a completely unique website that offers real-time and fresh information on fertility and infertility related topics. It’s a resource for people engaged in the process of becoming pregnant through fertility treatments or people studying this field who want to explore it.

And, it’s a unique resource in that it’s powered by a type of search called “browsing or universal search,” which is how we’re able to pull together all of the content for any given search term you see. You are able to see, in one place, the latest fertility related news, blogs, tweets, videos, images, articles and books.

We are excited by the positive feedback we have been receiving about fertilitywire.com. Here is one testimonial that sums up the experience very well:

“This website has a friendly approachable tone. It also covers so much, by the time I was done navigating, fertility issues seemed not intimidating but manageable and that there is a world that one could enter, (your center) and not be a stranger. At the same time, it seems like there is hope; if not here and now–it is being developed right around the corner.”

— Michael Lynn, PFC Patient

Visit fertilitywire.com. We hope you find everything you are searching for!

In the press today we see that the “world’s oldest new mom dies” at age 69 (see our earlier blog post clarifying that PFC did not treat this patient), three years after giving birth to twins conceived through IVF. Maria del Carmen Bousada apparently lied about her age to the Los Angeles Physician who helped her become pregnant, creating a firestorm of criticism in the press.

The case demonstrates one of the most basic dilemmas that we face in helping women become pregnant: at what age is a woman too old to become a mother?

Most of us might agree that a 25 year old woman is young enough to receive help, but that a 70 year old is too old. However, drawing the cut-off line at some point between these extremes is not easy. With the help of in vitro fertilization and donated oocytes, women like Maria can become pregnant at an age where nature would naturally prevent the possibility of conceiving. Typically, women run out of oocytes in their early 50’s and without oocytes and the granulosa cells that surround them, they lose their ability to make estrogen. This natural process, called menopause, can happen earlier or later for a given individual, but the ability to get pregnant and deliver a healthy baby declines rapidly for women in their late 30’s and on into their 40’s. The age of the woman is a determining factor of her since a 40 year old woman is trying to get pregnant with a 40 year old oocyte, and these older oocytes don’t perform well. For example, the older oocyte is not good at keeping track of its own DNA, as evidenced by the increasing incidence of genetic defects such as Down syndrome in older mothers. And as if this wasn’t bad enough, the rate at which oocytes are lost from the ovaries (also know as a woman’s biological clock) doubles at about age 38. If this doubling didn’t happen, we think that women wouldn’t reach menopause until their early 70’s. It is thought that the speeding up of the biological clock in the late 30’s is nature’s way of clearing out the remaining oocytes, so that women lose their ability to become pregnant but are then around to raise the children that they already have.

Based on nature’s model, we might consider limiting IVF treatment to women that are in their early forties or younger. But with donated oocytes, this limit can be pushed and there are no legal age limits for pregnancy. So, who gets to decide when it’s too late to become pregnant? As far as following “nature’s model”, is age different than other factors that lead to infertility? Do we make rules? And do the rules apply to men too, where nature doesn’t have limits?

Note: Pacific Fertility Center does have both lower and upper age limits in place.

News broke earlier today about the death of a 69 year old mother who had undergone fertility treatment at age 66. She gave birth to twins in December 2006.

This is a very unfortunate incident and we express condolences to the loved ones, especially the children who are left behind. However, it is necessary to clarify that Pacific Fertility Center was not involved in the treatment of this patient. The AP article printed the name of the clinic as “Pacific Fertility Center”, which is an error of ambiguity since there are two fertility clinics with similar names. The fertility clinic where this woman received services was Pacific Fertility Center-Los Angeles. Our center, which is located in San Francisco, has no affiliation with the clinic in Los Angeles. While our names are similar, our standards of practicing medicine are much different. To begin, here at Pacific Fertility Center in San Francisco, it is standard procedure to verify the identity and age of the persons being treated at every visit.  Our physicians would not have treated a woman at the age of 66, since we believe this to be unethical. At Pacific Fertility Center in San Francisco, we believe it is our foremost and ethical responsibility to assure the children that are a result of our services are provided loving and caring families.