Tune your radios to KGO 810 AM, tonight. Dr. Givens will be the featured guest on the Pat Thurston Show from 10 – 11 p.m. PST. Dr. Givens will be discussing many fertility issues including treatments, outcomes, and ethical issues. She will also be taking questions from callers. You may also stream the show live on the KGO website.

One of the biggest challenges we face as fertility medicine specialists is how to do more to help our least-likely-to-succeed patients. What I mean here is the 42-and-over age group, patients with high FSH levels (decreased ovarian reserve), patients with very low responses to fertility medications, or those with very poor quality eggs. Some patients have a combination of the above which leads to a really dim prospect of having a baby with their own eggs.

Some people get the impression that fertility clinics avoid these patients like they have a communicable disease. They get the impression that we try to cherry pick patients to keep success rates high and make the CDC stats look good.  My impression from talking to my colleagues across the country and certainly from our own practice is that we do not try to discourage patients with poor possibilities from making a consult appointment and discussing treatment options. We all have such patients. In fact, we have so many of them at PFC, I don’t think we would have many patients at all if we tried to pre-select our best prognosis patients for IVF. When it comes to treatment, although there are challenges and sometimes the rewards are few, we don’t just throw up our hands and give up. We try to come up with a strategy to achieve the goal, looking at the emotional reserves and financial resources we have to work with, and start by making a plan.

Sometimes that plan will be to try a couple of cycles of low-tech approach, like just intrauterine insemination or Clomid + insemination, or a mid-level approach, like injections of FSH along with  insemination. We would see how things go and play it by ear from there. Sometimes, the plan will be to blast ahead to the big guns, full steam ahead to IVF. Sometimes, it’s counseling with our marriage and family therapist to begin the discussion: are we ready to move on to donor eggs? Sometimes it’s a sequence of all of the above. There really is no one plan for any one person. It’s just too complex to say one size fits all.

A certain percentage, even of the-less-likely-to-succeed patients will get pregnant with their own eggs and go on to deliver a healthy baby. The remainder may be faced with a tough decision. Do we just stop here and live child-free?  There are certain perks to that plan (sleeping in on the weekends, eating in nicer restaurants, adult vacations to name just a couple) but most people want to have a family no matter what or how. So then there is the adoption vs. egg donation question. There is no right or wrong choice here, either: just choices.

Progress has been steady at the Center this week. From last Sunday up until this coming Saturday we will do 13 egg retrievals, 14 fresh embryo transfers, 6 frozen embryo transfers and one hysteroscopy. It looks to be a fairly typical week.

Last Saturday I attended an investigators’ meeting, along with our lab director, Dr. Joe Conaghan, for a new clinical research study that we may be undertaking with Gene Security Network (GSN). GSN is one of the pre-implantation genetic diagnosis/screening (PGD/PGS) laboratories with which we work. I really can’t discuss the details of the study at this time, as we have signed a standard non-disclosure agreement with GSN, but this will be a big study to investigate how useful PGS will be to the average IVF patient.

This leads me to the topic of today’s blog: clinical research. Although PFC is not an academic institution, we are still interested in research because this is how the field of reproductive medicine advances. In fact, since there are so many private IVF clinics, much of the research on IVF is currently being done in the private sector. We would not have the field of assisted reproduction today if it were not for clinical research and for the thousands of patients who have participated in this research to this point. I’d like our readers to know that participation in research is not taken lightly by anyone conducting the studies. As investigators, we all have to be trained in the ethical conduct of research, to make sure the risks of participation are minimized and that there is potential benefit to patients from participation. Our number one goal is still to get our patients a healthy pregnancy. We will not compromise that goal for the sake of a clinical study. The study protocols are carefully reviewed by an independent Institutional Review Board (IRB), tasked with ensuring there is no harm or undue coercion to participants. In most good studies, the design of the study includes a “control arm” and the patients who are randomized into this arm receive current standard treatment. The patients randomized to the “treatment arm” receive the treatment under investigation. It is very important that the patients in the treatment arm should be expected to be at least as successful, if not more so, than the patients in the control arm.

This year, PFC is participating in at least 4 clinical studies. Some, like our acupuncture study, are designed by PFC and are only being done at our facility. Some, like the GSN study, are being designed by the company and will be done at multiple IVF centers, then GSN will pool the data.  If you are interested, please let us know. I will be posting more details very soon to our PFC website.

UPDATE: Research web page is live

UPDATE: This study is currently on hold while we attend to some administrative details. Please check back to this blog often, as we will keep our readers updated.  You may also call the New Patient Coordinators at 415 834-3095 for more information.

PREVIOUSLY: Pacific Fertility Center is pleased to announce that as of October 1st we are enrolling patients into a groundbreaking research study to determine the value of combining acupuncture with IVF. Traditional

Chinese medicine has been practiced in throughout Asia for thousands of years:in the last decade, the west has been following suit.

There have been sufficient peer reviewed studies to warrant a clinical trial in which there are predictable parameters of patient involvement. One of the first studies involving acupuncture and IVF was published by Paulus et al in the journal Fertility Sterility in 2002. The Paulus study reported the influence of acupuncture on the pregnancy rate in patients who undergo assisted reproductive therapy. Clinical pregnancies were documented at 42.5% of patients in the acupuncture/IVF group, whereas pregnancy rates were 26.3% in the control group, using IVF alone. In this study, the acupuncture was performed before and after embryo transfer only.

How does acupuncture affect fertility? A review article in Alternative Therapies (Anderson 2007) suggested four possible mechanisms by which acupuncture could improve the outcome of IVF: modulatingneuroendocrine factors; increasing blood flow to the uterus and ovaries; modulating cytokines; and reducing stress, anxiety, and depression.

Pacific Fertility Center and The Fertility Flash would like to invite you to a special Valentine’s Day event.
Do You Love Your Genes? Tweetup/Meetup (a Valentine’s Day event)
Thursday February 11, 2010 at 5:30pm
Pacific Fertility Center’s Education Center
55 Francisco St., Suite 550
San Francisco, California 94133 Get Directions

Please join us for genes, love, award-winning wine, chocolate, and tasty, healthy appetizers!

To view the invitation, click here

This is an in-person and virtual event for all who would like to participate and learn about the leading edge of genetics and fertility. We will also be tweeting live during the event to communicate with and connect tweeters.

Genes are an important part of life, especially for those who are struggling to conceive a child.  At this event we will celebrate these building blocks of life in all forms, whether they come from biological parents, birth parents, or donors.

We will also be joined by representatives from Counsyl and the Gene Security Network (GSN) to speak about their cutting edge genetic testing technologies.

For more details on our presenters see:

Pacific Fertility Center: http://pacificfertilitycenter.com
Counsyl: http://counsyl.com
GSN: http://genesecurity.net

**

Please RSVP at rsvp@fertilitywire.com or on Facebook at http://bit.ly/bopZUZ

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insights founded by fertility doctors. Visit us: http://fertilitywire.com

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—Best regards from all of us at Pacific Fertility Center.

Special LGBT event happening tomorrow! We hope to see you there.

6:30 – 8:00 PM
LGBT Community Center
1800 Market St., San Francisco
Call 888-834-3095 or contact us for reservations

Attend an informative educational event on Wednesday, October 7th and hear firsthand from gay and lesbian parents about their family building experience. This is an opportunity to ask you specific questions and learn about advanced family building solutions.

Topics include:

* Selecting the right donor and/or surrogate
* Emotional & psychological aspects of gays & lesbians having children
* Hearing gay and lesbian parents accounts of their personal experience

Let Pacific Fertility Center be your guide on your journey to building a healthy family.

This summer, we are introducing a new procedure in our laboratory that will allow us to do genetic testing on embryos that have reached the blastocyst stage of development. Traditionally, embryos are biopsied when they are just 3 days old at which time they should have reached the 8-cell stage (see figure 1). The biopsied cell is sent to the genetics laboratory for testing while the remainder of the embryo continues to grow in our laboratory. The genetic testing results are received 48 hours later, when we hope that the embryo will have reached the blastocyst stage (see figure 2). Blastocysts that have passed genetic screening can be transferred or frozen for later use.

Performing the biopsy when the embryo has become a blastocyst is more technically challenging, and it allows less time for the genetics lab to do their testing. However, in a blastocyst, we are specifically able to biopsy from the part of the embryo that will become the placenta, and we can get more than 1 cell, which allows for greater accuracy in the genetic testing. Depending on how quickly the test is run, the embryo may have to be frozen while we wait for the results.

While freezing is inconvenient, it does allow time for more complex genetic testing, and for multiple tests if necessary. And, with the success of vitrification for preserving embryos (see Fertility Flash Vol. 7, Issue 3), we are confident that the frozen embryos will survive and implant at high rates when thawed.

In the next few years, we expect that the traditional methods for biopsy and genetic testing will disappear and that blastocyst biopsy will be the standard procedure. As genetic testing evolves, it will not be possible to rely on just a single cell from an embryo to get dependable results. We already know that there is genetic variability among cells in an individual embryo, a phenomenon known as mosaicism, and our new procedure will overcome this problem.

In the coming months, we will announce an exciting new partnership with a Bay Area genetic testing lab, and we will keep readers informed on our progress with genetic testing in embryos. This is an exciting field that continues to evolve.

We are excited to introduce a new website FertilityWire, http://fertilitywire.com.  This site is separate from our current website www.pacificfertilitycenter.com.

FertilityWire will provide access to a wealth of fertility information, news, and social content. Please take a moment to check out this exciting new resource. You can let us know what you think in the comments section.

Enjoy!

-Robb Mayberry, Director of Development

In October of 2008, after many months of planning, PFC began construction on our new lab. The design called for an environmentally friendly facility that was bright, open, and efficient for our 8 embryologists and the many thousands of embryos that we care for each year. The size of the lab was doubled to allow for the addition of more embryo incubators and ensure room for future growth.

Traditionally the embryology lab is an area that is not accessible to patients or visitors, but our new design utilizes glass walls in key areas and makes our activities more transparent to the outside world. While the lab remains a secure area with limited access, the activities inside can be observed from the outside by anyone passing through our facility. This openness is important to all of us at PFC; we want to remove any mystery associated with the IVF lab, and allow patients free “visual” access. Large TV monitors are installed above several of the microscopes to further open up the world of IVF. We are proud of the work we do at PFC and we want to share.

While the glass walls are largely a cosmetic change, almost every other part of the new lab was designed with the health of our embryos in mind. The installation of a specialized and custom-designed air filtering unit consumed over 20% of the budget for the project. Our goal is to have highly purified air circulating in the lab. The new air handler achieves this goal with the use of a series of filters that remove all particles and chemicals from the air. The lab is further protected from the outside by two separate air lock doors that use positive pressure from the inside to the outside to keep unclean air out.

All supplies and consumables for the lab are handled by the embryologists only, who also take responsibility for all cleaning and other custodial functions. We empty our own trash and wash our own floors. These precautions are in place not only to keep custodians and other building staff out, but also to control the chemicals and cleaners that might con- taminate our clean environment. All com- pressed gases (which feed our incubators) and liquid nitrogen (for our frozen embryo tanks) is piped in from outside the lab, so that it is not necessary for delivery people to enter the lab.

Our incubators in which the embryos develop are fundamentally the most important pieces of equipment in the lab. These incubators are monitored, serviced, and maintained by the embryologists, who have specific training in the use of all of our equipment. Quality control checks are exhaustive and performed daily to make sure that all equipment is functioning exactly as specified. A change of even a half degree in temperature could cause problems in an incubator, so monitoring is continuous and detailed. The gases that are piped into the incubators (carbon dioxide and nitrogen) are filtered as they enter the lab to make sure that they are pure.

The laboratory is supplied with emergency power from a large dedicated back-up generator located at the side of our building. Should there be a major power outage this generator produces power for at least 36 hours before it needs additional diesel. Our generator has proved itself many times over during the years of rolling black outs and other power failures.

We continue to upgrade our facility and maintain the standards of excellence that makes PFC the choice of patients. At the time of writing, we are working toward installing a second back-up system in the event that there is a power outage and our back-up generator fails. We are also always examining new equipment that will allow us to offer new technologies to patients. As we move forward, we will report our latest developments at PFC in the Fertility Flash. In the meantime, come by and visit with the embryologists through the glass. We won’t wave at you, but we’re happy to see you checking up on us. We want you to know that your embryos are in good hands.

To schedule a tour contact one of our New Patient Coordinators at 888-834-3095.

Cutting Edge Approaches to Sex and Relationship Therapy

Presented by: Dr. Naomi O’Keefe,
Licensed Clinical Psychologist

Thursday, March 26, 2009
Time: 4:00 – 5:00 p.m.

Program will be held at the
PFC Education Center
55 Francisco St., Fifth Floor
San Francisco, CA 94133
Parking in garage will be validated.

The Educational Series is a complimentary service provided by PFC to health care professionals specializing in the field of reproductive medicine, obstetrics and/or gynecology. Please watch for future talks on a variety of topics within the field.