I am very excited because this is my first blog entry. The world of social networking and blogging is new to me and I really like new things. That is why the field of assisted reproductive medicine is so fascinating. There is still so much to learn about human reproduction and we are finally getting the tools to crack open this black box. I’ve given a lot of thought as to what I’d like to accomplish with this blog. Pacific Fertility Center already has a very informative website and we do a good job covering scientific topics related to fertility very well in our Fertility Flash newsletter. So I think in this blog, I’d really like to focus on the day-to-day happenings in the Center. I’d like to give followers a picture of the goings-on in the office and what kind of daily challenges we face as we try to provide the absolute best technology and personalized care to our patients as they go through the infertility treatment process. Of course, readers, your feedback will be very important and I hope to address your comments as I present a day in the life of PFC….

Today all 5 doctors are in the office seeing patients. It’s a bit of a slow day in the Procedure Area and IVF Lab – only one egg retrieval and two embryo transfers are planned. We usually have about 4-6 egg retrievals and as many embryo transfer procedures but we do these procedures 7 days a week, 365 days a year, so anything can happen on any given day. Some days are crazy busy and some days, we can all take a collective breath and re-energize. For me as well, it’s also a slow day, which is giving me time to write this entry. I have 7 ultrasound appointments, one IUI (intrauterine insemination), one follow up in-person consultation and 6 scheduled telephone consultations.
We do free telephone calls and it really works out well for both patients and for us. We like to stay connected with our patients by phone and e-mail so their questions and problems can be addressed fairly immediately. We are having to transition away from standard e-mail to a new communication system because although we have a secure server, it’s still not really compliant with federal guidelines on privacy. So very shortly, we’ll be moving to a new system in our new EMR (electronic medical record) which will use a web-based patient portal through which we can have dialog and share lab results with our current patients.
We also have a two hour meeting amongst the 5 physicians and our Executive Director. We are going to be discussing changes in our protocol for our acupuncture in IVF study and also a potential opportunity to set up a collaboration to bring patients from China to PFC for IVF.

See article about fertility problems in China.

So, a bit of a slow day at the Center for my first blog entry but hopefully, there will be more exciting stuff to report on in the days to come. Stay tuned!

Carolyn Givens, M.D. was the first in San Francisco to successfully initiate a pregnancy using intracytoplasmic sperm injection (ICSI). She currently co-directs the Bay Area Pre-Implantation Genetic Diagnosis Program (PGD) and is director of PFC’s PGD program.

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.

The participants of our study will be randomly separated into two groups. One group will have acupuncture along with their IVF cycle and the other group will continue with their regular IVF cycle without acupuncture. Both groups will have the majority of their IVF medication provided for them at no charge. Those in the acupuncture group will also have their acupuncture treatments at no charge.

We are very excited about this study. It is the first of its kind involving extensive, onsite acupuncture treatment pre and post IVF. As a study participant, you have the opportunity to help us determine with greater certainty the influence of acupuncture on fertility. We hope to better understand its mechanism and use; thus assisting others in achieving their dream of having children.

If you are interested in finding out if you are eligible to participate in our study please call 415-834-3000 and ask to speak to the Patient Care Coordinator.

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

FertilityWire is a source of real-time fertility information and
insights founded by fertility doctors. Visit us: http://fertilitywire.com

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Become a fan on Facebook at http://bit.ly/dB7ewl

Thank you for your interest in subscribing to Pacific Fertility Center’s free monthly newsletter. We respect your privacy: Your email remains confidential and will not be shared or sold.
Please click here to change your subscription preferences.

—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.

Joe Conaghan, Ph.D., HCLD is PFC’s laboratory director. Dr. Conaghan is internationally recognized for his work on improving embryo culture conditions. His interests include developing programs for the treatment of severe male factor infertility; diagnosis of genetic disease in embryos; and improved embryo culture.

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.

—Joe Conaghan, Ph. D., HCLD

Joe Conaghan, Ph.D., HCLD, is PFC’s laboratory director. Dr. Conaghan is internationally recognized for his work on improving embryo culture conditions. His interests include developing programs for the treatment of severe male factor infertility; diagnosis of genetic disease in embryos; and improved embryo culture.

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.

This year Pacific Fertility Center is undergoing a much anticipated structural and design change. The clinic located on the fifth floor at 55 Francisco Street was purchased in 1999 from a previous owner, and after 8 very busy years, we are ready for a facelift. The opportunity to renovate our space came last month when PFC was offered an adjacent suite vacated by another tenant. The suite, adjacent to our laboratory, was perfect for an expansion that we had been considering for some time.

While the additional space is a bonus, the major benefit of the expansion is the ability to install a state-of-the-art air handling and cleaning system for the laboratory. With the addition of special air-lock doors, the laboratory will have improved separation from the rest of the building, ensuring the highest air quality. The air inside the laboratory will have an updated purification system to remove all particles and chemicals. These combined upgrades will further protect the laboratory from outside environmental influences.

The driving force behind the current construction is the air purification system, and isolation of the lab. However with this opportunity we are also expanding our laboratory space, purchasing new equipment, redecorating and painting. In the past, our laboratory was closed for several weeks at the end of each year to allow for major maintenance, equipment servicing, and cleaning related to normal wear and tear. The use of volatile paint and certain cleaning products is prohibited during the year on the entire fifth floor to protect the delicate growing embryos. The cleaning products normally used throughout the year, are ones we know do not affect our embryos.

We do have many other noticeable upgrades planned. We are taking this opportunity to update the rest of our center. The front reception and lobby are undergoing a significant renovation, as are our exam rooms and some of our offices.

All materials being used in the remodel are organic and toxin free. PFC continues to promote a safe and clean environment. Special paints will be used that are plant derived and free of volatile organic compounds (VOC’s). The chairs and furniture we purchase will also be VOC free. New carpets and flooring are already laid out in warehouses so that any chemicals used in their manufacture can dissipate before being installed.

As a further precaution, to ensure that all furniture, equipment, flooring and paint are guaranteed VOC free, we’re going to “cook-off” the lab by raising the temperature to about 120 0F continuously for 4 days prior to reopening. The high temperatures drive out any residual VOC’s and chemicals which will then be removed by the charcoal and potassium permanganate filters in the air handling system.

All of these changes will cause some minor disruption in our office during the next few weeks. To minimize the amount of disturbance we have construction crews working around the clock. In addition, we have dedicated some of our staff to assist patients in navigating the new space and construction areas.

Pacific Fertility Center is making a clean start. We look forward to welcoming you to our newly renovated clinic. We anticipate even greater success in the years to come. Thank you for your understanding. Please let us know if we can assist you in any way during this time of transition. Joe Conaghan, Ph. D., HCLD

Joe Conaghan, Ph.D., HCLD, is PFC’s laboratory director. Dr. Conaghan is internationally recognized for his work on improving embryo culture conditions. His interests include developing programs for the treatment of severe male factor infertility; diagnosis of genetic disease in embryos; and improved embryo culture.