FROM US TO YOU    Low O2 Incubators

In the IVF laboratory we strive to provide the very best conditions under which we can maintain sperm, eggs and embryos. Sperm are resilient and could tolerate a little hardship, but eggs and embryos are extremely sensitive to their environment. Sperm are quite happy at room temperature, for example, but eggs suffer irreversible damage if allowed to cool.

A very important part of the environment is the air in the laboratory. Embryos are only indirectly in contact with the air since they are grown in a special culture fluid that is covered with a layer of mineral oil. But they do need some of the gasses from the air and these simply diffuse into the oil and then the culture medium. Carbon dioxide (CO 2) is present in only tiny quantities in air (less than 1% by volume), but since it is a product of respiration it is present in the body at higher levels. We therefore supply the incubators with CO 2 to create a more physiological environment. Oxygen (O 2) is necessary too, and because air has plenty (about 21% of its volume at sea level) we don’t need to supply more. In fact, we need to take some away.

Even though we all think of O 2 as a life giving force, there is a growing body of research showing that embryos from several species do better in a low O 2 environment. Human embryos can clearly do well without a reduced oxygen environment as evidenced by the many thousands of IVF babies that have been born to date. However, it is possible that they could do better. So far the research has shown that embryos do well under low O 2 when kept in the laboratory for 5 days and transferred when they reach the blastocyst stage.

At PFC, most embryos are transferred back to patients or frozen after 3 days in the laboratory.

So far, there is no evidence that a low O 2 environment is necessary for these embryos, but we are moving towards such a modified environment for all. Currently the laboratory has 13 incubators, of which only 2 have oxygen controlling capability. These are used for the 10% of cases that are having transfers at the blastocyst stage. However, 4 more of these incubators will arrive in the laboratory this October and another 4 by year’s end. Our goal is to replace all of the current incubators by early 2006.

Those of you who take a daily vitamin pill are probably aware that antioxidants are now a common dietary supplement. We even recommend antioxidants for men hoping to improve their sperm health. Examples are beta-carotene, vitamins C and E and selenium. Oxygen is an aggressive molecule that gives rise to superoxide radicals and numerous harmful intermediates that cause cellular damage (known as oxidation). These radicals are highly reactive and they oxidize other molecules in the cell. Consequently, organisms that live in oxygen rich environments have had to evolve enzymatic systems to prevent free radical damage. Eating a varied and healthy diet will of course provide individuals with the antioxidants they need, but still some 30% of Americans are thought to take antioxidant supplements. One example of oxygen damage in the body is the oxidation of low-density lipoprotein (LDL or “bad”) cholesterol that contributes to fatty buildups in arteries.

We supply antioxidants, such as pyruvic acid or taurine, in the culture medium in which we grow embryos, and these readily mop up products of free radical breakdown such as hydrogen peroxide. But reducing environmental oxygen is now an important target and by early 2006 we will be growing all embryos in a reduced oxygen environment.

The physicians at Pacific Fertility Center are internationally recognized specialists in reproductive endocrinology and infertility. They have completed top-level medical education, published groundbreaking professional papers, and held positions on the faculty of leading research universities. They continue to participate in reproductive research. All MDs are Board Certified by ABOG as Reproductive Endocrinology and Infertility Specialists. Our state-of-the-art laboratory has one of the most highly trained teams in the country.

PFC SPOT LIGHT     Just Married

 I grew up in Ireland in a small fishing town on the North West coast called Killybegs. My parents were keen for me and my 4 brothers to have a good education so we were all marched off to boarding school at age 12 where we were indoctrinated with a good classic Catholic education. At University I studied Biology and Agricultural Science, much to the disappointment of my parents who wanted me to become an accountant.

 After graduation I applied for and secured an embryology job at London’s Hammersmith Hospital. The training was hard, and we were a small team doing a lot of IVF cycles. Other than the lab director, there was just one other embryologist - an andrology technician - to handle and process all sperm samples - and me. It was 1988 and the medications that prevent patients from spontaneously ovulating during an IVF cycle were just coming on line. Without these medications, we were doing oocyte retrievals at all times of the day and night, and occasionally patients ovulated before we could get to do their retrievals.

Retrievals were performed laparoscopically in the operating room, but if emergency surgeries tied up resources through the night, cycles were lost.

During this time, Hammersmith’s lab was performing groundbreaking work on Preimplantation Genetic Diagnosis (PGD). The lab collaborated with USA’s PGD pioneer Mark Hughes, MD, PhD. Over the years Dr. Hughes and I have continued to collaborate. (PGD has come a long way in over a decade!) After 3 years as an embryologist, I enrolled in a PhD program at the University of London where I studied embryo metabolism and development. I continued to work as an embryologist on weekends to fund my studies and was finally done by the end of 1994.

I was very fortunate to make the acquaintance of Professor Roger Pedersen from UCSF during my final summer in London and he invited me to come to San Francisco to join the IVF team at the University of California, San Francisco. As luck would have it, I had just won a Green Card in the immigration lottery that the US government holds each year, so I was keen on a move to the US.

The IVF program at UCSF was small at the time but over a period of 5 years, under the direction of Dr. Schriock and Dr. Givens, we built it into one of the largest and successful IVF programs in the country. I particularly enjoyed learning and working with Dr. Paul Turek, one of the nation’s leading male fertility physicians. We had enormous satisfaction making Dads out of guys that had been told that they would never have kids, and after 5 years we had outgrown our space.

Dr. Schriock and Dr. Givens invited Dr. Ryan and me to join them in a new adventure with Dr.s Herbert and Chenette. Pacific Fertility Center was purchased late in 1999 and San Francisco Center for Reproductive Medicine (SFCRM) and Pacific Fertility Center merged. For 3 years, we ran both offices, but in 2003 decided to consolidate and close the SFCRM office. Having all five physicians in one office and one laboratory to run was a wonderful change and made life easier on all of us.

Running the laboratory at Pacific Fertility Center is a fascinating and interesting job: there’s never a dull moment. I am fortunate to have one of the country’s most experienced and qualified groups of embryologists working here and we are a close-knit group of talented people. Our job best suits individuals with a compulsive nature, extraordinary manual dexterity and a positive work ethic. As a group, we like to have fun and we socialize a lot outside the office, but we also take our work very seriously.

In addition to running the lab here, I have many extra curricular activities that I enjoy. I am a faculty member at San Francisco State University where I teach Reproductive Technologies to graduate students. Together with other members of the lab staff, I inspect other IVF facilities on behalf of our accreditation authority, the College of American Pathologists, but I also enjoy informal visits to other labs for educational purposes. I do some consulting for smaller facilities that don’t have access to good resources and I sit on a couple of scientific advisory boards. I am a member of the board setting the embryology, andrology and laboratory director certification examinations that ultimately allow individuals to become High-complexity Clinical laboratory Directors (HCLD).

 On a more personal note, I was married in Hawaii this past September and I now live in Half Moon Bay with my son Tom (7), my wife Leslie, and her daughter Julie (4). Leslie teaches Advanced Placement Biotechnology at San Mateo High School. We are very happy with our busy Bay Area lives. In January, I’ll be entering my 13th year here, which is longer than I’ve ever lived anywhere. This is home now

 Joe Conaghan , PhD, HCLD, Pacific Fertility Center’s ART Laboratory Director is internationally recognized for his work with embryos. His background includes involvement with the first PGD on human embryos. His high standards and extensive experience bring national recognition to our laboratory.

Joe Conaghan, PhD, HCLD

ASK THE EXPERTS    FSH Test Kits

Q.

I've noticed that there are FSH urine test kits for sale over-the-counter to help women confirm the onset of menopause. Since FSH testing is involved in determining fertility reserve, can I use this over-the-counter FSH test to help realize my fertility potential?

A.
It appears as if a fair number of over-the-counter FSH test kits are indeed sold in drug stores and over the Internet. I am not going to comment on their efficacy for measuring hormonal changes that the pre menopausal body starts to undergo. But I can answer your question. These test kits are not useful tools to help you determine your fertility potential.

By way of background, human follicle stimulating hormone (FSH) produced by the pituitary gland stimulates primordial follicular growth and estrogen production by the emerging follicle that will mature into an egg.

The urine test kits provide a black or white - yes or no answer, not a glimpse of your FSH level in the context of a gray scale range of indicators. For accurate fertility potential diagnosis, we analyze FSH level in much more detail. On day two or day three of your cycle (following menses) we test your FSH level in conjunction with other tests including estradiol (E2) and an antral follicle count.

Most home urine tests, such as for pregnancy tests and ovulation predictor tests, use a threshold level of the hormone in the urine to detect a positive. With FSH test kits, only when the level reaches menopausal levels of FSH, equivalent to around 40-50 mIU/mL or higher in the bloodstream, will the test turn “positive.” For most women interested in testing for ovarian reserve, we would be looking for levels equivalent to 5-20 mIU/mL. So the sensitivity of the testing is set for menopausal and post-menopausal levels, not the levels seen in women with regular menstrual cycles. By the same token, they will not be able to discriminate normal from decreased ovarian reserve.

Carolyn Givens, MD

MIND/BODY@PFC    Saturday Workshop

Saturday December 10th from 9AM to 4PM
This workshop is taught by our experienced fertility caregivers Peggy Orlin, MFT and Allison Chamberlaine, RN who are both trained by Alice Domar, PhD, a Harvard Medical School pioneer in the development of mind/body programs for infertility.

Peggy Orlin, MFT is a Marriage and Family Therapist who specializes in the emotional aspects of infertility, third party family building and adoption. She has been a therapist for over 20 years and affiliated with PFC for the past 6 years. Her personal history of infertility led her to specialize in infertility counseling.

Allison Chamberlaine, RN is a registered nurse with 15 years of experience in the field of infertility. Ms. Chamberlaine has taught meditation and relaxation techniques for over 20 years and has been with PFC since 1996 where she now coordinates care for individuals involved in third party family building. Her personal history of infertility led her to specialize in infertility nursing.

Who Can Benefit from the Workshop?
Couples or individuals who are attempting to conceive and are experiencing emotional distress, and/or stress in their life. (You DO NOT need to be a PFC patient and/or currently in fertility treatment.)

What to expect at the Workshop?
A nurturing, supportive workshop where you will learn how to:
• Identify the potentially adverse impact of lifestyle behaviors on your reproductive health
• Employ multiple relaxation and stress reduction strategies
• Reduce your feelings of isolation related to infertility
• Decrease your symptoms of stress

How do I register?
Please call (888) 834-3095 for fee and workshop information and registration forms.
Space is limited.

CRITICAL REVIEW    Gender Testing by Mail

The U.S. marketplace is punctuated with products and services trying to lure desperate parents into believing that somehow, someway, it must be possible to predict and even select the outcome of the baby’s gender through various hocus pocus methods. Perhaps not coincidentally, many products and services, such as www.fortunebaby.com, appear to be subsidiaries of companies based in China and India where male babies are prized over baby girls.

In the line-up of such products, Baby Gender Mentor blood test hit the marketplace with great Public Relations fanfare including a brief interview on the Today Show and a headline in the Boston Globe. Sadly, both of these popular press outlets focused squarely on the debate about gender selection ethics and never seriously questioned the accuracy of such a test. As a result, millions of viewers and readers may have assumed the expensive test results were accurate. Acu-Gen charges $275 to mail order the test.

This was in June. Now, three months later, enough women who were lured into buying the test and assured by the company’s guarantee that it will reimburse misdiagnoses with 200% of their money back, are asserting the test doesn’t work. Many women are trying to get refunds and are being told by Acu-Gen that a “vanishing twin” may have caused the test to fail.

National Public Radio, taking a more critical stand, recently broadcasted a story pointing out that Acu-Gen offers little proof of its claims and admits that it is not required to undergo FDA testing to verify accuracy. On its web site, the company describes how the process purportedly works.

Gender-specific DNA from the fetus floats around in the mother’s blood stream after having crossed over the placental walls. The presence of the Y chromosome in the female blood via a finger-prick blood tests indicates a “male-positive” baby.

A visit to Acu-Gen’s Gender Mentor test web site reveals some other questionable assertions. Men are not allowed to be anywhere near the pregnant woman as she is having her blood drawn for the test. Acu-Gen also lists on its web site the names and publications of noted experts on fetal DNA testing, some whom NPR interviewed and deny any involvement with the company.

The notion that just five weeks into a pregnancy a simple blood test can accomplish what amniocentesis or ultrasound can do much later in a pregnancy is at this point wishful thinking. A dedicated web site: www.in-gender.com takes a more comprehensive and critical look at the claims of many sex-prediction and selection techniques and includes descriptions of the high-tech methods that do work.

Eldon Schriock, MD

RESOLVE SYMPOSIUM    PFC Speakers

In conjunction with National Infertility Awareness Week, Northern CA Chapter of RESOLVE’s annual educational event will be held on Saturday, October 29, 2005 from 8:15 AM to 6:00 PM at Holy Names University in Oakland.

This year’s theme is Options 2005: A Family Building Symposium.
PFC is a Platinum sponsor and will have speakers participating in sessions I and II.

Session l: Getting Ready to Choose an egg Donor: Eldon Schriock, MD
Assessing Ovarian Reserve: Isabelle Ryan, MD
Session II: The Latest Developments in ART: Eldon Schriock, MD
Avoiding Mix-ups in the IVF Lab: Joe Conaghan, PhD

For more information and to register go to www.resolvenc.org

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