Growing up in a small town in New England, where the population of dairy cows outnumbered townspeople and the nearest neighbors were miles away, gave me the desire to work with people. As an Amherst College student in Massachusetts, my anthropology studies led me to an economic development project in eastern Africa. Upon my return the social and economic needs of people right here in the United States became more clear to me. My honors thesis included field work with homeless populations in southern California documenting their remarkably savvy ways of engaging in local politics and with the media to meet their basic needs and improve their quality of life.

As a graduate student at the University of Southern California I studied visual anthropology and media production in the schools of Anthropology and Film and Television. I received a Masters Degree in Film Production with an emphasis on ethnographic film.  My focus then shifted to interactive communications. I spent several years working for companies in Northern California that were developing low-cost and easy to use interactive technologies that would enable increased communication among distributed populations. I worked in usability and market research, which meant discovering how people interacted with these products in order to improve their usability and user experience.

After my experience in communications, I returned to a more anthropology focused career.  I joined a UCSF research team studying fertility decision-making.  For the next 8 years I worked in the field of medical anthropology with an incredible team of experts that included a distinguished Reproductive Endocrinologist and a pioneering Medical Anthropologist conducting research into patient experiences and decision-making with reproductive technologies and third-party reproduction. I worked with scores of patients who had experienced infertility and benefited from reproductive technologies to build their families. This turned out to be a great synthesis of my interest in people in their personal and social contexts and my love for technology which has continuously motivated me to better understand how social and technological innovation can be used to improve the quality of peoples’ lives.

I am privileged to now work with the amazing talent at Pacific Fertility, where as a Research Analyst on Cynthia Willson’s team, I shepherd clinical studies that continue to increase our understanding of human reproduction and the ways in which new and old technologies may improve fertility outcomes and patient experiences. One of our current studies investigates how the use of Traditional Chinese Medicine such as Acupuncture may affect birth outcomes and patient quality of life during treatment. Patients enrolling in this study may have the opportunity to receive acupuncture treatments before and during IVF at our in-house acupuncture clinic as well as having some IVF medications donated while they are in the study. I also have the honor to be helping conduct a trial of a ground-breaking imaging technology that is designed to predict which embryos at early stages of development will be most likely to result in viable blastocysts and subsequent pregnancies and births. Patients enrolling in this study are helping future IVF patients improve their chances for success while they also may be eligible to receive some reimbursement of IVF expenses. New studies are in the works that will be expanding our knowledge about the role of genetics in treatment as well as aspects of patient decision-making. Stay tuned for updates as research opportunities become available.  I am incredibly excited to be at the crossroads between the highest standards of treatment and patient care and new technological innovation that will continue to allow more people to create their treasured families.

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.

According to Resolve, Rep. John Lewis (GA) introduced a bill in the U.S. House of Representatives on November 30 that would provide eligible taxpayers a tax credit for the out-of-pocket expenses associated with infertility medical treatment. 

The “Family Act of 2011,” HR 3522, is a companion bill to S 965 which was introduced in the U.S. Senate in May 2011.  Advocates can now push for action on the two bills including bipartisan co-sponsorship, Committee hearings, and a vote in both chambers.

If you would like to support this bill, contact your U.S. Representative and ask them to co-sponsor HR 3522.  According to Resolve, you can do this by completing the following:

Contact your Representative 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.

To learn more about The Family Act 2011, visit the Resolve website today! 

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.

Tune in for a Channel 5 news special! The story shares the journey of Dino, a single restaurant owner, and his quest to have his own son. The special also features PFC’s Dr. Carl Herbert.

The two part special will air on Channel 5 on Wednesday, November 16th at 11pm and Thursday, November 17th at 6pm.

You won’t want to miss it!

PFC is proud to announce that all 5 Pacific Fertility Center Partner physicians have been named top reproductive endocrinologits on the U.S. News Top Doctors list.  Drs. Philip Chenette, Carolyn Givens, Carl Herbert, Isabelle Ryan, and Eldon Schriock were selected as top doctors based on a peer nomination process by U.S. News Top Doctors and Castle Connolly Medical Ltd.

Congratulations to each of you for this incredible honor!

In case you missed Dr. Carl Herbert on the Fertility Forum radio show, you can download the Podcast on iTunes or the MP3 version from the Fertility Forum website.  Hear Dr. Herbert talk about the History of ART, Genetics, Fertility Preservation, Egg Banking, and other topics in the field of Assisted Reproductive Technologies. 

We hope you enjoy!

Meet with a Registered Dietitian and:

Nutrition consultations consist of:

Not sure if you are a candidate for nutritional counseling?

Set up a time for a free 20 minute phone chat with the dietitian to find out!

Ask a member of the front desk or call 415-834-3000 for more information or to set up an appointment.

Alison Boden, MPH, Registered Dietitian

Alison received her undergraduate degree from UC Davis, followed by graduate training in nutrition and public health from the University of North Carolina at Chapel Hill. As a practitioner of integrative nutrition she takes a holistic approach to wellness, recognizing that the foundation for optimal health and healing begins with a health promoting diet. Her emphasis is on using medical nutrition interventions to create a basis for health promotion and healing.

A lover of good food, Alison believes that a healthful diet should be thoughtful, enjoyable and satisfying. Each meal does not only provide calories, but is an opportunity to supply our organs with the nutrients and building blocks needed for health. When the body is out of balance, as in the case of infertility, proper food choices can correct deficiencies and bring balance back to the system. What you eliminate from your diet is often as important as what you include. Consultations with Alison will help you address the key components of your diet that may be affecting your fertility and wellbeing, as well as help prepare your body for pregnancy.

Alison has experience assessing and counseling clients related to pregnancy and fertility, weight management, lipid control, food allergies, digestive health, sports nutrition, and chronic diseases such as cardiovascular, kidney disease and cancer. She views each person as a unique individual, and is dedicated to educating patients on natural ways to achieve optimal health and allowing them to take an active role in their health care decisions.

Alison is a member of the American Dietetic Association and the Women’s Health and Integrative and Functional Medicine practice groups.

Tune in and listen to PFC’s Dr. Carl Herbert talk about the History of ART, Genetics and ART, Fertility Preservation and Egg Banking on The Fertility Forum radio show Monday, October 17^th from 6-7 pm PST.

To listen, you can call in live to 877-864-4869 or go to The Fertility Forum webpage and listen there.  You can also click the LIVE CHAT button on the website to IM live during the show!

If you can’t tune in on Monday, you can download the audio AFTER the show from either the site above OR iTunes.

Don’t miss it!

Embryo freezing is a routine part of the IVF process.  Approximately 60% of patients have embryos in frozen storage after their cycle is complete.  These embryos can be used at any time; but it is common that some embryos remain after couples have completed their families.  This situation leaves patients facing a very difficult decision regarding the final disposition of any embryos still frozen.  Quite often patients are not prepared to make such a decision, nor are they aware of their disposition options. Patients were so focused on simply getting pregnant, they had not considered what to do with any remaining embryos after the cycle was complete. This article provides a brief explanation about the three disposition options available at PFC for surplus frozen embryos: disposal, research (and then disposal), or donation to another couple for use in achieving pregnancy.

Disposal of your embryos means they are removed from the storage tank and placed in a biohazard waste disposal container. Once the embryos are removed from the liquid nitrogen storage tank, they lose all viability in a matter of seconds. The embryos are not used for research purposes, not donated to any individual or company, and are not cultured beyond the stage of development at which they were frozen.  They are disposed of as medical waste.

Donating your embryos for use in research requires that the embryos be shipped to a company called Reprogenetics, LLC, based in New Jersey (www.reprogenetics.com). At Reprogenetics, the embryos are studied to understand normal and abnormal development.  Donating embryos specifically for stem cell research is also possible.  Reprogenetics offers a stem cell research option, however,  some additional paperwork must be completed directly with Reprogenetics  Whether donating to Reprogenetics for stem cell research or basic research, a PFC Research Disposition form must be competed.

Donating your embryos for use by another couple can be broken down into three sub-categories: known donation, open donation and anonymous donation. Known donation, also called directed donation, is the donation of your embryos to a person or couple that you know personally, perhaps a good friend or family member.

Anonymous donation of your embryos means that you donate your embryos to an organization, and the organization places your embryos with a family that you do not know and will not meet. The identity of both the donors and the recipients is not disclosed to either party. Through the PFC Embryo Placement Program, only anonymous embryo donations are accepted. Any stipulations about to whom or to what type of family situation the embryos are donated cannot be accommodated (i.e.: that the embryos be donated to a two-parent household, or a household of a certain income level, or living in a certain geographic area). The placement of anonymously donated embryos operates on a first-come, first-serve basis. At the moment, we have a very long list of patients wishing to receive donor embryos. Currently there is nearly a two year wait).

Open donation is the donation of your embryos to a party that you do NOT know, but wish to meet, and/or possibly remain in contact with, after the embryos are donated. Open donations require further legal expertise and overall guidance and handling beyond PFC’s current abilities. For these reasons, PFC is unable to offer open donations to our patients. For those interested in an open donation, or for those requesting certain criteria be met by the recipients, patients are encouraged to research third party agencies that facilitate embryo donations, both anonymous and open. One such program is the Snowflakes Frozen Embryo Adoption and Donation Program (www.snowflakes.org), operated by Nightlight Christian Adoptions. Snowflakes facilities both open & anonymous donation of embryos and can accommodate most requests from the donors and the recipients. Another possibility is Miracles Waiting (www.miracleswaiting.com), an online do-it-yourself matching program for donors and recipients. More general information about embryo donation and adoption can be found at the National Embryo Donation Center (NEDC): www.embryodonation.org.

At PFC, all embryo dispositions are handled by our tissue bank manager Alexis VonAustin.  Her contact number is 415-249-3636. She can assist you with information, paperwork, and if necessary, with the shipping of embryos to the agencies listed above.

- Alexis VonAustin and Joe Conaghan, Pd.D., HCLD.