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

**

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

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.

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.

Tuesday February 1st was a busy day here at Pacific Fertility Center. The front office was busy with their usual patient appointments, comings and goings for consultations, ultrasound scans and blood draws. In the procedure area and the lab, we were having one of our busier days, with 7 retrievals, 5 fresh embryo transfers and 1 frozen embryo transfer scheduled. It’s rare for us to have so many procedures on a single day, but because the exact date of a patient’s retrieval is uncertain and depends on their response to stimulation drugs, we get a day like this a few times per year. Fortunately, PFC has an exceptionally large and well-equipped laboratory, so we can cope easily with variations in case load. Also, both our nursing and embryology staff schedules are flexible enough to allow us to schedule extra staff when necessary. On that Tuesday for example, we had 8 of our 9 embryologists on duty in the lab

Even though most patient appointments don’t happen before 8 AM, lab and nursing staff are here between 7 and 7:30 in the morning to open up the facility and perform the usual quality control (QC) checks before the work day can begin. In the lab, once all QC and start-up procedures have been completed and documented, we begin looking at embryos that are to be transferred that morning, thawing frozen embryos for transfer, evaluating fertilization for the previous day’s patients, retrieving eggs and processing sperm samples. The nursing staff is busy checking in patients for retrievals, doing all their pre-operation checks and setting up IV bags, and coordinating patients for embryo transfers. Mornings are definitely our busiest time; we do this every day (7 days a week) so we like to think that the work flows smoothly.

At approximately 8:30 AM, right in the middle of the action, the power to our building and to those in a 10-block radius, went out. When a power outage occurs, there’s a split second when everything goes dark, but before you can think about it, emergency power kicks in and we almost seamlessly continue working. However, as part of our procedures for disaster preparedness, we have protocols for working during a power outage, and these immediately become active. First we check our emergency power generator and then all vital equipment to make sure that everything has power and is functioning normally. In the lab, one of our 15 incubators reset itself and went into calibration mode, so we simply moved its contents to a new home. No other problems or incidents occurred that day. We completed all retrievals and transfers in the usual way and our biggest concern was simply wondering why the power had gone out.

On the nursing end, patients were escorted up and down 5 flights of stairs because the elevators shut down, but otherwise their day was uneventful.

Emergency procedures and back-up power are a vital part of our operation. Our emergency generator will run our facility for 36 hours, or longer with the addition of diesel to the tank. The generator gets a 30-minute test run and an inspection every week. It receives a full service a minimum of 4 times a year and immediately after any power outage. After this instance, a service technician checked the generator and refilled the tank.

In the event there is a power failure when no one is present, the system will automatically switch over to back-up power. The alarm system in the lab then proceeds to dial each embryologist in turn on his or her home and cell phones until the call is received and verified with a code. All vital equipment is alarmed which enables us to check the status of the equipment from a remote location. We also have auditory monitoring capability and can listen to the background noise in the lab (such as a fire alarm) at any time. If it is necessary, we are prepared to have an individual physically present in the lab within 30 minutes of getting an alarm call.

Embryos and sperm in freezers don’t actually need power at all, provided that we physically fill the cryo tanks with liquid nitrogen once or twice a week. The computers that usually monitor and automatically fill these tanks do need power of course, but they are not essential to maintain refrigeration.

On February 1st, power was restored after 90 minutes, however we never know the time or duration of a power outage. At Pacific Fertility Center, we remain well rehearsed and prepared, just in case it happens on the busiest morning of the year.

Question: I am an OB/GYN in the bay area and I have a patient that is interested in having a baby girl. She asked about “sperm spinning” as a method of gender selection and whether it would be useful in her situation.

Answer: Our office receives a lot of questions from patients and members of the public about sex selection. Our location in the very liberal San Francisco may be cause for the increasing demand we see in having a baby of a predetermined gender. People are also well informed about what can be achieved with modern technology, and since sex selection is a reality, there’s definite demand for it.

The procedure that you ask about, “sperm spinning” is better known in the medical and scientific communities as the “Ericsson Method”. The technology was developed by the German scientist Dr. Ronald Ericsson and has been licensed in the US and internationally since the early 1970′s. It takes advantage of the fact that sperm bearing a Y chromosome (that would make a boy) are very slightly lighter than X-chromosome bearing sperm (that would make a girl). The distribution of X and Y bearing sperm in a normal sperm sample is equal, but Ericsson’s method uses gentle centrifugation of sperm through a slightly viscous fluid to segregate the heavier (girl) sperm from the lighter (boy) sperm. Since the difference in the weight of the 2 types is so slight (about a 3% difference in amount of DNA), a perfect separation cannot be achieved. Ericsson’s website (www.childselect.com) claims a 78-85% success rate in couples seeking a boy and a 73-75% success rate for girls. At PFC, we do not endorse or recommend this method of sex selection, nor can we verify the above success rates. As far as we know, couples availing of sperm spinning are not given details of how well purified their samples are prior to using them for insemination.

A more reliable method for separating sperm in our opinion is the “Microsort” technique offered at the Genetics and IVF Institute (www.givf.com) in Fairfax, Virginia. The technique was developed originally by Dr. Lawrence Johnson at the US Department of Agriculture, and was later refined for use in humans in collaboration with GIVF. Microsort also takes advantage of the small difference in DNA content between “boy” and “girl” sperm. The sperm are dyed with a stain that binds to DNA and then an instrument called a flow cytometer can effectively separate populations of sperm based on how much dye they have incorporated. The Microsort scientists test a small aliquot of every separated sample to determine the exact enrichment that they have achieved. According to the latest figures posted on their website (microsort.net) the average enrichment for X-bearing sperm is 88% with 91% (525/574) of babies born being female. The technique is less effective for Y-bearing sperm with an average sample purity of 73% and 76% (127/152) of babies born being male. Bear in mind that the figures for babies born might be distorted since some patients may have terminated pregnancies that were not the gender that they were seeking. You may also have noticed from the GIVF data that there’s more demand for girls than boys. This is likely due at least in part to the fact that X separations work much better and therefore may be used more, but Dr. Ericsson’s website also claims a much stronger female demand even though his technology supposedly works better for boys. We do support the use of Microsort sperm here at PFC but there are limitations on the use of this technology. First, the sperm can only be separated in 2 laboratories in the US, (Fairfax and Huntington Beach in southern California), and the Microsort researchers prefer that you attend in person to give a fresh sperm sample. Second, the technology is currently only offered under an FDA approved clinical trial, and you have to be doing family balancing or trying to avoid a sex-linked disease in your family to be enrolled. For most people, unless you already have a child of a different gender from the one you are seeking, you won’t be able to participate in this FDA study.

Last, but not least is preimplantation genetic screening (PGS) that can be used to tell the sex of embryos created during in vitro fertilization (IVF). We feel that this technology is the most accurate of the sex determining strategies since there’s less than a 3% chance of a misdiagnosis. Embryos generated in an IVF cycle are subject to a biopsy procedure on the third day of growth that allows a single cell from the embryo to be analyzed to see if it has 2 X chromosomes (female) or X and a Y chromosome (male). IVF with PGS is the most accurate method for sex selection, but also the most involved and the most expensive. The Ericsson method is the easiest and the cheapest, but carries a greater risk of being inaccurate.

Joe Conaghan, PhD

Pacific Fertility Center has consolidated into one location. Our smaller Laurel Street office closed on Aug 8, 2003. Dr. Chenette and his patients now enjoy magnificent views of the San Francisco Bay from our sun-filled headquarters, as well as easier parking – a welcome benefit for those navigating the city streets.

This move allows us to create the highest quality embryology and fertility program under one roof. In addition to improving both physician and patient access to resources such as clinical coordinators, nursing staff, fertility counseling, and laboratory/procedure facilities, the consolidation and expansion of our laboratories provides direct benefits to patient care.

The laboratory has increased its handling of embryos for PGD, preimplantation genetic diagnosis, using single-gene testing as well as aneuploidy testing. The latter is a significant development that can help those who experience multiple miscarriages. (See October’s issue coming up for a more detailed lab update). We have upgraded our frozen sperm and embryo facility and purchased 3 new state-of-the-art storage tanks. The new tanks replace more than 20 small tanks that represented the combined storage of our two laboratories. All our frozen specimens have been relocated to the new computer controlled tanks, which offer the most advanced and secure system available for tissue banking. Our continual attention to detail in the laboratory was recognized when once again PFC received the exceptional finding of “no deficiencies” from the College of American Pathologists-American Society for Reproductive Medicine (CAP-ASRM).

As always, your care comes first and it is our goal to make a seamless transition to a single practice location. Please do not hesitate to contact us should have any concerns regarding this transition. We’re excited about the changes here at PFC and look forward to the continued improvement of our center and our on-going role in your care.