Finally, I would like to share my philosophy about my role as a fertility physician and the set of beliefs that guides me in my relationships with my patients.

1. Be honest. My number one role as a physician is to care for my patients. This sounds so obvious, but I, as I suspect is true of most doctors, went into medicine because I wanted a career where I could provide for the medical and the emotional needs of those I CARE for. My job is to provide the best information to my patients, based on sound medical evidence (i.e. research studies) so that they can make informed decisions about their own care. Sometimes, the information I provide is good news: your chances are good, we can help you. Sometimes, the news is not so good: your chances of conceiving are statistically very low and you may need to consider alternatives. Whatever the situation, my job is to provide this honest assessment in a compassionate manner and help my patients come to the right decision.
2.  Commit to the treatment. Once the patient and I have made a decision on the course of treatment based on the best information, I commit myself to this completely. We may modify the plan as we gain more information in the process, but I am fully committed when it comes to implementing the treatment plan.
3. Keep striving to be the best. This means attending meetings, reading journals, staying current with research studies and applying sound data to keep the treatments we prescribe grounded in the best medical information. If I don’t know the answer to a problem, I do my best to find it.
4. Use information wisely. I do not jump into the latest fad in fertility treatment. After 20 years in this field, I have seen a lot of hot ideas come and mostly go. What sounds so good on the surface often, under the careful scrutiny of well done studies, does not end up being the magic bullet everyone had hoped.  However, other promising ideas (e.g. ICSI, egg and embryo vitrification, microarray PGD) do turn out to be sound. The beauty of PFC is that as soon as we can verify a treatment to be sound, we can incorporate it into our practice.
5. Strive for the overall health of our patients and their family. My responsibility is to ensure that my patients’ treatment is safe as well as effective. This means not only the safety of the patient during treatment, but also the fetus and baby.  We are working very hard to minimize multiple gestations, even twins, because this is the one thing we can do that will directly impact the health of our patients’ children.
6. Live compassion. If a physician does not take the time to get to know his or her patients and their individual needs, how can there be treatment of the complete person?  In my scrapbook I have saved the thank you cards, baby announcements and yearly holiday greetings from my patients of the last 15 years, so one day I can look back with pleasure on my life’s work. But the greatest compliment comes from the patient who tried very hard to conceive and could not, despite their and my best efforts, and says to me “thank you for giving me all you could. I know you tried your best and I was well cared-for.” That means the world to me.

 -Carolyn Givens, M.D.

I was born in 1948 in North Carolina to a red headed father who, sure that I would have similar coloring, nick-named me “Rusty”.  My father was an Ob/Gyn who eventually established his practice in Gainesville, Florida where I grew up in what was then a small southern town. Although the 1950s and 60s were interesting times in the deep south, we were quite fortunate to live in a “university” town with the University of Florida providing an important intellectual and social influence, which wasn’t present in other areas surrounding us. My father was from Manasquan, New Jersey and my mother from Brooklyn, New York, so my siblings (a family of five children) and I were mostly educated in the northeast after primary schooling in Florida. I graduated from high school, The Peddie School, and college, Rutgers University, in the garden state of New Jersey. During one summer of my college years, the summer of 1968, yes, the summer after “the summer of love”, I lived and worked in San Francisco, which is probably a major reason I now reside here. After college graduation, I returned home to attend the University of Florida where I earned an MS degree in Environmental Engineering Sciences and subsequently an MD degree, making me a fourth-generation physician.

I spent one year in St. Louis at Washington University as an intern in Ob/Gyn where I met fellow residents and long time friends Drs. Elliot and Denise Main, as well as my future wife, Katharine. At years end I moved to Nashville, Tennessee and completed both a residency in Obstetrics and Gynecology and a fellowship in Reproductive Endocrinology at Vanderbilt University Medical Center. While at Vanderbilt, Katharine and I enjoyed working together.  She as a nurse-midwife and I was a resident.  After the birth of our first child, Katharine became involved with county health care programs and I began my fellowship. I joined the Vanderbilt teaching faculty upon completion of my fellowship and served as the Director of the Reproductive Endocrinology / Infertility Division from 1989-90.

Early in my medical career, I had the good fortune to participate in some “firsts” in the field of reproductive endocrinology and infertility. While at Vanderbilt University, I did pioneering work with the first laser laparoscope and was involved with one of the first assisted reproductive technology programs in the United States. I authored several early articles on endoscopic surgery, including one of the very first articles published on the treatment of tubal disease via laser laparoscopy. I was also fortunate to be a part of those early difficult and formative years in the area of IVF and contributed to numerous articles as we tried to create additional and better ways for success.  

In 1990 I was recruited by the original Pacific Fertility Centers to join their San Francisco clinic, where I was appointed Medical Director. However, desiring to create my own concepts for care, I left PFC to become a partner and Medical Director with the San Francisco Center for Reproductive Medicine. Dr. Chenette joined me very soon thereafter. With much hard work and help from many of our current staff, SFCRM became a leading center for infertility care and assisted reproductive technology services in Northern California. In November of 1999, Dr Chenette and I joined forces with Drs. Givens, Ryan, and Schriock and took over the management of the current Pacific Fertility Center. Our vision was to create a center of excellence that was large enough to do good clinical research and answer some of the important clinical questions in our field. We all came from academic backgrounds and knew the benefits of collegial interaction, but felt there was a better way to offer patient-centered services. PFC is the culmination of our collective dreams and ambitions to create such an optimal center. We are indeed proud of the result.

After years of clinical practice in our field, I find I am most drawn to the numerous and complex ethical issues which are products of our ever changing technologies. This interest has led me to diverse activities as a 22 year membership in the Society for Humanism in Medicine, including the 2003 presidency, and a planned speaking engagement this year at the annual meeting of the American Academy of Child and Adolescent Psychiatry, regarding the ethical issues involving children conceived through reproductive technology.

When there is the “extra” time away from medicine, I enjoy the excitement of international travel, the pleasure of a good bottle of Burgundian wine, the stretch of great contemporary jazz music, and the stimulation of a unique piece of art. I have taken on the “egg” image as a passion for collecting and now own a wonderful group of vintage and modern photographs as well as “eggs” in other media, some of which you will see in our office. I have two wonderful daughters, Sarah and Rachel, and I feel so very fortunate to count myself as one of those who arise each morning looking for this day to be better than the last. 

” When you don’t know something can’t be done, it makes it possible to do.”  -Brother Thomas Bezanson  

Dr. Rusty Herbert, M.D.

Last November, PFC embryologist Erin Fischer had the opportunity to travel to Cairo, Egypt for the 16th Annual Meeting of the Middle East Fertility Society (MEFS). At the meeting, she presented an abstract on our vitrification results at PFC and also assisted with a vitrification workshop. She met many remarkable embryologists from all over the Middle East while teaching the embryo vitrification and sharing the successes that PFC has had with vitrification.She also had the chance to visit three IVF clinics in Cairo during her stay. “Seeing other IVF labs was the highlight of my trip, I was impressed by the large number of cycles that these teams performed daily,” comments Erin. She adds,“Traveling to Egypt was an amazing experience. I was proud to represent PFC and appreciate our state of the art facility.“

After 10 years of publishing newsletters, many with personal stories from our own employees, we have decided that it is time to do personal stories on our own physicians. So this is the first of our five physicians’ own stories we will be sharing with our readers over the next several issues. We hope you enjoy these stories and get to know our PFC doctors a little better.

I was born in Wahiawa, Hawaii in 1957, two years before Hawaii became a state. My mother was a Nisei Japanese woman, born and raised on the Big Island of Hawaii, where I hope, if I live long enough, to retire someday. My father was a Texan, raised on a dry land cotton farm in the Panhandle of Texas. He was adopted so I don’t know his genetic and ethnic background, but we suspect perhaps Welsh-Scottish. My parents met in Hawaii during WWII. I grew up the youngest of four children. I have two older sisters, with whom I am very close, and I had an older brother I loved very much but lost to kidney cancer two years ago. My mother never got to graduate from high school as she had to help her father in his general store, but she was a remarkably intelligent woman with a life-long thirst for knowledge. She received her G.E.D. at age 42; in another time, she could have been a very accomplished career woman. I was very lucky to have her for a stay-at-home mom. My father finished high school and joined the Navy just before WWII. He never went to college, but worked for the US government all his life in civil service for the Army. He rose to quite a high rank by the time he retired, due to his diligence and competence. We lived in Hawaii until I was 8 years old, then we lived in Okinawa, Japan during the Vietnam War (1965-1973). After that, my father was stationed at Ft. Hood, Texas. It was good for him to return to his home state after 35 years on islands, but hard on my mother and me, who had always lived on tropical islands with Asian culture. I graduated from high school in Central Texas and, not knowing what I wanted to do, enrolled at the University of Texas at Austin, because it was inexpensive and close to home. This was a stroke of luck because I received a wonderful education there for very little money, and it paved the way to medical school. I worked all kinds of low paying jobs to help pay my way through college, as my parents didn’t really have much money. I entered the university as an English major, as I loved literature, but quickly realized there would be no work in that field. I took a biology course my freshman year and absolutely fell in love with it. I considered being a biologist, a veterinarian (I love animals!) and eventually realized I wanted to work with people, not animals and not at a research bench. I went to medical school in Dallas, at the University of Texas Southwestern Medical School. This school has an incredible reputation for excellent research (they are always in the top 2-3 medical schools in the nation to receive NIH grant money), a well-developed program of philanthropy that supports their mission, and most of all, the best teachers one could have. I feel truly blessed to have been able to attend that wonderful medical school. During medical school, I had a job (always working!) in a research lab that was doing research on how the genes that make FSH work. That experience exposed me to reproductive endocrinology early in my career. I was even able to publish a few papers during medical school. Small stuff, but it felt great at the time.

During medical school, I discovered I liked many different specialties, but really liked caring for women. It was natural for me to go into obstetrics and gynecology. I stayed at Southwestern because their teaching hospital is Parkland Memorial Hospital, an incredible training ground for residents. During my four years there, I delivered thousands of babies, performed or assisted about 600 Cesarean sections and did all kinds of gynecologic surgery. It was very hard work, but gave me a sound foundation and a lot of confidence that I could do most anything. I remained interested in Reproductive Endocrinology, although at the time, in vitro fertilization was just beginning to develop around the country and wasn’t the major emphasis in the field. Back then, the specialty was more about taking care of menopausal women, doing surgery for infertility (especially endometriosis, because at the time, we thought surgery helped fertility for these patients, something we now know isn’t really true) and doing microsurgery to put the tubes back together for women who had previously had their tubes tied and now wanted to be pregnant again (we now treat this with IVF). I decided that rather than going into practice in general ob/gyn, I would continue two more years of training to become a Reproductive Endocrinologist.

After 17 years in Texas and 8 years at Southwestern, I knew I wanted to go somewhere else and gain new experiences and exposure to different teachers. I only applied to a few fellowship programs and was fortunate to be accepted to my first choice: the University of California San Francisco. During my fellowship there, I met and was taught by the best mentor one could have, who is now my close friend and partner, Dr. Eldon Schriock. At the end of my fellowship, I was incredibly fortunate to be recruited by him and the department to stay on as a faculty member. While there, we instituted many new techniques into the infertility program such as ICSI and PGD. We doubled the size of the IVF program. We also taught many of the Reproductive Endocrinologists that now practice in the Bay Area, including our own Dr. Isabelle Ryan. While at UCSF, we almost merged with Drs. Carl Herbert and Philip Chenette, who were in private practice in San Francisco, but due to a variety of reasons, we were unable to realize the merger with them within the UCSF system. We got to know them very well, though, and we knew we could work together.

Dr. Givens was born in Hawaii in 1957, 2 years before Hawaii became a state.

Since I finished my fellowship, I knew I wanted to be part of a world-class fertility center that could provide the best care for our patients. For many reasons, during the late 1990s, this was becoming more difficult to do within the University. In 1999, when the previously existing Pacific Fertility Center came up for sale, Dr. Schriock and I got together with Drs. Herbert and Chenette and took the opportunity to realize our dream. We were able to recruit Dr. Ryan to join us. It has been a challenging but very exciting 10 years at PFC but now we are all able to say that the dream has become a reality. I am getting to do what I love to do every day.

On a personal level, I met my husband Michael when I was at UCSF. We were so sure about each other that we married 7 months after we met! I was a little older by then and at first we struggled with the idea of whether we would try to have a family. Since neither of us had any family living close by and my professional career (as well as his business) was very time consuming, we realized we would be stressed-out parents living the day-care life. We finally decided to live child-free. I only regret not having adult children to be proud of and having grandchildren to spoil. We now live in Marin and our children are our two dogs that I adore and spoil way too much. I love gardening, boating, cooking, reading and travelling. I don’t really have a passion for any particular hobby, just a passion for my work. But someday, as I said, I hope when I retire to return to Hawaii. Even though we left there when I was young, it is a big part of my family’s history and culture. I feel most at home with the aloha I feel when I am there. I would love to volunteer at an animal shelter after retiring. I still sometimes wish I had gone into veterinary medicine, but I think I will enjoy it more as a volunteer and since I have the best job in the world, that will have to wait for another lifetime.

— Carolyn Givens, M.D.

These tests can be done by your primary care physician or gynecologist prior to consulting your Reproductive Endocrinologist:

• Day 3 FSH (follicle stimulating hormone) and Estradiol (Day 2-3 is acceptable)
• TSH (thyroid stimulating hormone)
• Prolactin
• Progesterone: 7 days prior to menses, this test is occasionally helpful
• Semen analysis

These tests may be useful based on each patient’s particular needs:

• Hysterosalpingogram (HSG) or documentation of tubal status
• Hysteroscopy
• Laparoscopy: The surgeon should be able to treat during this procedure, not just diagnosis.

The following treatments may be done, if indicated, for a limited number of cycles:

• IUI (intrauterine insemination)
• Clomiphene citrate (Clomid, Serophene)

At Pacific Fertility Center, we bring a complete team of specialists together to focus on your fertility situation. With extensive backgrounds as REI specialists, embryologists, nurses, marriage and family therapists and financial counselors, we develop a single, integrated solution to your medical, psychological and financial needs.

Please use our Ask the Experts resource if you have further questions.

– Philip Chenette, MD

These tests are best done through your Reproductive Endocrinologist (fertility specialist):

• Strict sperm morphology
  Strict morphology is a very specific method of evaluating the shape of sperm. Most laboratories do not use strict criteria thus potentially missing a sperm problem. Our laboratory is staffed with embryologists trained to analyze sperm with these strict criteria.
• Evaluation of ovarian reserve
  Evaluation of ovarian reserve includes family history, ultrasound to detect the antral follicle count (AFC), a cycle day 2-3 FSH and estradiol level (both must be done at the same time), Anti-mullerian Hormone AMH, and clinical and family history.  An REI can bring all of these assessments together into one consistent picture of a woman’s ovarian reserve.
• Ultrasound
  A pelvic ultrasound is a very useful test when it is done at the appropriate time in the menstrual cycle. A few days prior to ovulation an ultrasound can evaluate ovulation, follicle growth, endometrial thickness and pattern, polyps, and fibroids. During menses is the best time to evaluate the ovary for cysts and endometriosis.
• Genetic testing
  Genetic testing is important in women with premature menopause and multiple miscarriages and men with very low sperm counts.  Patients with a family history of a genetic disease can use genetic testing to determine if they are carriers of the disease.  Universal genetic testing (Counsyl, www.counsyl.com) can be used to assess risk for certain genetic illnesses that run in families. If detected, Preimplantation Genetic Diagnosis (PGD) can help prevent genetic illness in your child.
• Insulin
  Women who have irregular periods and have been told they have Polycystic Ovary Syndrome (PCOS) should be evaluated by an REI.  Testing can lead to more effective treatment.

Treatments by a fertility specialist

The advanced training of an REI is helpful to provide the most successful treatments for infertility.

Some of these treatments include:

• In vitro fertilization with embryo transfer (IVF, or IVF/ET),
• Fertility preservation
• Egg freezing
• Intracytoplasmic sperm injection (ICSI)
• Preimplantation genetic diagnosis (PGD)
• Ovulation induction
• Intrauterine insemination

A specialist is able to evaluate simpler treatments and finely tune them to make them more effective. For example, a specialist can monitor ovulation induction with clomiphene (Clomid) with ultrasound and blood tests. The vaginal ultrasound can be used to assess follicle development and endometrial pattern and thickness. Intrauterine inseminations can be done to bypass hostile mucus caused by clomiphene. The specialist can also help decide when to stop a particular treatment and/or proceed with more.

Alternative medications like letrozole (Femara) are just as effective as clomiphene but have fewer side effects.  Since letrozole is not approved by the FDA for marketing for fertility use, its use is generally restricted to specialty clinics, that is, REIs.

Gonadotropins, the injectable drugs, for example Follistim, Gonal-F, Bravelle, and Menopur, are potent stimulants to the ovary.  They are designed to produce multiple follicles, in order to improve pregnancy rates.  Due to the risk of multiple pregnancy and overstimulation of the ovaries, the medications should be used only by experts in the field.  Most of these treatments are performed by REIs in the United States.

At Pacific Fertility Center, we bring a complete team of specialists together to focus on your fertility situation. With extensive backgrounds as REI specialists, embryologists, nurses, marriage and family therapists and financial counselors, we develop a single, integrated solution to your medical, psychological and financial needs.

Please use our Ask the Experts resource if you have further questions.

– Philip Chenette, MD

A Reproductive Endocrinologist (REI) is a specialist in Reproductive Endocrinology and Infertility, a medical doctor with advanced training in the science of fertility and its evaluation and treatment.  An REI focuses on the hormones and mechanics of conception with advanced knowledge of sperm, eggs, male anatomy, female anatomy, and the complex interactions between pituitary and reproductive hormones.  An REI will be trained in evaluating the problems that can interfere with conception, and has in depth knowledge of the treatments for fixing these problems.

An REI starts training after medical school in a 4 or 5 year residency in obstetrics and gynecology.  Specialty training in reproduction after residency requires 2-3 years at an advanced educational and research institute.  The fellow in REI works side-by-side with experts in the field, developing clinical expertise in evaluation and treatment of fertility, and researching new areas of reproduction.  The REI will be trained in laboratory and clinical research techniques, the mechanics and hormones of fertility, and in maintaining a lifelong love of the pursuit of advancing knowledge of fertility.

After completing the fellowship, an REI is “board eligible”. To be “board certified,” an REI must publish a thesis in a peer-reviewed journal. The REI must pass an in-depth written exam and then appear before experts in the field for an oral exam to test their depth of knowledge, defend their thesis, and demonstrate reasoning in solving fertility problems.  If they pass the exams, they are then “board certified”. This certification is the highest level of achievement in the field of infertility.

All REIs certified since 1990 are required to maintain their certification every year (a few are grandfathered in).  This involves reading and evaluating peer-reviewed journal articles on current advances in the field, and a written exam every year.  New standards require demonstration of clinical knowledge and a commitment to advancing standards of clinical care, the Maintenance of Certification (MOC) process.

While there is no formal requirement, most REIs will maintain membership in national and international fertility societies, such as the Society for Reproductive Endocrinology and Infertility (SREI).  The Society for Assisted Reproduction (SART), devoted to in vitro fertilization and its variants, does not require REI certification.  The American Society for Reproductive Medicine (ASRM) is the umbrella organization supervising these specialized societies.  Most anyone with a professional interest in fertility can join ASRM, but SREI requires board certification.

At Pacific Fertility Center, we bring a complete team of specialists together to focus on your fertility situation. With extensive backgrounds as REI specialists, embryologists, nurses, marriage and family therapists and financial counselors, we develop a single, integrated solution to your medical, psychological and financial needs.

Please use our Ask the Experts resource if you have further questions.

– Philip Chenette, MD

This past summer, I had the opportunity to travel to Amsterdam, Holland for the annual meeting of the European Society for Human Reproduction and Embryology (ESHRE). Though largely attended by Europeans, this scientific meeting draws physicians, embryologists and scientists from around the world to discuss their research, attend courses and lectures, and discuss the latest topics in our field. Although I don’t think this year’s meeting was as quite as good as last year’s ESHRE in Barcelona, there were still some good learning opportunities. Here are some of the highlights of the meeting:

“From Gamete to Heartbeat: The Missing Link”

This was a post-graduate course offered in conjunction with the meeting. The course covered sperm and egg evaluation,

expression of genes in the early embryo and in the endometrium (uterine lining) and some of the latest research into basic embryo implantation mechanisms.

One of the interesting talks was on gene expression in the early embryo. We have come to believe that the differences in pregnancy rates between younger and older women is mainly due to an increase in the number of abnormal chromosomes in embryos from women as they age (such as increased risk for Down Syndrome). However, this only explains part of the differences in successful pregnancy in younger compared to older mothers. New research into expression of proteins from embryonic genes is showing that in both chromosomally normal and abnormal embryos, there are differences in the number and types of genes encoding proteins in younger and older women. This suggests that it is not just changes in the number of chromosomes but subtler differences in the way individual genes are being expressed that affect the developmental competence of their embryos. Determining which genes and proteins are involved, and what the mechanisms are for regulating the expression of these genes in early embryos, will be an area of focused research in the coming years.

“Hyaluronic Acid (HA) favors selection of spermatozoa with intact DNA and normal nucleus, resulting in improvement of embryo quality” (Bologna, Italy)

This presentation (Parmegiani, et al.) looked at the percentage of sperm showing DNA fragmentation based on several methods of sperm preparation for IVF-ICSI (in vitro fertilization with intracellular sperm injection). They compared sperm in the fresh specimen 30 minutes after ejaculation, sperm that had been processed with a standard “swim-up” technique, and sperm that were placed in PVP (polyvinyl propylene), a substance used to slow sperm down so they can be picked up from a culture dish just prior to injection into the eggs. Lastly, they looked at sperm that had been placed into dishes that contain a ring of hyaluronic acid at the bottom of the dish, a substance to which some sperm will automatically bind. They looked at the percentage of sperm showing total or partial fragmentation of the DNA with each of these steps in the sperm preparation process. In the freshly ejaculated sperm, the DNA fragmentation was 16.5% of tested sperm. In the “swim-up” sperm prep, 11% were fragmented and in the PVP-exposed sperm, it was also 11%. Sperm that had bound to hyaluronic acid showed the least amount of fragmentation, at 5.3%.

These findings suggest that using HA binding to select sperm for sperm injection may result in fewer abnormalities in embryos, and possibly higher pregnancy rates. PFC is currently investigating HA binding on our own to see if it is something we would wish to routinely incorporate into IVF. The downside (like everything else!) is that HA plates are expensive.

Stress and Fertility – an enlightening symposium

Jacky Boivin, PhD., a researcher from Cardiff University in Wales, presented some very interesting data about the stresses of infertility treatment. She discussed a new study from Alice Domar’s group in Boston that surveyed why women/couples discontinued IVF treatment before achieving pregnancy (Fertility and Sterility, in press 2009). In this study, 132 women who had insurance coverage for IVF were surveyed. The two main reasons given for dropping out of treatment were the toll that infertility took on the couples’ relationship and being too anxious or depressed to continue. Among the less common reasons for dropping out were medication-related issues (such as difficulty with injections) and feeling the need for a female doctor. Dr. Boivin also discussed results from her own study that was published in the journal Human Reproduction in 2008. In that study, she developed a copingstratagem for women awaiting results of their treatment (i.e. the time between embryo transfer and first beta hCG). It is known that this is a most anxious time for women and the stress of waiting can become overwhelming. She utilized something called the “positive reappraisal coping intervention” card, or “PRCI” card. This is a small printed card that a patient can carry around in his or her pocket and it is meant to be read 2 times per day, every day during the 9-11 days between embryo transfer and first pregnancy test. The card has several little sayings such as: “During this experience I will try …to do something that makes me feel positive” and “During this experience I feel that….I’m energized or I’m creative.” This is a way of programming thoughts towards the positive and away from the negative. She and her colleagues were able to show that patient felt less stressed and felt that the PRCI was helpful during this period.

Currently, at PFC, we have begun a task force to look into ways to better incorporate counseling and tools for stress management for our patients. Please also see this recent Patient Odyssey. Support groups are a wonderful way to diffuse stress and feel more positive.

Corifollitropin: a modification of Follistim to allow a once-a-week injection.

As most people know, the medication we most commonly use for fertility treatment, Follistim, is pure human FSH, manufactured using recombinant DNA technology. The company that makes Follistim, Schering Plough, is working towards FDA approval of a modified version of Follistim, called Corifollitropin, that will make the drug very long-acting.

For those interested in the details; Corifollitropin is the recombinant FSH molecule + 22 C-terminal peptides from betahCG. It does not bind to the LH receptor. This modification lengthens the half-life of Follistim from 22-34 hours to 60-74 hours for Corifollitropin. The recommended regimen will be one dose per week, starting at baseline, then switch to daily recombinant FSH after that. After injection, peak levels are reached in 2 days then they slowly level. It may be possible to only take one injection per week!

A symposium at ESHRE presented information from the ENGAGE trial with data from 14 European and 5 Asian IVF centers, using women with body mass indices (BMIs) between 18 and 32 (generally less than 60 kg -132 lb). The patients were randomized to receive either Corifollitropin or conventional daily recombinant FSH for oocyte recruitment. The number of days of stimulation was the same in both groups (9). The number of eggs retrieved was significantly higher in the Corifollitropin group (13.3) vs. the FSH group (10.6). The rates of ovarian hyperstimulation syndrome were the same in both groups (about 3%). The pregnancy rates were 25% in the Corifollitropin group and 34% in the FSH group, a difference that did not quite reach statistical significance.

Data were also presented on a second study of Corifollitropin from the U.S. and Europe, comparing two doses of the drug. In the study, 100 mcg/dose was given to women less than or equal to 60 kg and women greater than 60 kg were dosed at 150 mcg. Over 1500 patients were included in this large trial. In this study, the average number of eggs recovered was 13.7 for the Corifollitropin group and 12.5 for the Follistim group. The mature egg and fertilization rates were the same. The percentage of good quality embryos was the same.

The clinical pregnancy rate in the Cori group was 38.9% and was 38.1% in the Follistim group. These rates were statistically the same. We expect that Corifollitropin will likely be available in the U.S. in 2010 or 2011.

On May 15th, we were fortunate to have Dr. Daoshing Ni, D.O.M, L.AC., Ph.D., a Licensed Acupuncturist in the State of California, a Diplomat of Chinese Herbology, and a 76th generation acupuncturist come to speak at PFC about the benefits of combining acupuncture and ART.

Dr. Ni spoke about some of his own research studies on acupuncture and ART and also discussed some of the issues with the current protocols that are being used today. He emphasized that the Paulus protocol is a good guideline when doing embryo transfers, and he encouraged the addition of other supportive acupuncture points. He also strongly encouraged that patients be treated with Chinese medicine for at least 3 months before their ART cycle begins. Dr. Ni also spoke about how the use of Chinese herbs contribute to improving egg quality.

This outstanding program was attended by PFC’s acupuncturists, physicians, and staff. In addition, area wide acupuncturists were invited to hear Dr. Ni’s presentation, meet one another, and share ideas.