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The American Fertility Association Blog
Co-culture and IVF
April 30, 2009 - Thursday
Posted by Lisa
Written by Dr. Kreiner, Director, East Coast Fertility
In the past 30 years great strides have been made in the field of in vitro fertilization (IVF). The use of ovulation induction to recruit multiple eggs increased the IVF success rate in the late 1970’s. The addition of FSH and a GnRH agonist (such as Lupron) to the stimulation protocol increased success rates even more. Ultrasound-guided retrievals made the oocyte (egg) pickup less invasive, and the ultrasound-guided transfer improved the efficiency of the transfer. In the late 1990’s, a culture revolution, that is in the media environment bathing and feeding the embryos, greatly improved success due to our ability to provide a healthier environment for the embryos. All these advances have had a great impact on our success rates with IVF to the point that approximately 50% of retrievals will result in a pregnancy. Unfortunately, older patients and some younger ones as well have yet to share in this success.
Many IVF programs have reintroduced the concept of utilizing a co-culture medium to improve the quality and implantation of embryos. Co-culture is a procedure whereby “helper” cells are grown along with the developing embryo. Today, the most popular cell lines include endometrial cells (from the endometrium, or uterine lining) and cumulus cells from women’s ovaries. Both cell lines are derived from the patient, thereby eliminating any concerns regarding transmission of viruses. Endometrial cells are much more difficult to obtain and process, while cumulus cells are routinely removed along with the oocytes during IVF retrieval.
Cumulus cells play an important role in the maturation and development of oocytes. After ovulation cumulus cells normally produce a chemical called Hyaluronan. Hyaluronan is secreted by many cells of the body and is involved in regulating cell adhesion, growth and development. Recent evidence has shown that Hyaluronan is found normally in the uterus at the time of implantation..
Co-culture of cumulus cells provides an opportunity to detoxify the embryo’s culture medium that the embryos are growing in and produce growth factors important for cell development 1,2. This may explain why some human embryos can experience improved development with the use of co-culture.
Preparation of co-culture cells starts with separation of the cumulus cells from the oocytes after aspiration of the follicles. These sheets of cells are washed thoroughly and then placed in a solution that permits the sheets to separate into individual cells. The cells are then washed again and transferred to a culture dish with medium and incubated overnight. During this time individual cells will attach to the culture dish and create junctions between adjoining cells. This communication is important for normal development. The following morning, cells are washed again and all normally fertilized oocytes (embryos) are added to the dish. Embryos are grown with the cumulus cells for a period of three days to achieve maximum benefit.
Performing co-culture of embryos has improved implantation and pregnancy rates above and beyond those seen with the IVF advances previously described. More importantly, It promises to offer advantages for those patients whose previous IVF cycles were unsuccessful.
References:
1. Barmat LI, Worrilow KC, Paynton BV. Growth factor expression by
human oviduct and buffalo rat liver coculture cells. Fertil Steril 1997;
67:775–9.
2. Fukui Y, McGowan LT, James RW, Pugh PA, Tervit HR. Factors
affecting the in vitro development of blastocysts of bovine oocytes
matured and fertilized in vitro. J Reprod Fertil 1991;92:125–31.
—
David Kreiner, MD
Director, East Coast Fertility
Categories
IVF
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Does This Blog Make Me Look Gay?
April 29, 2009 - Wednesday
Posted by Corey
Is anyone out there NOT watching American Idol right now? I so love that show. It’s the only two nights of the week I can actually get my kids to sit down with me for a full hour or two.
Apart from the family love fest, I’ve been riveted by the talent on that stage – I think it will come down to Adam vrs. Allison, although I have to admit that my favorite singer is the cuddly/hunky Danny. How cute is he?
To me, Adam is not hunky, but evidentally he is, to a lot of, um, guys out there. Is he or isn’t he gay didn’t even occur to me, until all the brouhaha about it. I spoke to my daughter Caitlin and she said “Are you kidding Mom? Of course he’s gay.” She loves to laugh at how dorky/old I am. I just thought Adam was an amazingly talented retro throwback to the 80’s. But I work very hard not to remember my own curly haired, lace dripping 1980’s, so what do I know anyway.
So. Is Adam gay? Does anyone really care? Now that it’s up as a controversy, I kinda do care. In my own head, I have a dream……I would love to see Adam, the Idol most loved and adored by millions, come out as being openly gay. I would love to see him come of age – I have no idea how old he is but he looks about 7 – and fall desperately in love with some amazing guy. And I would love to have the public that is so openly gaga about him now, watch him and his partner start off on their quest towards family. I’d love to watch these two men father a beautiful child, and be role models to queer youth and their families everywhere. I’d like them to show the world what wonderful parents gay men can be That is my dream.
But I still like Danny best.
Corey Whelan
Program Director
The American Fertility Association
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Strollers?
April 28, 2009 - Tuesday
Posted by Lisa
Strollers, and lots of them at the American Fertility Association’s 1st Annual Walk For Infertility? That was the last thing I was expecting to see at an event such as this. I almost felt as if I were in the wrong place. Moms and Dads were talking about their babies, their Dr. Kreiner success stories. I know all too well about the ups and downs of infertility from my own personal experience. And as a Marriage and Family Therapist specializing in infertility, I listen to many stories about despair. What a thrill it was to hear about new pregnancies, new parenting and even becoming a new grandparent, as one woman shared.
Everyone appeared to know one another. With over 100 people in attendance, I knew this wasn’t the case. I suppose when people walk a similar path, they are linked in some way. And on this bright and beautiful Sunday morning, families walked together perhaps meeting for the first time, but heading in the same direction.
As a volunteer, and wanting to share my professional and personal background, I was truly happy to play a small part in this huge cause.
Sheryl Stern, MA, LMFT
Categories
Family Building •
Fertility •
Infertility
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Karen
April 27, 2009 - Monday
Posted by Lisa
You know how the scent of the beach makes you feel? That combination of salt air and coconutty sun screen. For me it elicits an immediate aura of ahhh. That finally, summer is here feeling.
Just last week it was teeming rain in NYC and we were wearing light weight coats. How smart of East Coast Fertility, headed up by Dr. Kreiner, to launch the summer season, on Jones Beach no less! With their 1st Annual Long Island Walk for Infertility.
Yup, it was just last week, I was on the phone with Karen Malamud, of East Coast Fertility, on a typhoon like day having a conversation about the eight people who were registered for this event. Eight. People. My only goal for this event at that point was for Karen to be happy. This Walk was coming out of Karen’s heart. I have never seen anyone work so hard, or with so much spirit, or with so much caring. Karen became a total commitment to raising money for The AFA and for bringing a walk of hope to Long Island.
All week as the skies cleared, people started to register. Twenty, then thirty, then fifty. On notoriously stay at home Long Island, we wound up having way over 100 people breathing in that intoxicating beach air last Sunday.
And what an amazing day it turned out to be. For me it was the babies. I’m a sucker for babies and these little Kreiner tots were like little mushkies to me. All the girls looked like my daughter when she was toddling, in those silly little floppy brimmed floral hats, pulling up fistfuls of grass from the ground. You could have died from cuteness.
And then we walked. The Jones Beach boardwalk was filled with strollers, and couples, and teenagers, and grandmommies and daddies. With people who cared. People walking for hope, walking for those who wish to push those strollers themselves someday. Dr. Kreiner himself was out there pushing an adorable set of twins to the finish line.
The AFA is grateful beyond measure for the generosity of our friends at East Coast Fertility, who raised a little over $10,000 in support of The AFA’s Infertility Prevention Initiatives. East Coast Fertility and The AFA share a goal of making less patients, not more. We share a goal of making families.
Most importantly, for me anyway, Karen was happy. She deserves to be. She earned it. And she earned our heartfelt gratitude as well.
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Men Lie
April 21, 2009 - Tuesday
Posted by Corey
Nothing makes me happier than seeing a man thoroughly enjoying himself. So I was very happy last night, watching Richard Grazi having a ball, talking with a room full of young women at our most recent Manicures & Martinis event in Brooklyn. His take home message? Men lie.
Did you know that? I had my suspicions, but still….Dr. Grazi confirmed it last night. Yup. Men lie. Why did that little tidbit come up at an infertility prevention event? Hmmmm. Have you ever heard of STD’s?
Oh yeah. One of the key points of the Manicures & Martinis events is a simple one – if you are not currently trying to get pregnant, use a condom. You would be surprised how many women don’t. And the reasons why they don’t got knocked out of the water by Dr. G. over and over again last night. He told them straight – married men lie too. And no man really likes to wear a condom, he said. It feels like wearing surgical gloves when you’re playing the piano.
Most importantly, he told them what chlamydia does to your tubes – fills them with puss and makes them scar over. You know it’s funny, we’ve become so anesthetized by language – you hear everything everywhere these days. But use a word like puss in a room full of young women and you get a reaction. Major league eewww factor. But you also get something else. You get change.
And that’s what this simple, national initiative is really all about. Changing women’s understanding of their bodies, to reflect their true reproductive reality.
Yup. Men lie. But I’m personally grateful to Dr. Grazi for putting himself out there and telling the truth to a roomful of women who really needed to hear it.
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