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ART, IVF and Everything In Between to Maximize Pregnancy Success

June 27, 2006 - Tuesday
6:52 PM to (EST)
Guest Speakers: Lawrence Werlin, M.D.
Coastal Fertility Medical Center

Categories
Acupuncture • Egg Freezing • IVF • Male Factor • PGD • Pregnancy • Pregnancy Loss


Session Date: June 27, 2006 - Tuesday
Guest Speaker: Lawrence Werlin, M.D.
Coastal Fertility Medical Center
Topic: ART, IVF and Everything In Between to Maximize Pregnancy Success

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deb Good evening and welcome to our Online Education Session, hosted by The American Fertility Association and sponsored by Fertility Lifelines. As always we will start promptly at 8pm Eastern and close our session at 9pm Eastern.
deb Our guest tonight is Dr. Lawrence Werlin. Dr. Werlin is the director of Coastal Fertility Medical Center and principal investigator of Genesis Network for reproductive health. Dr. Werlin sees more than 500 patients annually and understands the need for information that so many patients crave.
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deb Since the birth of Louise Brown (the first IVF baby!) in 1978 more than 1 million babies have been born thru IVF. Tonight we will be talking about ART, IVF and everything in between to maximize pregnancy success.
deb I am Deb Capone and I am your moderator. If you need to "talk" with me privately, please double click on my name in the left hand column and you will be connected directly to me. Other than that, Dr. Werlin is ready to take your questions.
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deb Good evening, all...and especially to you Dr. Werlin. We will be starting in about five minutes.
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drwerlin thank you
deb Dr. Werlin, I'd like to invite you to make some opening comments...and if this session goes true to form, the questions will fly at you fast and furiously....
deb Good evening and welcome to our Online Education Session, hosted by The American Fertility Association and sponsored by Fertility Lifelines
deb Our guest tonight is Dr. Lawrence Werlin. Dr. Werlin is the director of Coastal Fertility Medical Center and principal investigator of Genesis Network for reproductive health. Dr. Werlin sees more than 500 patients annually and understands the need for information that so many patients crave.
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deb Tonight we will be talking about ART, IVF and everything in between to maximize pregnancy success.
drwerlin Thank you for inviting me to participate tonight. Hopefully I will be able to answer questions regarding ART and more specifically, PGD.
deb Just for the record, can you give us a primer on PGD and why it is important.
drwerlin PGD is a process whereby a cell (blastomere) is taken from an embryo, and specialized probes are applied to that cell to look at the chromosome make-up. PGD can also be used to look for specific gene defects such as cystic fibrosis.
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deb Who should consider PGD?
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deb Welcome to the session, Smiley and kjs25.
smiley thank you it's a pleasure to be here
drwerlin In certain high-risk groups such as Advanced Maternal Age (AMA), recurrent pregnancy loss, previous multiple failed cycles of IVF, and severe male factor, aneuploidy (too many or not enough chromosomes) occurs in 70-100% of embryos.
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deb Welcome back, pruizch. Dr. Werlin is ready to answer all of your questions on ART, IVF, PGD and any other questions regarding maximizing pregnancy success.
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kjs25 Thanks for the welcome. I have a question about the likelihood of success with IVF and ICSI when there are only a few sperm available for use and only 2 sperm are motile. How important is motility to a successful outcome with ICSI?
smiley i am down to 3 cups of decaf green tea per day (15mg caffiene). i am currently on suppression meds, moving forward with first IVF cycle. is this minute amount of caffeine okay or would you recommend caffeine free beverages?
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deb Welcome aboard, RoadCyclist and CTina, we have Dr. Lawrence Werlin from Coastal Fertility Medical Center answering questions about ART, IVF, PGD and maximizing pregancy success.
drwerlin In reality, one needs 1 sperm for 1 egg. Typically, when ICSI is done, it is the goal to pick those sperm that look the best and move the best. In fact, when chromosome studies are done on sperm (FISH), typically if one picks a normal moving, normal looking sperm, theoretically, 93% of the time it will have normal chromosomes.
smiley also, what are your thoughts on acupuncture during an IVF cycle? how often?
RoadCyclist Dr. Werlin - thanks for taking the time. I am an avid road cyclist who spends 10+ hours a week on my bike training. My wife is certain that her inability to get pregnant is due to my excessive hours on the bike, in my tight shorts and various other cycling related stresses. Could this be a factor in her inability to get pregnant? Thanks.
drwerlin Although the data is not clear on caffeine, it is probably safer to err on the side of using less. With respect to acupuncture, I believe that there is now good data to show that acupuncture may be beneficial in IVF. How frequently it is performed is in the realm of the acupuncturist.
drwerlin Unfortunately, of all athletes who have problems with sperm, cyclists are probably the hardest hit. Unfortunately, the heat that is generated from the bicycle shorts and the seat pressing up into the prostate can have negative effects on the sperm.
smiley i am age 40, will be 41 in november. how many embryos are typically transferred?
drwerlin Numbers of embryos that are transferred are based on a number of different factors. Age of the patient, quality of the embryos, previous failed cycles, and number of embryos available. All of these factors must be taken into account prior to ET. Each clinic makes those decisions.
kjs25 Thank you for your response, Dr. Werlin. Actually, I'm wondering if non-motile sperm can be used for ICSI...Why would my RE be trying to get my body to produce 15 eggs if we have no more than a couple motile sperm to use? Is this unique to my doctor or a common practice?
drwerlin There can be reasons why sperm may not be motile other than those sperm being non-functional. For example, men who have had previous vasectomies may have immobilizing antibodies which will render the sperm non-motile, however, they may still be functional.
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deb Hi, Mr. Mom...glad to have you here.
deb : Our guest tonight is Dr. Lawrence Werlin. Dr. Werlin is the director of Coastal Fertility Medical Center and principal investigator of Genesis Network for reproductive health. Once again, I want to thank Dr. Werlin for joining us tonight.
MrMom Doctor - is their a place I can go online to learn more? Do you recommend a certain website to do research for my wife. We are trying to get pregnant for a second time and are thinking we need some help the second go round as we are now approaching our 40's.
ctina Good evening everyone, we have recently been told that our situatoin is bizarre and I was wondering if it really is. I am 24 yrs. old and my husband is 27, he has cystic fibrosis so is missing vas deferens, we have done tesa and icsi on every ivf cycle so far and this past time which was our third time, he had almost no sperm, and before he had plenty and we kept losing embryos so we did PGD and found we only had one normal embryo and we tranferred that but found out about our third failure today.
deb Not to steal, Dr. Werlin's thunder, but The AFA's website (www.theafa.org) has great online resources. It is a great place to start, Mr. Mom....as are our weekly online sessions...
drwerlin Mr Mom, if in fact you are truly approaching your forties, I would recommend that you seek consultation with a Reproductive Endocrinologist. The age of the egg is by far one of the most critical factors fertility deals with. I agree with Deb that the AFA website is an excellent place to begin.
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smiley i have read that L-arginine, which is an amino acid, actually improves blood flow to the pelvic organs. A 1999 study documented increased ovarian response, endometrial receptivity, and pregnancy rates in IVF patients who took daily supplements of L-arginine. what are your thoughts on this?
drwerlin I am sorry for your unsuccessful cycles. Unfortunately, when doing PGD in high-risk groups, such as multiple failed cycles, 70-100% of the embryos will be abnormal. Even though the husband and wife's chromosomes may be normal, events out of our control occur after fertilization, which may render the resulting embryos abnormal. Perhaps in this situation, it would be reasonable to consider the possibility of donor sperm.
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drwerlin L-arginine is an amino acid and as long as it does not cause harm, if it can be beneficial, it may be useful.
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deb Hi, Rella12639!
rella2639 i hear more and more about egg banking, preserving my eggs for future fertilization.. how viable is this option?
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ctina Thank you for your information and we are going to talk to my husbands CF doctors to find out more about CF patients and sperm quality also.
deb And to you, too Capecrew99!
smiley hi cape crew! are you from the cape like me??
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capecrew99 someone else is from cape cod??
capecrew99 Hi everyone!
smiley mashpee
capecrew99 Harwich
smiley nice to meet you
drwerlin It is true that egg banking is becoming a more viable option at this time. The more that we learn about the ability to freeze and thaw eggs, the better our results will be. Certainly, if you had the option of freezing embryos, the results will be better.
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deb Dr. Werlin is answering our questions about ART, IVF and anything else we can do to maximize pregnancy success.
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skleba6130 hello everyone. we recently had our 1st IVF cycle cancelled because my body began the ovulation process naturally which did not allow enough time for egg retrieval. Are there any signs I can look for to see this coming or anything I could do to prevent this from happening in future IVF cycles?
smiley we're approved for 4 cycles of IVF. we signed consents for cryopreservation. will they use fresh eggs/sperm each cycle and only resort to the frozen embryos if there is a problem? how do they determine when to use fresh vs. frozen?
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drwerlin Typically, Lupron is a medication that is used to prevent your own LH surge (ovulation). In some protocols where Lupron is not used, medications such as Antagon or Cetrotide (LH antagonists) are used to block LH.
drwerlin Smiley, your questions are best answered by the RE's who are directing your care.
smiley thank you
skleba6130 I was taking lupron but apparently my LH surge occured anyway. Is this common and if it happened once, what is the likelihood that it will happen again?
sana if anti thyroid antibodies are positive, what will be the effect of this on ivf cycle?
drwerlin This is a very uncommon occurance. Typically, when HCG is given to take your eggs the final step of maturation, as long as the retrieval is done within 34-36 hours, ovulation will not occur.
capecrew99 Hi Dr. Werlin, thanks for your time. I just finished my second cycle with PGD, and my transfer got cancelled both times due to "no embies normal" on testing. I have low fert rate, gettting 18 eggs with only 6-8 that fertilized, only 4 or 6 to test each time, and all came up abnormal. Typical abnormalities(18, 21, 21, monosomy). I am 39, husband s/p prostatectomy with TESE. My question: What are my chances of getting normals in the future, how to increase fert rate, should I do PGD again? I feel we do great leading up to the PGD, and that's where we fall....I know i only have about 20% of my eggs that are good, because of my age.
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deb Thanks for joining us vickalina!
drwerlin There are two types of thyroid antibodies that occur. ATPO and ATGA. This entity is called Auto-immune Thyroid-itis or Hashimotos Disease. Typically, this will be associated with low thyroid function. As long as your thyroid function studies are normal (with or without medication), it should not play a role.
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vickalina Thank you ! Hi all!
deb Welcome, Olivia5302.
drwerlin Unfortunately, as is demonstrated in your case Capecrew, the results appear to be consistent from cycle to cycle. That is in each cycle, in those patients who are at greater risk for aneuploidy somewhere between 70-100% of embryos will be abnormal.
sana at the age of 35 the long protocol of lupron is good or it is good to use antagon?
kjs25 On behalf of a friend, with a sperm count of 10 million and only 15% morphology, is IUI a reasonable option or is IVF a necessity?
drwerlin Sana, age is only 1 factor that determines the type of protocol we use. Antral count is a significant factor that helps to determine type of protocol.
olivia5302 sorry to join late..how effective is PGD for screening for a genetic disease that runs in the family? how does the whole process work? what can i expect?
drwerlin Unfortunately, IUI even in the best of situations has a success rate of about 10% per cycle. IVF is always a better option.
sana is drilling of ovary is bad in pcod case? it will affect on quantity of eggs in ivf cycle?
drwerlin PGD with respect to specific gene defects such as Huntington's disease, cystic fibrosis, muscular distrophy, is an excellent tool to use to screen for these abnormalities in your embryos. Typically, you will undergo an IVF cycle in which your eggs will be harvested, ICSI will be performed, and 3 days after retrieval (6-8 cell stage), a cell will be taken, placed in a medium that will lyse the cell and free up the DNA. PCR is then used to look for these specific gene defects. On day 5, only the normal embryos will be transferred.
drwerlin Sana, ovarian drilling has been used in women who have PCOS in an effort to decrease the surface area of the ovary. It would be unlikely to affect the quantity of eggs in your subsequent IVF cycle.
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deb Dr. Werlin, what, if any, are new uses of PGD and are there any health risks?
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capecrew99 With those 2 cancelled transfers I had d/t "no normal embies" with PGD, i was on luteal lupron, but have heard others in my situation "get normals" with something called the antagen lupron, or something like this. Can you explain the difference and possible advantages?
california1 i've heard about its ability to screen for cancer genes, is that accurate?
drwerlin PGD is primarily used to look for aneuploidy (chromosomal defects), or specific gene defects.
capecrew99 good question deb
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sana progestone injections are good or progetone tablets are good in ivf cycle?
drwerlin Luteal Lupron is used primarily to suppress the pituitarys LH and FSH. Antagon is an LH Antagonist and only blocks LH. Using one or the other would really have no effect on the genetic results of your embryos.
 
drwerlin Yes, it is accurate to state that certain cancer genes can be screened for such as BRCA1 and BRCA2 which are breast cancer genes.
drwerlin Progesterone injections are always better with IVF cycles since oral medication can have variable absorption.
capecrew99 what about the risk of "over cooking the eggs" during stims for an older woman of 39?
smiley i was wondering that myself. are there any risks to the developing embryo once they remove a cell for PGD?
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deb As a reminder, our online sessions happen every Tuesday night-except for next week-July 4th. You can get additional support and information 24/7 at www.theafa.org. If you aren't already a "No Barriers" member-sign up now...its free!
drwerlin When stimulating patients, it is important to look at both the size of the follicles and the estradiol production to give an accurate estimate of timing.
capecrew99 What are the percentages of chromosomal abnormal pregnancys for woman age 39. I'm thinking of NOT doing PGD next time to take my chances. Any thoughts?
deb We have time for one or two more questions. I want to thank Dr. Werlin again for this terrific session.
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capecrew99 Yes, thank you Dr. Werlin
california1 thank you!
deb Dr. Werlin, can you make a few closing remarks and then give us your contact information.
drwerlin Smiley, as with any process, there are always risks with PGD. 1) Typically, we look at 9 chromosomes (13, 15, 16, 17, 18, 21, 22, X and Y), since these are the 9 most common chromosome abnormalities that make up about 85-90% of all aneuploidies that occur in nature. Although, in stating that, there is a small percentage then that could be missed in one of the other 14 chromosomes. 2) All embryos when biopsied, do arrest. The real question will be whether or not they proceed 3) There is a small percentage of false positives and false negatives.
sana during ivf cycle before starting antagon ,dr is there any chances of some eggs get ovulate?and some not.
drwerlin I want to Thank You for allowing me to participate in this online chat, and if any further information is required, please contact Deb for our information.
sana thank you dr for your time .
capecrew99 yes, thank you DR.
deb Thank you again, Dr. Werlin.
smiley thank you!
drwerlin Sana, as long as Antagon is started appropriately, the eggs will not ovulate.
drwerlin Thank You
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deb I will 'see' all of you on July 11th, when Dr. Mark Leondires from RMA-CT talks about IVF Mysteries. Have a great July 4th...
capecrew99 you too, thanks
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sana thankyou
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