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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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Facing Change

March 16, 2009 - Monday
Posted by Ken

Last year I wrote an article addressing how issues surrounding the topic of infertility would only become more intense in the coming year. What I didn’t realize is the degree to which the infertility conversation would enter mainstream media, and how quickly.

Thus far in 2009, the topic of infertility is everywhere. Whether it’s the mother of eight babies in California or a 60 (plus) year-old woman becoming pregnant through in-vitro fertilization (IVF), infertility has become part of most people’s daily listening and reading, if not daily conversation.

As I write this in mid-March, I’m wondering what’s going to happen this week when the Georgia State Senate considers a “personhood” bill, which defines life at the moment of conception and ascribes all human rights to the embryo from that point forward. The bill would make anyone who damages or destroys an embryo criminally liable, subject to both fines and imprisonment. It would further forbid any disposition of unused embryos except the option to donate them to another couple, (and they do mean married, heterosexual couples). The option to freeze embryos for use at a later date, donate them to scientific research, or dispose of them would be illegal if this bill becomes law.

There are several other bills floating around state legislatures right now. Many are designed to dictate to physicians and patients having difficulty conceiving how many embryos they can create, how many they may transfer, and what the disposition of any unused embryos must be.

New questions are being raised about the use of sperm taken posthumously from a male for the purpose of continuing a family line or ensuring inheritance. Who has the final say in these matters?

Egg freezing is emerging as the most asked about fertility topic of the year. Women and men want to know if eggs can be frozen for use at a later date, similar to what is currently being practiced with unused embryos. If so, what’s the success rate? Is this something we should be encouraging? Are there risks? What are they?

Egg freezing, taking sperm from dead men, legislators dictating what physicians and patients can and can’t do, and the very real possibility of microscopic tissue being called a “child” are just some of the issues The American Fertility Association (The AFA) is helping consumers sort through as they begin or find themselves in the midst of their family building journeys.

7.3 million American women experience difficulty conceiving or bringing a pregnancy to term. Fertility challenges among men may be just as high, as male factor infertility is the sole or contributing cause in about 40% of infertile couples. We are, indeed, faced with a significant challenge.

In addition to providing education and support for those facing fertility challenges, this year, The AFA began an infertility prevention program in which we take education to young women at places they already frequent - like nail salons and health clubs.

Why? There are types of infertility that can be prevented. Avoiding environmental toxins, taking into account the biological clock (fertility begins to decline at age 27 for women and 35 for men) and preventing STD’s are all things that can keep options open for individuals and couples if and when they decide to have children. As everyone knows, prevention, when possible, is the best cure.

Our mission is simple: prevent infertility whenever possible and support people in building families of choice. To learn more, visit us at http://www.theafa.org.

The American Fertility Association, a 501 (c) (3) national non-profit organization is a lifetime resource for infertility prevention, reproductive health and family building. AFA services and materials are provided free of charge to consumers and available to everyone without reservation. These services include an extensive online library, monthly online chats, telephone and in-person coaching, a resource directory, hosted message boards, daily fertility news and a toll-free support line.
http://www.theafa.org or 888.917.3777.

Ken Mosesian
Executive Director

Categories
Donor Egg • Donor Sperm • Egg Donation • Egg Freezing • Embryo Donation • Family Building • Fertility • Fertility Preservation • Frozen Embryos • Frozen Sperm • Infertility • IVF • Reproductive Freedom • Sexual Health • Sperm Donation • Third Party Reproduction

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The Dignity of the Person

December 17, 2008 - Wednesday
Posted by Ken

I’ve received several calls over the past few days asking if The AFA was going to “take on the Vatican.” I admit that I was a bit smitten with the “David vs. Goliath” imagery, but quickly got over that. I am going to respond to the latest document “Dignitas Personae,” or “The Dignity of the Person,” issued by the Congregation for the Doctrine of the Faith, but we’re not going to “take on” the Vatican. That is not our place.

A little background: I’m a gay man in a committed relationship for the past 15 years. I’m also a Catholic. Traditionalists would tell me that without assenting to all of the teachings of the Church, including those on human sexuality, I cannot be a Catholic. Liberals applaud me for sharing my “lived experience” as a Catholic in an honest and forthright way, and claim that I, like many others, are leading the way, and the Church will eventually recognize this. I’m not comfortable with either description. I prefer to think of myself as honestly wrestling with my faith, doing my best to live my life in integrity and at the same time trying to hear the Church’s teaching with an open heart.

You’d think it would be easy to write off the Bishops of the Church as a bunch of out of touch old men. I tried doing so. But for those of us for whom being Catholic is more than just a label, but rather something that is in our bones, it just doesn’t work for long. Many years ago, I shared with my Pastor that I was gay, and wondered how we could support the many other gay Catholics that attended our parish. At our Pastor’s suggestion, we formed a small faith community of five people, our Pastor included, and for the next nine months we met on a monthly basis, sharing our stories of faith and talking frankly about the disconnect we felt between the teachings of the Church and what we were experiencing in our lives. At the conclusion of the nine months, we launched Gay & Lesbian Outreach, which now claims 300 members - at this one parish.

We did not change Church teaching. But we did gain something and give something: a safe place where people could come and discuss the reality of their lives, and in doing so, be truly heard and treated with dignity and respect. And we helped the clergy understand in a very real way that Church teaching affects not just “lives”, but the lives of people they knew and loved and cared for. And we saw a subtle but continual change in the words and actions of others. In short, the community began to come together as just that - a community. Diverse and not always in agreement, but united in spirit nonetheless. Years later, when a couple of straight women in the parish decided to have kids as single moms by choice, our Pastor’s response was, well, pastoral. He welcomed them to have their children baptized, and I couldn’t help but think that we helped to pave the way.

So to those of you who are Roman Catholic and have children via IVF or are in the process of having IVF, talk to your Pastors. Let them know that you love both your Catholic faith and your children. That the very conscious decision to have children via IVF was born out of perhaps the most loving and intimate conversation that people can ever have. That the hoped for child or the one already here is perhaps even more precious because of the sacrifices - on so many levels - that went into making the decision and ultimately bringing the baby to term. Let them know that if they feel compelled to speak about the subject to also remember that there may be children present who know their origins, and what seems like a simple sermon explaining Church teaching can take an ugly turn towards denigrating human beings.

And by all means, if you hear preaching that does, in fact, denigrate children born of IVF or their parents, speak up. Let your pastors know that you are counting on them for spiritual care, even if you disagree on some issues. Finally, if your children do know that they were born as a result of IVF, and you feel it’s appropriate, talk to them in advance about this. Let them know that they are loved beyond measure, and that this particular teaching in no way alters that love or lessens their value as human beings, and that God, and yes, even the Church Fathers, above all things, value life, no matter how it was conceived.

I realize that this is probably not as satisfying for some as a good old-fashioned rant, but as I approach 50, I more often come down on the side of conversation and the importance of just showing up, authentically. Of being a witness to what you believe by simply being.

So I encourage you to be, and to be proud. You’ll be amazed at the change it creates - for good.

Ken Mosesian
Executive Director
The American Fertility Association

Categories
Family Building • IVF

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Life Is Change

March 4, 2008 - Tuesday
Posted by Ken

Change. It’s a word that both inspires and terrifies. On one hand there’s the opportunity for growth and adventure, on the other, we’re called out of the familiar and the comfortable.

And yet all of life is change. In the few seconds that it took you to read the sentences above, we have all changed. We’re older, cells have died and been recreated, new thoughts have emerged, and old ones have been rekindled. The only constant in life, the saying goes, is change.

Organizations experience change as well, and I’m writing to share with you the changes that have taken place at The AFA. As some of you may know, Pamela Madsen, The AFA’s founder, recently resigned her position as Executive Director. As she stated in her farewell blog, “I have given everything that I had to give.”

Her contributions to The AFA were considerable, and her commitment to those facing reproductive challenges unsurpassed. So I acknowledge all that Pam did to bring The AFA from infancy to this point in its growth. Simply stated, we could not have gotten here without her.

Though Pam is no longer with the organization, the rest of the staff remains, fully committed to taking the good work that has been done and building upon it.

I was hired, two years ago, to consult with The AFA to help position the organization for growth and development in a rapidly changing field. Now, the board has asked that I continue to work with them as the Acting Executive Director while a dedicated board committee conducts a national search. The committee members have invited me to formally apply for the position, which I intend to do.

I am certain that the board will hire the most qualified person to fill the position of Executive Director, and regardless of the outcome, I will work with The AFA - in whatever capacity the boards requests of me - to help guide this organization through an incredibly exciting time in its history.

It is a great privilege to continue to work with such tremendously dedicated staff members and board of directors who are focused on working together to deliver the very best education and support services possible, and to effectively advocate for your interests at every opportunity.

During the past few months, this unique team of staff, volunteers and board members has continued and expanded the work of The AFA, producing three separate e-Newsletters, answering support line phone calls, conducting phone-coaching sessions, producing the first Family Matters San Francisco Conference, and building alliances with other non-profits across the country.

There’s much more to report, including an updated website, an expanding mission to help lift the conversation about fertility into the larger conversation about reproductive health care, an emphasis on preventing STDs in order to protect fertility, the relationship between fertility and the environment and our work with the lesbian and gay communities in their efforts to create families. And of course, our core work with people who are experiencing reproductive challenges.

Thank you for your support. You have my word that you can count on us to continue to earn your trust and respect every day, to produce the best quality work possible, and to do it all with integrity.

Please feel free to contact me if you have any questions at: [email protected]

Working together, we can make a difference—for good.

Categories
Fertility • Fertility and the Environment • IVF • LGBT • Reproductive Health

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Beyond Sex Education: Teens Talk About Their Origins

December 11, 2007 - Tuesday
Posted by Pamela

One of the biggest problems I have as a Founder/Executive Director...is that I have been doing this work for most of my adult life...and sometimes even I forget what we have done in the past...and it is good to remember...and think about how we can be incorporating past ideas and programs into what we are doing now.

I have been looking through some of my older writings...past programs...and remembering...and boy oh boy did I shamelessly put my kids out there for “The Cause!” And my husband reminded me, the struggles that we had when we decided to let the kids do media on behalf of the fertility community. Kai was concerned that the kids would be tainted...that other kids would tease them. Was it fair for us to turn our kids into activists?

In the end...we decided that if we were frightened of our children being tainted in some unknown way by being known as IVF kids...then it was our job to let the world see these beautiful, articulate children that were indeed “Test Tube Babies”. We needed to put our family out here to change perceptions. And so we did.

In 2003, we put out this press release..and conducted a media tour with my oldest son Tyler as one of the spokespeople!!! And guess what I asked my poor teenage son to do? Read the headline!!! And the Press Release!!

Beyond Sex Education: Teens Talk About Their Origins
Teens born through Assisted Reproductive Technology speak about their perceptions of their conception

*New York, NY, April 25, 2003 *** In celebration of World Infertility Month, teenagers take sex education a step further and talk about how they feel about their high tech origins.

Tyler Madsen and Lily Johnson were conceived through Assisted Reproductive Technology (ART) and they’re not afraid to talk about how they were conceived.

Since Louise Brown made her debut in 1978 in England, it is estimated that 1,000,000 children have been born though ART, said Karen Hammond, Chair of The American Infertility Association. These children, many of them young adults now, are telling us they’re comfortable, confident and secure with who they are. The news is that children born through ART feel no different than other children.”

AIA spokes-teen, Tyler Madsen, is a freshman at LaGuardia High School in New York City focusing on drama. Tyler has spoken in many public forums about his conception, including a press conference in Lucerne Switzerland and last year at the U.S. launch of World Infertility Month (WIM) at the United Nations. Tyler was conceived through In Vitro Fertilization (IVF) in 1988, using his mother=s eggs and father=s sperm.

“Some people may think that my conception makes me different or special from others,” said Tyler Madsen. “In fact, I’m like any other teenager with the same concerns, the same goals and the same dreams. I think all kids are special and unique. It doesn’t matter how they were conceived. That’s just a technicality.”

Lily Johnson is 13, an avid swimmer, and in 7th grade at Las Colinas Middle School in Camarillo CA. Over the years, Lily has done many interviews about her conception including two documentaries with her brother, Chase, who is 9. Lily was conceived through surrogacy, using artificial insemination and a surrogate’s egg and uterus.

“I was born through surrogacy and I think it is excellent because couples can have children, even if they can’t biologically,” said Lily Johnson. It doesn’t matter how children are created, as long as they ARE created.”

I think it’s important that children born through ART talk about it, so that people will realize that they are just like everyone else and its nothing to worry about or feel funny about,” said Fay Johnson, Lily’s mother. Hopefully with teen role models, other kids born through ART can feel comfortable.”

In order to help parents talk to their children about their conceptions, The AIA created fact sheets for guidance; “Out of the Dish: Talking to Children About Their IVF Origins” and “Talking with Children about Ovum Donation” are available on The AIA website at http://www.americaninfertility.org or by contacting The AIA toll free at 877-917-3777.”

So...yes...a lot has changed! We are no longer called The American Infertility Association....and WIM is now WorldFAM (http://www.WorldFAM.org) ....The Co-Chairs are now Stuart Miller and Patricia Mendell...and Tyler....well he is now at Parson’s School of Design where is he is majoring in Technology and Design...and by the way...he still helps out The AFA...he helped implement this new website....in fact Tyler designed this blog for his dear old mom. And yes...I am shamelessly proud of him.

To see a link to one of the interviews that resulted from these press tours...please click here!!!. It is very cute...and you get to see pictures of much younger Tyler and Spencer.

Until Tomorrow,
Pamela

Categories
Adoption • Fertility • Infertility • IVF • Reproductive Technologies • World Fertility Awareness Month