California IVF: Davis Fertility Center Newsletter Now Online

California IVF: Davis Fertility Center, Inc. has released our November 2010 edition of our infertility newsletter titled "Babies in Davis". In the first edition of our infertility newsletter, we discuss what it takes to make us more than just a fertility center. Our extended family and the referrals from the Sacramento area doctors help make us the successful clinic we want to be and our patients deserve. We are very aware that our patients would rather get pregnant on their own without having to go to the local infertility clinic.  When patients see our help, the California IVF family is happy to adopt new members into our family so we can work together to provide the best possible chances of having a baby.  Our family is what makes us great.Photos from the previous reunion fill the pages of our newsletter along with other interesting stories and announcements. California IVF has announced a donor embryo program know as California Conceptions, an egg freezing program, and recently launched our online egg donor application. It has been a busy year for the staff and infertility doctors at California IVF: Davis Fertility Center.  Continuing to expand our services is important in our efforts to provide our patients with the very best infertility treatments.
Rounding out the newsletter is a brief article on surgical services for our infertility patients.  Many of our patients seeking infertility treatment help with inseminations (IUI) or in vitro fertilization (IVF) are not aware that our doctors perform many infertility surgery procedures to help correct problems that affect fertility.  Among these surgeries are myomectomies, or surgeries to remove uterine tumors that can prevent pregnancies, hysteroscopies to correct uterine polyps and remove a uterine septum, and tubal ligation reversal surgery which allows a woman to have her tubes put back together after a tubal ligation surgery.

Stay tuned for more interesting developments including an option to sign up to receive our newsletter via email.  Once again, we would like to give thanks to our family that was able to make it to our third annual family reunion.  It was a rainy day but that didn't stop our event!  It was a great day of "babies and bellies" in the park.  Photos from our events as well as an electronic copy of our newsletter can be found at http://www.babiesindavis.com/.
 
 © California IVF: Davis Fertility Center, Inc. Male and female infertility specialists near Sacramento.

What Does an Embryologist Do? #Infertility #IVF

An embryologist is a scientist that works with sperm, eggs, and embryos. This field of work is known as embryology. Embryologists can work in human or animal embryology. Animal embryologist can help with breeding programs for a zoo, repopulation of endangered species, and breeding of livestock. Human embryologists work with infertility programs with the goal of helping couples have a baby.


The embryologist in an in vitro fertilisation program (IVF) plays a vital role in the journey to pregnancy for a couple struggling with infertility. During the course of infertility treatments, the embryologist will be involved from the start to finish of an in vitro fertilization – IVF cycle. During the testing phase before IVF treatments, the embryologists will prepare the embryology lab for infertility treatments by regulating and testing environmental conditions in the embryology laboratory including temperature, air quality, and humidity. Ordering supplies and the culture media, or liquids used to grow the embryos, is also a necessary step when preparing to start an IVF cycle.

Testing of sperm and freeing sperm samples from couples about to undergo treatment is another job of the embryologist during the testing phase Often, an embryologist will also work in the role of an andrologist, which is an individual that works with sperm.

In the IVF program at California IVF: Davis Fertility Center, Inc., our embryologist Deborah Johnson conducts an educational seminar before patients undergo the egg collection procedure, or oocyte retrieval. This “egg class” is designed to introduce infertility patients to embryology and terminology used in an embryology laboratory.

During the egg retrieval procedure, embryologists receive test tubes containing liquid removed from the ovaries. The embryologist will search this fluid under a microscope and identify the eggs. The eggs are collected together and placed into petri dishes for the remainder of the IVF process. The embryologist is also responsible for fertilizing the eggs with sperm by conventional insemination techniques or intracytoplasmic sperm injection (ICSI).

ICSI is a more complicated procedure that involves using microscopic instruments to remove the cumulus cells surrounding the egg, allowing the embryologist to assess egg maturity and egg quality. After the sperm preparation procedure, an individual sperm is injected into each egg. When ICSI is not needed, sperm are placed in the dish with the eggs after the sperm preparation or sperm washing procedure is completed.

The day after the sperm and eggs are combined, the embryologist checks for fertilization by examining each egg under the microscope. Eggs that did not undergo ICSI will need to have the outer cells removed so the embryologist can perform the fertilization check. The fertilized eggs, or zygotes, are placed into an incubator that has been regulated to control gas mixture, temperature, and several other conditions. Optimal conditions in the embryology laboratory will allow the zygote to progress to the cell division stage, at which point the zygote becomes an embryo. The embryologist will check on the embryos and change the culture media as needing during the 3 to 5 days before the embryo transfer procedure.

Embryologists also perform embryo biopsy procedures on embryos at day 3 or day 5. During the embryo biopsy procedure, an embryologist must rely on experience to remove a single cell from an embryo while minimizing the risk of damage to the embryo. The embryologist will work with the laboratory performing the genetic test and coordinate the handling of the cells and test results. The embryologists skill at performing micromanipulation procedures on embryos can play a vital role in the success of IVF.

Using micro-surgical techniques, embryologists may also perform assisted hatching on embryos. During this procedure, microscopic tools are used to thin the outer shell of embryos and make a hole in the zona pellucida to facilitate the hatching process. The embryologist will also assess the quality of the embryos and provide the infertility doctor with a report on embryo quality. This information is used to determine if there are any issues with poor embryo quality that could affect the chances of a pregnancy.

When the best quality embryos are identified, the embryologists will load the embryos into the transfer catheter and work with the doctor to perform the embryo transfer procedure. Any remaining embryos that are not transferred and appear to have the capability of making a pregnancy, are frozen for later use. The embryologist is responsible for the cryopreservation of extra embryos during the IVF process.

Embryologists usually obtain their training in biologic sciences. Many embryologist gain their initial experience in animal laboratories before transferring into human IVF. Over the last few years, embryology training programs for human IVF have been formed. It is likely that there will be more of these programs in the future. Regardless of the training background of an embryologist, hands on experience is one of the most critical factors in an IVF lab.

California IVF: Davis Fertility Center, Inc. has some of the most experienced embryologists with over 30 years combined experience. Their experience allows us to easily adapt to developments in embryology that will help our family maximize our patient’s chances of having a baby.

--> © California IVF: Davis Fertility Center, Inc. Male and female infertility specialists near Sacramento.

Infertility Supplements and Dietary Aids

Infertility problems affect millions of couples in America. As the stress of infertility increases, it is common for people to search for answers on the Internet and printed sources such as magazines. Much of the information and advice available to women trying to conceive has not been written or reviewed by an infertility specialist. Even worse, much of the information is simply not true, and can lead to couples to take medications or treatments that may actually decrease their chances of getting pregnant.

It is important to understand that any medication or dietary aid that is labeled with the words “nutritional supplement” or “dietary aid” are classified as food items by the Food and Drug Administration (FDA). This means that these supplements are not regulated by the same laws that regulate medications. Laws pertaining to medications require that new medications are equivalent or better to existing medications, and these medications can not be misrepresented in terms of their effects and side effects. Nutritional supplements do not even have to contain any medications, and there is not government oversight to protect against harmful contamination in these medications.

Most of the dietary supplements advertised to help with infertility have no evidence supporting the proposed benefits. Unfortunately, the nutritional supplement market for infertility is a multibillion dollar industry. As long as there are individuals that will believe the marketing hype surrounding infertility diet aids, these products will continue to be sold. These products are frequently packaged like medications and the advertisements frequently report that the effects are clinically proven. Other than a potential false advertising claim, there are no restrictions on how these supplements are marketed, and no requirement to test the quality or effects of these supplements.

Scientific studies on some of these compounds showed very harmful contamination and broad ranges of chemicals and hormones that can have harmful effects. Infertility specialists are frequently asked for their opinion about these supplements and often encounter resistance when patients are advised to stop using these supplements. Most of this faith placed in these nutritional supplements comes from the marketing and hype placed on these nutritional aids and vitamins. This marketing does not take into account the well-being of infertility patients, but instead seeks only to make a profit. Infertility doctors are committed to the health and well being of their patients and keep up to date with all of the evidence-based treatments designed to improve an infertile couple’s chances of having a baby.

Vitamins may play a role in overall health, however, patients do not need to take anything more than a multivitamin or prenatal vitamin. It is recommended that women trying to conceive take at least 400 micrograms of folic acid (folate). In certain circumstances, women may be advised to take additional vitamins or other nutritional supplements, but should do so only under the advice of a physician or other health care provider.

California IVF: Davis Fertility Center, Inc. does not support the use of dietary supplements or nutritional aids, and remain concerned that many of these nutritional aids may have harmful effects in addition to being very expensive. There is no evidence that nutritional supplements for male and female infertility will have any benefits on the chances of having a baby. Please inform your physician of any and all nutritional aids, dietary supplements and vitamins that you are taking.

Our infertility doctors fully support and educate our patients about healthy eating and diet changes that can help women get pregnant.  Diet can have a big effect on PCOS and having a baby.  A balanced diet and healthy lifestyle including exercise and avoiding smoking and smokers can help improve a woman's fertility health and chances of conceiving.

Pregnancy Success Rates May Improve With Genetic Testing of Day 5 Embryos

The “buzz” at the ASRM Annual Meeting in Denver, October 2010, was biopsy of Day 5 (blastocyst) embryos with subsequent genetic analysis. Current embryo biopsy techniques focus on Day 3 embryos for pre-implantation genetic testing (PGD) of embryos.

Day 3 embryos are usually composed of 6-8 cells, and one cell is removed, fixed to a slide, and analyzed in the lab. Having only one cell to work with, though, can be a negative in several ways. Firstly, there’s always the chance that the material from one cell will not be enough to provide a sample for analysis. Secondly, there is the somewhat complicated issue of mosaicism.
As cells grow and divide, genetic mistakes can happen. Since the embryo is made up of several different dividing cells, it’s possible that some of the cells divide normally, while some of them create genetic mistakes during their division.

The result can be a mosaic embryo—one that has some normal cells and some genetically abnormal ones. The concern with embryo biopsy on Day 3 is that with removing only one cell, how do you know that all the other cells have the same genetic makeup?

Studies show that embryos that make genetic mistakes have a high tendency to correct themselves by the time they reach the blastocyst (Day 5) stage. In other words, the normal cells continue to grow and divide, forming a healthy embryo, and the genetically abnormal cells disperse. This phenomenon is called self-correction. So a significant concern with Day 3 embryo biopsy is that a single cell can be analyzed and identified as abnormal, leading to discarding of that embryo, while in fact, it could undergo the process of self-correction, leading to the discard of a perfectly fine embryo.

Day 5 embryo biopsy has definite advantages over Day 3 biopsy. Day 5 embryos generally have 100-150 cells, so usually 10-15 cells can be removed without harm. This allows a larger sample to test. The test is also run at the later, Day 5, stage, which allows for self-correction to happen. Also, by the time the embryo reaches the Day 5 stage, it has formed two separate structures: the inner cell mass, which can become a baby; and the trophectoderm, the outer cells which will form the placenta. The cells removed in the biopsy come from the trophectoderm, leaving the inner cell mass intact.

The major disadvantage of Day 5 biopsy is in the time it takes to run the genetic tests. The blastocyst stage is when the embryo would begin to burrow in and implant in a woman’s uterus. So by the team an embryo reaches blastocyst stage in the lab, it can only be transferred into a uterus or frozen for storage. Genetic testing may take several days, so an embryo that is biopsied on Day 5 must be frozen until the results are available. This would involve a scheduled future transfer of the normal embryo in another cycle, after preparing the uterus with hormones. Fortunately, improvement in embryo freezing techniques, primarily the use of vitrification, has made this option a successful alternative. It was revealed at the 2010 ASRM Annual Meeting that some centers are also working to shorten the time the diagnostic testing takes, so that the biopsy could be done early on Day 5 and allow transfer early in the morning the following day, with excellent pregnancy rates.

About Dr. Laurie Lovely:

Sacramento Infertility Specialist Dr. Laurie Lovely is board certified by the American Board of Obstetrics and Gynecology (ABOG) in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. She has received a research grant from the American College of Obstetricians and Gynecologists for her work on the effects of hormones and the endometrial lining. She presented a prize-winning paper on the effects of stress and infertility at an annual meeting of the American Society for Reproductive Medicine. Additional professional interests include pubertal problems and reconstructive tubal surgery including tubal ligation reversals.

--> © California IVF: Davis Fertility Center, Inc. Northern California Male and female infertility specialists near Sacramento and Roseville.

Trying to Conceive After 35? Advanced Maternal Age, #Infertility and Getting Pregnant

Natural pregnancy rates are affected by age and the average woman’s chance of conceiving on her own during a 12 month period of time decreases as she gets older. Advanced Maternal age is one cause of infertility.

• 20-24 year old women have a 86% chance of conceiving in 12 months
• 25-29 year old women trying to conceive have a 78% chance of getting pregnant within a year
• 63% of women between the ages of 30-34 attain pregnancy naturally with 1 year
• At 35-39 years old, most women have a 54% chance when trying to get pregnant over the course of one year.
• After 40, a woman who is trying to conceive over 1 year has a 36% chance of pregnancy
• By 45, only 5% of women conceive a child naturally after one year of trying for a pregnancy

In addition, after 1 year of not conceiving, there is only a 5% chance of getting pregnant by waiting an additional 6 months to 1 year. Another way to view this information is by a woman’s chance of getting pregnant per month. During the first year of trying, a woman at age 23 would have an approximately 25% chance of pregnancy each month, whereas a woman at age 40 would have a 13% chance of pregnancy each month.

The decline in a woman’s chances of getting pregnant is not related to a woman’s health or how young she feels. The main cause for this decrease in the chances of getting pregnant lies within the genetics of the egg.

As a woman ages, the quality of the eggs deteriorates. The decline in quality causes an increased risk of chromosomal problems within the eggs, which leads to fewer normal eggs and an increased risk of miscarriages due to chromosomally abnormal embryos such as Down syndrome. Preimplantation genetic testing (PGD)of embryos is one way to detect chromosomally abnormal embryos.

There are not any known medications or treatments that can change the effects of age on the eggs, since the problem lies within the genetics of the eggs. When a woman’s ovary is being formed, the body sets aside cells that will make up the eggs within the ovary. A woman is born with all of the eggs she will ever have in life. The eggs have not finished their cell division and still contain 2 complete sets of chromosomes. Before an embryo can be formed, the egg must finish separating the chromosomes so that the egg will only contribute one set of chromosomes that add to the set of chromosomes provided by the sperm. Over time, the ability of the egg to separate the chromosomes normally starts to decline, and there will be an increase in the number of chromosomally abnormal eggs. Many eggs will stop living because of the abnormalities, though a woman may still ovulate normally. Some embryos will be formed from an abnormal egg, but most of these pregnancies will end in a miscarriage.

In addition to the increase in chromosome abnormalities, the number of eggs available for fertility treatments will also decline. In a normal menstrual cycle, only one egg survives and goes through ovulation. During fertility treatments, medications are used to increase the number of eggs produced. As a woman ages, the number of eggs available, or “ovarian reserve,” decreases. Having fewer eggs available can result in lower pregnancy rates with fertility treatments. There are tests available to try to evaluate “ovarian reserve,” but these tests are often inaccurate. A normal ovarian reserve test does not imply that a woman has a better chance of getting pregnant and will not undo the effects of age on her chances of getting pregnant.

There are tests that can be used to detect abnormal eggs and embryos with genetic problems.  These tests are referred to as pre-implantation genetic diagnosis, PGD, and pre-implantation genetic screening, PGS.  There are various techniques for looking at genetic material from embryos before pregnancy.  California IVF continues to push forward with new clinical infertility treatments to help with recurrent pregnancy loss, testing eggs before pregnancy, and gender selection.

When an egg from a donor is used, pregnancy rates are generally not affected by age. Women who are interested in becoming an egg donor are younger, screened for infectious diseases and generally provide excellent chances for another woman to become pregnant. Additionally, women using donor eggs would be more likely to have extra embryos which could be used in a frozen embryo transfer so the overall pregnancy rate is even higher than depicted. Donor eggs are often used as an option for women who are unsuccessful using their own eggs or who have reached an age where their chances using their own eggs become too low.