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.

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Why is in vitro fertilization (IVF) so expensive?

California IVF: Davis Fertility Center, Inc. strives to make in vitro fertilization (IVF) a cost effective approach to maximizing the chances of pregnancy. We understand the additional stress finances place on patients wishing to get pregnant and that for many, the cost of starting or continuing treatment is a barrier to pregnancy.

Cost, Overhead and the Modern Embryology Lab

The combination of physician, embryologist and staff experience along with our modern embryology laboratory, which creates an environment that mimics the human body, is why we can help women get pregnant with in vitro fertilization (IVF). However, in addition to high staffing costs, maintaining a high tech lab contributes significant overhead and affects the cost of treatment. Major lab systems include the:

Air System – Designed by a specialized engineer, this system creates a positive airflow that pushes air out of the lab, limits temperature fluctuations within 1-2 degrees and constantly removes contaminants with four Hepa filtration units. It is inspected annually for clean air compliance and maintains a 96% seal from the outside world.

Gas System – The oxygen concentration of normal air is toxic to embryos. Specialized incubators, microscopes and handling techniques protect the embryos and maintain a gas mixer that optimizes growth.

Microscope System – Given the tiny size of embryos, high powered microscopes fitted with mechanical manipulation devices are required to perform treatments such as intracytoplasmic sperm injection (ICSI) or embryo biopsy for pre-implantation genetic diagnosis (PGD).

Safety System – This system continuously monitors the lab for proper air and incubator temperatures and gas levels as well as the liquid nitrogen level of frozen embryos and semen samples. If there is a power outage, our diesel generator automatically starts and can run for several days without refueling.

California IVF: Davis Fertility Center, Inc. uses its modern embryology lab to increase the effectiveness of fertility treatment and patient pregnancy rates. If you have any questions regarding the embryology lab and its affect on the cost of treatment, please ask. We remain committed to helping patients realize the joy and miracle pregnancy can bring.

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

Sacramento Area Infertility Support Group for Fertility Patients

California IVF: Davis Fertility Center, Inc. encourages its patients to seek group support for general infertility issues as well as during advanced reproductive therapy like in vitro fertilization (IVF).

The Infertility Support Group of the Sacramento area is one resource for all Northern California women struggling with infertility to turn to so they do not have to struggle with getting pregnant alone.

The Infertility Support Group of the Sacramento area is a peer led support group for women that provides a place to discuss the emotional impact of infertility. Women are provided a welcoming space to discuss treatments for infertility like IVF and artificial insemination as well as alternatives like using acupuncture to help with stress and increase ovulation. Recommendations and experiences with Sacramento area infertility doctors and clinics many also be discussed openly and honestly.

Women with fertility issues may want to contact the Sacramento Area Infertility Support Group if any of the following statements apply:

• I'm feeling lonely and isolated because of my infertility.


• I have very few people to talk with about my infertility.


• No one understands how infertility is affecting me.


• My husband is the only one I have who provides emotional support in dealing with infertility.


• Infertility is affecting my work and career.


• I feel that my life plan is out of control because of infertility.


• I'm having trouble navigating my medical treatment options for infertility.


• I can't decide when "enough is enough" of infertility treatments like IVF, IUI and fertility medications like Clomid.


• Holidays and coping with family and friends is becoming more & more difficult the longer I deal with infertility and answer questions about why I am not getting pregnant or having a baby.

For more information about the Sacramento Area Infertility Support Group, email your questions or comments to Christine at sacramentoinfertilitygroup@gmail.com

Bimonthly Meetings take place on the 2nd and 4th Monday of every month in the Sacramento area.

Visit http://resolve.org for more information about infertility issues and a list of Northern California Support Groups

--> © California IVF: Davis Fertility Center, Inc. - Male and female infertility specialists serving the Sacramento, Roseville and the greater Northern California area including the San Francisco Bay Area.

Pre-Implantation Genetic Diagnosis of Embyros Provide "Gene Security" to Sacramento Area IVF Patients

In recent years, genetic testing has made the leap from science fiction to science present. While many older moms-to-be worry about disorders such as Down Syndrome, they are not the only women who can benefit from advanced genetic testing. Couples of any age who have miscarried frequently may gain new insight into their best pregnancy options by combining in-vitro fertilization (IVF) with a 24 gene screening test. At California IVF: Davis Fertility Center, Inc., we are proud to be the greater Sacramento area partner for Gene Security Network, an innovative genetic testing company based in Redwood City, CA. This partnership allows us to provide patients and referring doctors with the cutting edge technology necessary to make informed decisions about the best chances for pregnancy.

Performed in the three to five day window between egg fertilization and embryo implantation, a twenty-four gene pre-implantation genetic diagnosis (PGD24) is a battery of tests that looks at twenty three pairs of chromosomes along with the X/Y gender selecting pair. The result is a chromosome-level glimpse into the viability of a patient’s developing embryos. Ruling out the implantation of embryos with known genetic disorders is the primary reason for this test. Although it is not recommended to perform PGD24 for gender selection alone, this is one potential benefit for couples who are concerned about potential genetic disorders, already have children and wish to balance out their current families by favoring the selection of healthy embryos of a certain sex.

On its website, Gene Security Network lists the following reasons for combining IVF and PGD24 testing:

- the female partner is 35 years of age or older

- the couple has had recurrent miscarriages of unknown cause

- a previous child or pregnancy has had a chromosome abnormality

- the couple is concerned about having a child with a chromosome abnormality

- the couple has had a previous, unsuccessful IVF cycle

- one member of the couple carries a balanced chromosome translocation or inversion

- the couple is at risk of having a child with an inherited single gene genetic disease

Contact California IVF: Davis Fertility Center, Inc. at (530) 771-0177 to learn more about combining IVF with a PDG24 screening from Gene Security Network.

Learn more about the genetic diseases and family balancing reasons that cause many Sacramento, Roseville and Greater Northern California area fertility patients to combine IVF with genetic screenings at our center.

On-site Acupuncture, Stress, Fertility and IVF Embryo Transfer

California IVF: Davis Fertility Center now provides expanded on-site access to acupuncture services from the Acupuncture Fertility Specialists, based in Sacramento and Roseville.

Safe and convenient, Dr. David Cherry, O.M.D., L.Ac. and Jennifer Horton, L.Ac., MSTCM coordinate their appointments to provide the maximum benefit to patients undergoing IVF or other fertility treatments.

Regular appointments at the Acupuncture Fertility Specialists office help relieve the stress of taking fertility medications and procedures like egg retrieval and build up to on-site sessions before and after embryo transfer.

By having acupuncture available on-site during embryo transfer days, California IVF hopes to save patients the hassle of driving to additional appointments, reduce overall stress, and possibly improve the chances of implantation and pregnancy.

While the scientific benefits of combining fertility treatment and acupuncture are still being studied, many people are convinced of the positive effects. Many patients report lower stress-levels and believe these combined treatments helped them get pregnant.

California IVF proudly offers this on-site service to provide a comprehensive and stress-reducing approach to fertility treatment for its patients in the greater Sacramento and Northern California area including the San Francisco Bay Area, Stockton and Modesto.

For more information about combining in vitro fertilization or other assisted reproductive therapies with acupuncture, call California IVF: Davis Fertility Center at (530) 771-0177 or Acupuncture Fertility Specialists at (916) 486-0187 or (916) 789-1006.

Learn more about increasing fertility by combining IVF with acupuncture and where to find this service on-site in the greater Sacramento and Northern California area.