Thursday, November 12, 2009

Assisted Hatching – Conception Option for Older Women

Assisted hatching is a good option for couples experiencing poor IVF outcomes or who have been diagnosed with a poor fertility prognosis. The procedure offers them a better chance for conception. It is a technique where an embryo is fertilized outside the womb via IVF and the zona pellucida or outer coating of an embryo is partially opened so as to assist the embryo to escape or hatch from the zona and improve implantation and pregnancy rates.

Sometimes IVF may not lead to positive results because of genetic abnormalities of embryos and abnormalities of the zona pellucida which may impair embryonic hatching.

Assisted hatching helps in overcoming these conditions.
Assisted hatching is recommended in case of advanced maternal age, for those who have had a number of unsuccessful embryo transfers and where embryos have increased zona thickness.

How Assisted Hatching is Performed
Assisted hatching is a very delicate procedure and can be performed only by a skilled micromanipulator or an embryologist. The embryo is held with a specialized holding pipette and a very delicate, hollow needle is used to expel an acidic solution against the outer shell or zona pellucida of the embryo. A small hole is made in the shell by the acidic solution and the embryo is then washed and put back in the incubator. Shortly afterwards, the embryo transfer procedure is initiated. This procedure may be accomplished chemically, mechanically, or with a laser.

Risks Associated with Assisted Hatching
Those opting for assisted hatching should be made aware of some of the risks associated with this procedure:
• A small risk exists of damage to the embryo during the micromanipulation process or at the time of transfer
• Risk of identical twins and in rare cases Siamese twins
• A greater chance of fetal complications
• It does add extra laboratory manipulation and therefore added costs

East Bay Fertility Center offers several IVF techniques, including assisted hatching in select appropriate cases. The Center assesses the possible benefits of assisted hatching before finalizing the process as part of a treatment plan. The patient is made aware of the risks and benefits of the procedure and consent must be given for an embryologist to use assisted hatching. Under the guidance of Dr. Ellen U. Snowden, Medical Director and Reproductive Endocrinologist, medical staff at East Bay provides dedicated treatment for infertility and reproductive endocrine issues.
For couples who have attempted assisted reproductive procedures many times and for women, whose time is running out because of their age, assisted hatching offers hope of realizing their dreams of becoming parents.

Wednesday, November 11, 2009

Pre-Implantation Genetic Diagnosis (PGD) in Fertility Treatments

For couples undergoing in vitro fertilization (IVF), pre-implantation genetic diagnosis (PGD) is a procedure undertaken to screen the embryos for a host of genetic diseases and disorders to ensure the delivery of a healthy baby. PGD helps physicians to identify some genetic defects within the embryo, prior to implantation, before the pregnancy is established. The couple can then decide whether or not they want to continue with the pregnancy. The procedure was first conducted in 1988 and since then this technology is increasingly being used in fertility clinics in the United States.

PGD is normally recommended for couples where one or both of the parents are a known carrier of a genetic disease such as hemophilia. The procedure involves the removal of one or two cells from an embryo which are then screened for genetic abnormalities. PGD identifies the embryos with chromosome abnormalities, thereby avoiding their transfer during an in vitro fertilization procedure. The analysis helps to detect certain inherited or chromosomal diseases such as Down syndrome, Thalassemia, cystic fibrosis, hemophilia A, Tay-Sachs disease, and Turner syndrome among others, prior to implantation.

Most fertility clinics offer PGD in select cases such as:
• Women over the age of 35 who have had miscarriages or failed attempts at becoming pregnant through IVF
• Women who have repeated pregnancy loss due to genetic disorders or who already have one child with a genetic problem
• Any couple who have been unable to become pregnant through multiple IVF cycles
• Couples who wish to identify a tissue match for a sick sibling who can be cured with transplanted cells

For couples who are at risk of passing on serious inheritable genetic diseases to their offspring, a diagnosis before embarking on a pregnancy is preferable to medically invasive, emotionally demanding prenatal diagnostic techniques. However couples with genetic disorders should receive adequate counseling about the risks of misdiagnosis and the possibility of no diagnosis before going in for PGD.

East Bay Fertility Center California, offers a wide range of infertility treatments along with expert medical counseling to couples facing difficulty in conceiving. Under the guidance of Dr. Ellen U. Snowden, Medical Director and Reproductive Endocrinologist, medical staff at East Bay provides dedicated treatment for infertility and reproductive endocrine issues.

At the center, PGD is offered as an option to couples who are at high risk of passing on a genetic disease to their children. The Center’s IVF experience and access to advanced genetic testing and counseling holds the promise of increasing the probability of a successful pregnancy outcome from an in vitro fertilization procedure and reducing the incidence of genetic disease. The use of this advanced genetic testing procedure allows only normal embryos to be transferred back into the uterus, providing a much better chance of achieving a full-term pregnancy with chromosomally healthy embryos.

The Embryo Toxic Factor in Recurrent Miscarriages

One of the complex medical reasons for recurrent miscarriages may be traced to a condition known as embryo toxic factor (ETF). ETF is a cytokine secreted by the immune system’s white blood cells in response to pregnancy tissue. If excess amounts of cytokine are produced by white blood cells during pregnancy, the immune system may consider the embryo as a foreign body and try and eliminate it, thus leading to miscarriage. Embryo toxic factors have also been reported in women experiencing unexplained infertility and infertility associated with endometriosis.

Diagnosing Embryo Toxic Factor
Testing for embryo toxic factor is a complex laboratory experiment and is opted for only if other tests for miscarriage do not lead to any conclusive results. ETF testing is still considered an experimental testing.

A blood sample is first taken and the lymphocytes are cultured for several days. They are then combined with cultured mouse embryos and left to sit for a few days. Subsequently, a fertility specialist studies the embryo development in relation to how it has been affected by these lymphocytes. If the embryos have stopped developing or have died, it shows the presence of ETF. If the embryos are developing normally, the conclusion is that no ETF is secreted.

The Treatment Regimen


Women suffering from ETF usually have to engage in a multiple treatment regimen to avoid future pregnancy complications. Since the cause of ETF is an over-active immune response, the treatment for ETF revolves around immune system repression. This includes

Intravenous immunoglobin (IVIg) infusions which suppresses the production of cytokines
Vaginal applications of progesterone in suppositories or gel caps, taken until the sixteenth week of pregnancy

In case the woman is undergoing IVF treatment, progesterone oil injections may be given

Recurrent miscarriage is a condition that could be a sign of a more serious problem and a fertility specialist should be immediately consulted. East Bay Fertility Center California, offers a wide range of infertility treatments along with expert medical counseling to couples facing difficulty in conceiving. Under the guidance of Dr. Ellen U. Snowden, Medical Director and Reproductive Endocrinologist, medical staff at East Bay provides dedicated treatment for infertility and reproductive endocrine issues. East Bay Fertility Center specializes in providing infertility treatments such as in-vitro fertilization, insemination, Intracytoplasmic sperm injection, egg donation and gestational surrogacy. With the right type of treatment and intervention, the Center assists couples who have been having problems conceiving to overcome those difficulties in the shortest possible time in order to realize their dreams of having a healthy baby.