Advances in egg freezing:

Vitrification technology and our ongoing IVF clinical trial to advance our ability to help preserve fertility

Embryo freezing and the transfer of these frozen embryos months or even years later has become almost routine as a tool to manage infertility. The first calf (Frostie) from a frozen embryo was born in England in 1973 and the first human baby from a frozen embryo in Australia followed about 10 years later in 1983. Today, approximately 20% (~20,000 babies per year) of all IVF babies born in the United States are the result of frozen-thawed embryos.

However, the ability to freeze an unfertilized egg proved to be much more difficult. If successful, egg freezing allows the preservation of eggs and, subsequently, potential fertility preservation for patients facing imminent life-saving cancer treatment. Furthermore, this technology can rescue eggs during an IVF cycle where sperm cannot be obtained in a timely manner. If able to successfully bank donor eggs, the cost of donor-oocyte cycles can be reduced significantly, since eggs from a single donor can now be shared between two or more recipients. Eggs age with their owner and; therefore, fertility significantly decreases with patient age, starting as early as age 34. Banking younger eggs for later use may be an acceptable approach to increase the potential for future child bearing.

The first baby from a frozen egg was born in 1986 in Australia using conventional slow freezing techniques. Routine egg freezing never became feasible because of very low success rates, compared with that of routine IVF or even if compared with the use of frozen embryos (a pregnancy rate of only about 1.5% per frozen egg). Early in the 2000’s a new technique made its appearance - vitrification. Vitrification differs from conventional slow freezing by being an ultra-rapid cryopreservation method, using high concentrations of three or more cryoprotectants, and very high cooling rates (thousands of degrees per second), thereby preventing any ice formation inside or around the egg. Vitrified eggs result in significantly improved and consistent post-freezing survival. Indications are that pregnancy rates obtained from vitrified eggs are now much closer to those obtained from frozen or even fresh embryos.

Despite the promise of egg vitrification, very few infertility programs in the world currently offers this as a clinical service to their patients. This is partly due to a lack of confidence, experience and the significant time lag between vitrifying the egg and knowing the outcome. Appreciating the future need and promise of egg vitrification, the Frisco Institute of Reproductive Medicine very recently received Institutional Review Board (IRB) approval to conduct a formal patient-compensated clinical trial on egg vitrification starting in February, 2012. Infertility patients meeting criteria (≤37 years old, not overly overweight, able to produce a reasonable number of eggs, and having a medical reason for in vitro fertilization) may choose to participate in this study at the Frisco Institute for Reproductive Medicine. During this study, half of the eggs will be vitrified (frozen), warmed back up (thawed) a few minutes later, and then fertilized with the other half of the eggs. All other aspects of the IVF treatment plan remains as determined by the doctor. Patients participating in this study receive significant financial support for their willingness to advance knowledge in this important area of infertility treatment. A total of 20 slots are available. More information about this study can be obtained at www.clinicaltrials.gov or by contacting the Frisco Institute for Reproductive Medicine.

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New Year’s resolution: Shed pounds, optimize fertility

One of the woes of our modern lifestyle and eating habits has been the development of the obesity epidemic. There are many medical conditions caused by or worsened by obesity, such as diabetes, heart disease, stroke and infertility.  Recently there have been several studies demonstrating the negative impact of obesity on reproduction. Pregnancy rates in obese women may be as much as 30% lower than those of non-obese women with otherwise similar characteristics.  We also know that obese women can be less responsive to fertility medications. For the same medication dose, obese women often produce less eggs than normal weight women.

What is obesity?

A standard medical definition of "normal" body weight is a body mass index (BMI) of 18.5 - 24.9

• A BMI under 18.5 indicates that the person is "underweight"
• A BMI of 25.0 - 29.9 indicates that the individual is "overweight", but not obese
• A BMI over 30 indicates obesity
• A BMI over 40 indicates extreme obesity.

The BMI is calculated based on a person’s height and body weight. That being said, BMI calculation does not take into account percent body fat, so theoretically someone with lot of muscle mass could have a higher BMI but not have the same negative health consequences as someone with the same BMI but much higher percent body fat.

Why does obesity cause infertility?

The main culprit in the metabolic manifestations of obesity is the increased number of fat cells. The extra fat can cause insulin resistance, leading to type-2 diabetes and an increased production of male-like hormones which, in women, can lead to ovulation disorders. In obese women, there are increased inflammatory processes in the body that can contribute to infertility, increased risk of miscarriage, as well as other unrecognized metabolic abnormalities.

Not only do women that are obese have a more difficult time getting pregnant, but once pregnant, they also have a higher risk of miscarriage and giving birth to babies with birth defects. While maintaining a healthy weight is important, one does not have to aim towards becoming a size 2 supermodel. Even just a 5%-10% weight loss can significantly improve the chances for successful conception.

More causes of infertility here.

How can I lose weight?

I always recommend a healthy, balanced diet and moderate exercise. Stay away from “Fad” diets as they are not sustainable. The goal is to lose the weight and keep it off, which may involve a complete change in the way one approaches food. Consider the advice  of a professional dietician.  Think about signing up for a program like “Weight Watchers”, “Jenny Craig” etc., since structured programs can often make the difficult task of losing weight a little easier, providing discipline and emotional support. A healthy rate of weight loss while trying to conceive is acceptable, but be sure to discuss the plan with your doctor and get the help and support you need.  Weight loss can dramatically improve your chances of success, regardless of which infertility-treatment option is chosen.

When is bariatric surgery appropriate?

If a woman has been unsuccessful with diet and lifestyle modifications and still has a BMI greater than 35-40, bariatric surgery can be considered. Often, in people with a BMI over 45, bariatric surgery in conjunction with lifestyle modifications is needed to effectively lose an adequate amount of weight.

Can one undergo fertility treatments if obese?

The answer is yes, as long as the patient has realistic expectations and is aware of the lower success rates of any fertility treatment in obese patients. Since the age of the woman as well as the egg reserve have a more profound impact on fertility than anything else, it would not be prudent to expect a 40-year-old woman or a woman with a very low egg reserve to lose weight and then come back at a later time, because sometimes the window of opportunity may be lost. It is always my advice to patients to do the best they can to optimize their lifestyle and weight before they start attempting pregnancy or while undergoing treatment. Unless a pregnancy is unsafe for the patient, withholding treatment only based on weight may be an unfair thing to do, especially in older women.

Contributed by: Dr. Rinku Mehta, published extensive research in Polycystic Ovarian Syndrome and specializes in all forms of male and female infertility.

Current Practice:
Frisco Infertility Clinic Frisco, TX
8380 Warren Pkwy., Suite 201
(972) 377-2625

Schedule an appointment here

PCOS

What is PCOS?

Polycystic ovary syndrome (PCOS) is a very common reproductive endocrine disorder affecting about 5-10% of reproductive age women. Research is still ongoing to delineate the causes of PCOS, however most experts believe that it may have a multifactorial etiology that invloves genetics, environmental factors as well as fetal and childhood exposures. Some of the symptoms commonly experienced by women with PCOS are menstrual irregularity, increased male hormone actions in the woman (such as increased coarse facial hair), resistance to the actions of insulin in the body and a characteristic appearance of the ovaries on pelvic ultrasound.  Although many women with PCOS are overweight or obese, thin women can have PCOS as well.

How does PCOS affect fertility?

Women with PCOS often have irregular periods because of lack of regular ovulation caused by abnormal hormonal secretory patterns. This leads to infertility caused by ovulatory dysfunction. However, it is extremely important to exclude other causes of ovulatory dysfunction such as thyroid or pituitary abnormalities before pinpointing PCOS as the cause of the irregular periods.  Due to chronic anovulation in women with PCOS, intercourse can be difficult to time and pregnancy hard to achieve. Treatment for infertility due to ovulatory dysfunction involves the use of medications such as clomiphene citrate (“Clomid”) which help induce ovulation. Most pregnancies achieved with Clomid occur within 3-4 ovulatory cycles. If you are not successful by that time then it would be prudent to seek care from a reproductive endocrinologist.  If you are already seeing one, then it makes sense to move on to more aggressive treatment modalities. Not all women will respond to clomid, even at the higher doses, such as 200-250 mg. For these women, treatment options involve injections of the hormone FSH which helps induce ovulation. The biggest “side effect” of treatment is multiple gestations. The risk of twins is estimated to be about 5-8% with clomid and 15-20% with injectable medication. Another medication to consider before moving on to the injectable medications is an aromatase inhibitor such as letrozole which is an oral medication like clomid, but with a different mechanism of action. Some clomid resistant women may respond to letrozole.

What are the long term impacts of PCOS?

Since PCOS is an endocrine disorder associated with resistance to the action of insulin in the body, there can be long term metabolic impacts on the development of disorders such as diabetes and coronary artery disease. It is important for women with PCOS to have testing for glucose and lipid levels at least once every two years. This is done by checking a 2 hour glucose tolerance test and a fasting lipid panel. Often women with glucose intolerance can benefit from medications such as metformin which help improve the action of insulin in the body. The development of the “metabolic syndrome”, which involves high triglyceride levels, abnormal glucose levels, hypertension, and an increased waist to hip ratio, can have a profound impact on the development of cardiovascular disease. Maintaining a healthy diet and weight is of great importance to slow or prevent the onset of type 2 diabetes, lipid disorders, metabolic syndrome and ultimately coronary artery disease.

Another important aspect of chronic anovulation is its effect on the endometrium, which is the lining of the uterus. If a woman goes for long periods of time without having menses, then she can be prone to developing hyperplasia (precancerous abnormal growth) of the endometrium.  Atypical hyperplasia can ultimately lead to endometrial cancer if untreated. It is important to protect the endometrium either by using a progesterone containing contraceptive or by inducing a period every couple of months by taking a course of Provera or other such progesterone.

PCOS is a complex disorder with no easy fix, but many of its manifestations can be controlled with the right lifestyle modifications, medications and of course fertility treatments in those desiring pregnancy.

Contributed by: Dr. Rinku Mehta, published extensive research in Polycystic Ovarian Syndrome and specializes in all forms of male and female infertility.

Current Practice:
Frisco Infertility Clinic Frisco, TX
8380 Warren Pkwy., Suite 201
(972) 377-2625

Schedule an appointment here