Where Motherhood Can Be Possible

Dr. Louis R. Manara

Freeze–All Strategy In High-Responding Patients

May 7, 2017 — by manara99
Tags: Ovarian Hyperstimulation Freeze All Gnrha Trigger Shot

 

Introduction – In recent years there has been increased use of the GnRH agonist as the final trigger to complete oocyte (egg) maturation in IVF treatment cycles.  While the use of the GnRH trigger has proven quite effective in preventing ovarian hyperstimiulation syndrome, it has not been without drawbacks. The traditional method for completing the maturation of oocytes has been through the administration of human chorionic gonadotropin (hCG).  In addition to completing the maturation of eggs, hCG also has a favorable effect on the developing uterine lining.  When the GnRH agonist trigger shot is used to complete oocyte maturation, the beneficial effect of the uterine lining is lost, and the uterine lining breaks down very early unless aggressive hormonal supplementation is given. A recent study looks at freezing all embryos in high responder patients when a GnRH trigger shot is used.

 


Preimplantation Genetic Diagnosis/Screening – Update July 2016

Jul 31, 2016 — by manara99
Tags: Infertility Ivf Failure Implantation Failure Pgs

The idea of genetically testing embryos to select the best embryo for transfer is not a new concept.  We have been applying one technology or another for over a decade and yet we remain unsettled in terms of answering some of the basic questions surrounding proper clinical application of this technology.  In this blog post we address the current controversies surrounding this technology and attempt to answer the questions of who should undergo testing, and which specific testing should be offering to our patients.


Why Does A Genetically Normal Embryo Fail To Implant?

Mar 12, 2016 — by manara99
Tags: Infertility Ivf Failure Implantation Failure

 

In recent years we have developed technology that enables us to determine if an embryo is genetically normal before it is transferred to the uterus. Various technologies are available to analyze cells taken from the embryo at the blastocyst stage of development and these technologies continue to become more sensitive and comprehensive. With the ability to confidently transfer genetically normal (euploid) embryos, our expectations for successful implantation are high. However, in spite of the application of this technology, a substantial number of these embryos fail to result in a live birth and we are left with the task of understanding these failures and explaining them to our patients.


A Look At IVF Results With Poor Prognosis Patients

 

It is fair to say that the majority of infertile couples with access to care will be successful given the right combination of patience, determination, and good treatment.  However, there is a sub-group of patients who may not achieve success.  This sub-group of patients is often referred to as “poor responders”, this term being broadly applied to patients who do not respond vigorously to ovarian stimulation.  It is important to define this group clearly so that information obtained from multiple centers may be compared and looked at cumulatively.  In this blog post, we review a recent study that looked at results of  768 treatment cycles in a group of patients who were categorized as poor responders/poor prognosis patients.


Highlights From the 2015 Meeting of The American Society For Reproductive Medicine - IMPROVING IVF SUCCESS RATES

The annual meeting of the American Society For Reproductive Medicine took place in Baltimore

from Oct 17-21. The meeting attracts reproductive professionals from around the world including

physicians, embryologists, researchers, mental health professionals, and nurses. Attendees

have the opportunity to choose from a wide variety of post-graduate courses according to their

specific discipline and interests. One course addressed methods of

improving IVF success rates. This post is a review of some of the highlights of this course.


Highlights From the 2015 Meeting of the American Society For Reproductive Medicine - FERTILITY PRESERVATION

The annual meeting of the American Society For Reproductive Medicine took place in Baltimore

from Oct 17-21. The meeting attracts reproductive professionals from around the world including

physicians, embryologists, researchers, mental health professionals, and nurses. Attendees

have the opportunity to choose from a wide variety of post-graduate courses according to their

specific discipline and interests. One of the courses addressed fertility

preservation. This course was designed to provide an update on the methods of fertility

preservation currently available for women facing cancer treatment or who the need to delay

child bearing for other reasons.


Letrozole - More Information!

Sep 19, 2015 — by manara99
Tags: Infertility Treatment Ovulation Induction Letrozole

Letrozole has been used for over a decade as an alternative to clomiphene for ovulation induction agent. In spite of growing enthusiasm for this medication for infertility treatment in the U.S., FDA has not yet approved it for this use. Clinicians continue to accumulate favorable experience with letrozole as new publications address issues of efficacy, safety, and appropropriate use become clarified.
 


Are male chromosomal abnormalities associated with repeated implantation failure and pregnancy loss?

 

Diagnosing male causes of recurrent pregnancy loss and repeated IVF failure can be quite difficult.  It is well understood that the standard semen analysis will fail to identify all males with abnormally functioning sperm.  Sperm count, motility, and microscopic assessment may all be quite normal in some men who have poor sperm quality and function.  When a specific technique called fluorescence in-situ hybridization (FISH) is used to evaluate the sperm of men whose partners have experienced repeated pregnancy losses or multiple failed IVF treatments, an increased incidence of sperm chromosomal abnormalities has been found.  If the sperm count, motility, and microscopic evaluation are abnormal in these patients, then the incidence of chromosomal abnormalities is even higher. 


Embryo "Glue" - Does it work?


 

Among all of the steps involved in IVF, the step associated with failure most often is embryo transfer.  In most treatment cycles, eggs are successfully obtained, fertilization occurs, and at least one embryo is available for transfers the uterus. Any safe, reliable, scientifically valid method for improving embryo implantation rates would be a welcome addition to any IVF program. Solutions referred to as  "adherence compounds" have been investigated for use in IVF laboratory culture media and may improve embryo implantation rates according to a recent review of the available literature.  A recent review of the available literature on the subject of "adherence compounds" published in the June, 2015 issue of Fertility and Sterility suggests that one of these compounds, hyaluronic acid, may be effective in improving pregnancy and live birth rates.


 


More Encouraging Research On “Freeze-All”!

May 25, 2015 — by manara99
Tags: Ivf Success Freezing Improving Ivf Success

There have long been concerns that high hormone levels generated through controlled ovarian hyperstimulation used for IVF may adversely affect the receptivity of the endometrium.  However, it is only in the past two years that studies have focused on implantation and ongoing pregnancy rates when all embryos are frozen, then transferred to the uterus in a future natural or minimally controlled cycle.  This approach avoids transferring any embryos when hormone levels may be high from stimulation and endometrial receptivity low. 


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