Where Motherhood Can Be Possible

Dr. Louis R. Manara

Egg Banks – An Update!

Jan 8, 2014 — by manara99
Tags: Best Ivf Practices South Jersey

Vitrification, or rapid freezing, has enabled us to freeze human eggs while minimizing damage to delicate intracellular spindle fibers that are responsible for moving chromosomes during cell division.  Available technology allows fertilization rates comparable to fresh eggs upon thawing, and has led to the opening of commercial sperm banks.

Is Double Intrauterine Insemination (IUI) More Successful Than Single IUI?

Intrauterine insemination coupled with ovarian stimulation is a common infertility treatment, which may be utilized for couples with unexplained infertility, male factor, ovulatory disorders, or endometriosis.  The generally accepted technique incorporates one properly timed insemination.  Numerous studies have failed to demonstrate a significant advantage for performing two consecutive IUI’s compared to one, when looking at heterogeneous groups of infertile patients.  However, a recent abstract suggests that with male factor infertility, there may be a distinct advantage to double IUI.

PCOS Management – An Update

Our understanding of polycystic ovarian syndrome (PCOS), the most common endocrine disorder of women, has improved dramatically in recent years.  Its association with metabolic abnormalities has been well established and new treatment approaches are being studied and often implemented.  This review will look at recent developments in the management of PCOS and attempt to clarify contemporary management of the syndrome in the context of the available scientific information.

More Evidence That Genetic Abnormalities Explain Age Related Infertility!

Mounting evidence suggests that the significant reduction in infertility treatment success as women age is mostly related to increased production of genetically abnormal (aneuploid) embryos with advancing years.  A recent multicenter study in which embryos were studied with PGD (preimplantation genetic diagnosis), demonstrated that the percentage of genetically abnormal embryos produced by women less than 35 years of age was 31.7%, while the percentage of genetically abnormal embryos produced by women 41-42 years of age was 76.3%.  However, when genetically normal embryos were available, the implantation rate was not significantly different across all age groups.

Letrozole For Ovulation Induction – Better Than Clomid?

Letrozole is one of a class of drugs termed aromatase inhibitors, which work by inhibiting the production of the enzyme responsible for the synthesis of estrogen.  With low blood levels of estrogen, the hypothalamus and pituitary are released from their negative feedback mechanism and will increase their production of pituitary hormones, which control ovulation. While not yet FDA approved, letrozole seems to have some distinct advantages and applications making it an attractive first or second line treatment option for certain categories of infertility.  Treatment with letrozole seems to result in improved pregnancy rates and reduced multiple birth rates compared to clomid treatment.

Do Uterine Fibroids Cause Infertility?


Uterine fibroids are present in approximately 30-50% of reproductive aged women, and are often identified through ultrasound in the course of the infertility evaluation.  It is well established that fibroids located within the uterine cavity (sub-mucous fibroids) can cause infertility, but there is uncertainty concerning whether fibroids located within the walls (intramural) of the uterus or just beneath the outer surface of the uterus (sub-serosal fibroids) cause infertility.  Proximity of the fibroid to the uterine lining and size of the fibroid are two important factors in determining whether a fibroid is responsible for infertility, but it is not always completely clear that the fibroid(s) in question is the cause of infertility and needs to be removed.

Repeated IVF Failure: What Do We Know In 2013



Repeated in-vitro-fertilization (IVF) failure is perplexing for patients as well the infertility team providing care.  In spite of repeated placement of what appear to be healthy embryos, ongoing pregnancy does not occur.  These patients usually have had extensive evaluations that include careful evaluation of the uterine cavity, genetic testing of both parents, testing for clotting disorders (thrombophilias) in the woman, comprehensive endocrine assessment, and evaluation of the male.  Conventional wisdom has been that there is most likely a genetic explanation for these repeated failures.  That notion may be incorrect based on a recent study. 

Elective Single Embryo Transfer


Because of the known significant risks of multi-fetal gestation, there have been substantial efforts directed toward decreasing the number of multi-fetal pregnancies associated with assisted reproductive technologies (ART).  While efforts over the past 10 years have substantially reduced the number of triplet and higher order pregnancies, the incidence of twins remains unacceptably high among ART pregnancies.  Incentivizing elective single embryo transfer (eSET) is one of the methods being considered toward reducing the incidence of twins.  A recent abstract presented at the IFFS/ASRM conjoint meeting in Boston, October 16, 2013 reviewed  incentivizing eSET.  

Improving IVF Success Rates Through Embryo Freezing

Oct 18, 2013 — by manara99
Tags: Ivf Success Freezing Improving Ivf Success


In recent years embryo and egg cryopreservation techniques have been refined through the use of vitrification, a rapid freezing technique that results in improved live birth rates.  This has led to re-evaluation of the standard practice of placing fresh embryos into the uterus three to five days after insemination. Research is suggesting that in certain circumstances it may be advantageous to cryopreserve all embryos produced during the egg retrieval cycle and return embryos to the uterus in the future through a simplified frozen embryo transfer cycle. This approach eliminates any adverse effects of ovarian stimulation on the process of embryo implantation.

Novel Approach To Treating Infertility Caused By Aging Eggs


A recently published case report describes a procedure, which restored fertility potential in a 49-year-old woman.  The technique involved the injection of a purified population of monocytes (a type of white blood cell) into the woman’s ovaries.  The patient, who was menopausal prior to the treatment, experienced return of her periods four months after the procedure and conceived in the fifth month following the treatment and delivered a healthy female neonate at 37 weeks of gestation

Voorhees, New Jersey

Dr. Louis R. Manara


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