THE YEAR IN REVIEW

THE YEAR IN REVIEW

By Elena Trukhacheva MD, MSCI, President and Medical Director for Reproductive Medicine Institute 

CELEBRATING REPRODUCTIVE ENDOCRINOLOGY, INFERTLITY AND NATIONAL INFERTILITY AWARENESS WEEK

2016 was an interesting year in almost every sphere, from politics to medicine, and everything in between.

Always leading the charge of technology and thought, the field of Reproductive Endocrinology and Infertility (REI) has once again been in the forefront of much news and National Infertility Awareness Week (NIAW), April 23 – 29, is a good time to look at this more closely.

Ever advancing methods in embryo selection to assist in single embryo transfer (SET) as well as continual progress in the area of Preimplantation Genetic Diagnosis (PGD) and the freedom and relief it provides for families looking to assure the good health of a future child.  More information on conception for those of advanced maternal age as well as ways of optimizing third party reproduction, noting the role of epigenetics that link mother and baby regardless of the genetic connection.

These advances move forward on a daily basis, making REI one of the most exciting fields of science and medicine.  This week, National Infertility Awareness Week, we invite you to Listen Up! and celebrate with us as well as plan for the future.

ART and Technology

ART and Technology

by Reproductive Medicine Institute (www.teamrmi.com

A new smartphone app has shown early promise in its ability to detect healthy sperm at home

Assisted Reproductive Technology, also known as ART, continues to share ‘pillow space’ with cutting edge Technology when it comes to medical and surgical treatment for Infertility. But, when it comes to some of the newest computer applications, ART and Technology may be unlikely bedfellows.

Recent reports tout a new smartphone attachment that can evaluate a man’s semen and determine his level of fertility with up to 98% accuracy, a new study has shown.  The technology, which developers hope will be available in the next few years, consists of an external accessory in which sperm samples are inserted and an app that analyzes them. While the aim is to make testing as straightforward as a home pregnancy test, many Reproductive Endocrinologist and Infertility (REI) specialists are cautiously optimistic when it comes to a ‘do it yourself’ approach.

“For some couples, this exciting new technology may be a welcome alternative to testing in the clinic, which for some, can be an undesirable or awkward experience,” says Shweta Nayak MD, an REI with Reproductive Medicine Institute (www.teamrmi.com) with offices throughout the Chicagoland area. “It’s important to remember that while an abnormal test result should definitely lead to a consultation with a fertility specialist, a normal result still does not assure a couple the absence of infertility or subfertility.” Supporting this is that the new technology appears to be qualitative rather than quantitative. “Those who test normal, may still be on the low end of normal,” says Nayak, “a distinction which may still require medical intervention in order to conceive.”

Regardless, and in the presence, of at home testing, experts still recommend that couples still consider a formal, complete reproductive evaluation if they have been unable to conceive after 1 year and are under the age of 35, or after 6 months if over the age of 35. Another limitation may be the cost of at home testing, which unlike diagnostic testing in a physician’s office, will not likely be covered by insurance. “We do have systems already in place that provide a home collection kit for those who are unable or unwilling to produce a specimen at the clinic,” says Nayak. This alternate form of collection does depend on reasonably close proximity to the clinic, however, in order to assure an accurate analysis. “In the case where time and/or distance are limiting, this new technology may be quite beneficial,” says Nayak.

Overall, the new app may be a promising alternative for those considering at home testing, especially for those early in their journey towards building a family. “Couples should consider all factors contributing to their decision to test at home,” says Dr. Nayak. “We need to be certain that our testing is not just easier but also every bit as effective and comprehensive. Technology is a wonderful tool, but the best medicine also utilizes the physician’s touch.”

Using technology to track fertility

Using technology to track fertility

Advancements in technology have made fertility tracking more accessible than ever before to couples who are trying to get pregnant, but does all of this technology really help? Or does it add stress to what can already be a stressful situation?

According to Rebecca Flyckt, M.D., a fertility expert at Cleveland Clinic, tracking and charting is helpful to a point.

“Sometimes this technology raises more questions than it answers,” said Dr. Flyckt. “I think a lot of couples get really caught up in the aspect of tracking and timing and charting, and that’s certainly part of the equation, but it’s not the whole thing.”

There are several smartphone apps that are available that help track ovulation cycles, including a relatively new app that will analyze a man’s sperm count, as well as the sperm mobility. There are also over-the-counter tests that can be purchased at a pharmacy that will give “at-home” sperm count results.

Dr. Flyckt said she often talks about technology with her patients, because there is so much that is on the market that it can be overwhelming.

She said after trying to get pregnant after six months to a year, or sooner if there is a history of gynecological problems or irregular periods, couples should focus on other potential factors with the help of a professional.

“In a general way, for people who are interested in this kind of thing, it can be reassuring or even helpful,” said Dr. Flyckt. “But I think once a pattern has been established, a lot of talking that we do in the office is about other kinds of tests that we can order to figure out really what’s at the bottom of their infertility.”

Dr. Flyckt said it’s important for couples not to lose the forest for the trees. She said technology may be helpful, but it’s still in the early stages, and while it might be a good place to start, it’s always best to follow up with a professional after doing any tests at home.

What your sexuality, age and location have to do with your IVF coverage

What your sexuality, age and location have to do with your IVF coverage

Article on coverage provided by USA Today.

Advocates argue that in vitro fertilization, like other medical treatments, should come standard in the menu of coverage offered by insurance carriers.

Only eight states across the country require carriers to cover IVF in their plans, according to Resolve, a national organization fighting for states and employers to expand coverage of infertility treatments. Resolve President and CEO Barbara Collura said a few states have a mandate that requires insurance companies to at least propose IVF coverage, often at an extra cost.

Just because a state mandates it, insurance provides it and a person wants it, that doesn’t mean the person will qualify for it. A litany of criteria could exclude a woman from coverage, including her age, the amount of time she’s tried to conceive and even the size of her company.

Some states restrict who can be the sperm donor. Hawaii and Arkansas offer coverage only if the egg is fertilized with the partner’s sperm, an obvious roadblock for lesbian couples. Collura called the law “discriminatory” and said Resolve is working to overturn the regulation.

The criteria used by some states and insurance companies remain a barrier for certain demographics, said Nanette Elster, vice president of Spence & Elster, a Chicago law firm specializing in fertility law. Some state statutes use phrases such as “husband and wife,” which she said “clearly is problematic” for same-sex couples. Age requirements also can be a barrier. Elster said she’s encouraged that some of these restrictions are going away.

The requirements vary by state. Here’s a snapshot of coverage in each of the eight states that require carriers to cover IVF.

Massachusetts: The state requires the best IVF coverage, Collura said, with few restrictions. To qualify as infertile in Massachusetts, a woman under age 35 would have to not conceive for a year. For those older than 35, that period is six months. There is no limit to the number of IVF treatments covered and no dollar lifetime cap. An IVF treatment, Collura said, costs $12,000 to $15,000.

Rhode Island: Treatment is available to women ages 25 to 40 with a $100,000 treatment cap after two years of trying to have a baby.

Illinois: Women qualify for IVF after a year of unprotected sex or the inability to maintain or achieve a pregnancy with a less-expensive infertility treatment. Insurance covers up to four egg retrievals. If there’s a live birth, two additional egg retrievals will be covered. Employers with less than 25 employees do not have to provide coverage.

New Jersey: The state requires women under 35 to try to conceive a baby for at least two years; those older than 45 have to try for one year. Only women under 46 qualify. Employers with staffs of less than 50 do not have to provide coverage.

Connecticut: Infertility is defined as being unable to conceive or sustain a pregnancy after one year. The state covers two cycles of IVF. Religious organizations don’t have to offer coverage.

Myths about IVF, surrogacy and adoption

Myths about IVF, surrogacy and adoption

Article Provided by USA Today

As fertility options advance, myths about their methods increase. Couples and singles unable to conceive naturally have a variety of options to find a child, as long as they have the financial means and patience to do so. Not every option works for everyone. So, it’s important to do research.

Here are a few common myths about surrogacy, adoption and in vitro fertilization.

Gestational surrogacy

The baby is biologically related to the surrogate. Gestational surrogacy means the woman who carries the baby is not the mother. Embryos already prepared using an egg and sperm are implanted into a surrogate’s uterus. While the baby grows inside, it does not have the genetic makeup of the woman — but, rather will be biologically related to the egg and sperm donors.

Surrogates are poor or have no choice but to have babies for rich people. Gestational surrogates are required to have already had a successful pregnancy before they can carry, and fertility organizations often go through stringent vetting processes before accepting candidates into their programs, according to Teo Martinez, CEO of Growing Generations. Martinez said his agency receives up to 200,000 applications a year, but only accept 1% of those. The women must be able to provide for themselves.

Gestational surrogates are paid over $100,000. Many believe gestational surrogates receive exorbitant amounts of money for their services, but they typically receive between $25,000 – $40,000. Carey Flamer-Powell, the founder and director of All Families Surrogacy, said the amount a surrogate makes depends largely on the state she lives in and whether she has insurance that will cover parts of her care. Flamer-Powell said it can range from $30,000 for a single child to $40,000 for multiples.

Adoption

Birth mothers have to be anonymous. Birth mothers have the option to define how much contact they’d like with the child and the adoptive family. In fact, some agencies encourage birth mothers to opt for an open adoption.

Birth mothers can take the child back at any time. Some states require a several-day waiting period after birth to confirm adoption, but once legal paperwork is filed, an adopted child belongs to the adopted parents. At that point, there’s no going back.

Are you experiencing infertility? What should you do next?

Are you experiencing infertility? What should you do next?

Article on infertility provided by USA Today.

For those with infertility, trying to have a child can be draining emotionally and financially, but while the experience may seem isolating, many couples are going through the same struggle.

One in eight couples has trouble getting pregnant or sustaining a pregnancy, according to the Centers for Disease and Control.

Jason Griffith, a reproductive endocrinologist and practice director at Houston Fertility Institute, said for care providers one of the most challenging aspects is that many couples wait to see a specialist.
“I encounter couples who have had three to four years of difficulty getting pregnant and haven’t sought care,” he said. “What I would say is at least get evaluated so you have options and at least we know what we are dealing with.”

While some couples may choose not to do anything medically, he said as with everything in the medical field “knowledge is power.”

Here’s a short explainer on what infertility is and how you can figure out your next steps:

What is infertility?

Infertility is defined as the inability to conceive after 12 months of sexual intercourse without protection, according to Griffith.

For those who are over 35, the time trying to conceive is reduced to six months.

When is it time to see someone?

Griffith said some women may need to see a fertility specialists for an evaluation before they even start trying to conceive. He points to women who may have three periods a year or fewer.

“If a woman has irregular cycles and has problems ovulating she should seek care early because getting her to ovulate through medication is probably going to be necessary to help her get pregnant so she shouldn’t wait a whole year,” he said.

For others who do not appear to have any issues, you should see a specialist if you’ve tried for a year or in the case of those 35 and older, 6 months, without success.

How is infertility diagnosed?

Griffith said fertility evaluations focus on three aspects necessary to get pregnant.

He said the first is the regular release of a competent egg, and getting a rough estimate of how many eggs the woman has in stock and whether that number is age appropriate. He said they typically conduct a sperm analysis to ensure the the male partner is producing enough sperm.

“The third component is making sure that the female reproductive tract is a hospitable place for the sperm and egg to get together,” he said. “…So making sure the fallopian tubes are open.”

How is infertility treated?

It depends on the cause of infertility. A specialist will start by diagnosing the cause of infertility and then prescribing the proper treatment. A couple may be able to conceive with hormone treatments, or need artificial inseminiation or in vitro fertilization.

Some couples may have “unexplained infertility” or what Griffith says can be referred to as “sub fertility.”

“Sub fertility is a better way to describe it because I’m not telling my patient they’ll never get pregnant, but the chance of getting pregnant naturally is a lot lower,” he said.

Is HSG a Cheaper, Less Invasive Alternative to IVF?

Is HSG a Cheaper, Less Invasive Alternative to IVF?

Old is new again, even when it comes to fertility treatments. A study published in The New England Journal of Medicine suggests that a 100-year old technique is still very effective in helping women to become pregnant and to stay pregnant.

Infertility

According to the Office of Women’s Health, 6.1 million women in the United States between the ages of 15 and 44 struggle to become pregnant or maintain a pregnancy. Increasingly, alternative treatments like IVF are helping women to conceive, but this method is often not covered by health insurance and can ultimately be an expensive proposition.

What is hysterosalpingography?

Hysterosalpingography sometimes referred to as HSG is a fertility enhancing technique which utilizes colored contrast dye to assess the ability of a woman to have a successful pregnancy. In this new study, researchers separated patients into two groups. One group used a water-based contrast liquid and the other group used an oil-based contrast liquid. The oil-based contrast referenced a technique used by midwives at the turn of the 20th century who would recommend that women flush their fallopian tubes with poppyseed oil. At the conclusion of the study, researchers determined that the patients that who had the HSG procedure with the oil-based contrast showed significantly better results maintaining a pregnancy and having a live birth with little to no side-effects.“Tubal flushing with hysterosalpingography during a fertility workup is minimally invasive and inexpensive, as compared with IVF,” Dr. Kim Dreyer and colleagues wrote.

So if you are looking to conceive and looking for alternative treatments than IVF, ask your doctor about HSG today.

 

Under NY Law, Insurance Companies Now Required To Cover Fertility Treatments For All Women

Under NY Law, Insurance Companies Now Required To Cover Fertility Treatments For All Women

Article Provided By CBS New York.

Under New York law, insurance companies are now responsible to provide coverage for fertility treatment to all women regardless of sexual orientation or marital status, Gov. Andrew M. Cuomo announced Wednesday.

Prior to the announcement, coverage only included women trying to conceive naturally.

“In New York, we firmly believe that everyone, no matter who they are, deserves the right to control their own bodies and make their own reproductive health decisions,” Cuomo said. “All women who wish to have a child are entitled to insurance coverage for fertility treatment regardless of their sexual orientation or marital status, just as all women have the right to reproductive choice and to decide if and when to start a family, and New York will always stand up to protect and preserve those rights.”

These initiatives are part of a series of actions by Cuomo to champion women’s rights, known as “New York’s Promise to Women: Ever Upward.”

New York is currently one of just 15 states to mandate that insurers cover infertility costs.

MyeIVF.com Second Giveaway Winner

MyeIVF.com Second Giveaway Winner

Back in March, we announced our second Amazon Giftcard giveaway. The winner was selected at random for telling our community a few things they were not warned about before meeting a fertility doctor. Thank you to all who entered the contest and shared your experiences! Take a look at a selection of the responses below.

“I have only been seeing a fertility doctor for about 2 months now, but we have been struggling with fertility problems for about 3 years. Most of my friends did not have to use a fertility specialist in order to have babies, so I really didn’t know much about the process at all. I was surprised at how often I have had to go in for blood work and sonograms, although I guess I shouldn’t have been. What really surprised me though was the sonogram on day 3 of my cycle while I was still bleeding! No one ever told me about that before seeing the fertility doctor!”

“You always know that it will take time and perseverance but you don’t realize how much is needed until you go through with it month after month. Being at the fertility clinic, tracking everything necessary and the drugs is like having another job! Initially I didn’t realize how much testing would be involved, but now having been on the other side I do like how much testing is involved. That means that cycles are being monitored to try and figure out how make this all work!”

“One of the biggest things I found surprising before I saw the doctor was how long the fertility treatment timelines are. I had an idea in my head of how long it would take to see each treatment through, however, in reality it has been much longer. This has been a real test of patience, but has taught me to appreciate the journey as it comes.”

“I think I had a picture in my mind of taking some pills and being able to magically conceive with ease. Instead when I went to the RE, I could not believe how much monitoring is involved. I had never had a vaginal ultrasound before and now I cannot begin to count how many I’ve had. I was also very surprised it was done on Day 3! I was also surprised that I could not leap into treatments immediately. My RE ordered an HSG first and when that came back abnormal, I had to have a hysteroscopy done. A year into it, I really respect the science of what is being done.”

“1.The amount of testing was the biggest thing. I have never had so many blood tests, ultrasounds, tests I’ve never heard of, etc.
2. The cost, I did 5 iui at another clinic before moving and when I added up all the “small” bills I paid I could’ve covered a large part of ivf which has a better success rate.
3. The time involved- i figured once I decided to see a doctor it would happen at least within a month or two but it’s been much longer than that.
4. How much patience you need- waiting for your cycle to start, waiting for test results, waiting to see how the meds work and then doing that over and over
5. This ties into #2 a little bit but if you feel something is taking longer than it should don’t assume your doctor has your best interest at heart, stand up and demand answers or switch clinics.”

“The first doctor we went to never gave us a specific breakdowm of the cost. I think they just assumed we had it up front? When I called I asked if they had a menu of services vs cost in writing, she proceeded to tell me all that info over the phone. This is a very overwhelming process as it is.

Controversial “three-parent baby” fertility technique takes off in Mexico City

Controversial “three-parent baby” fertility technique takes off in Mexico City

Sitting in his spotless office in the New Hope Fertility Clinic in Mexico City, soft music playing in the hallway in the background, Doctor Alejandro Chávez-Badiola shows an affable smile. “’Three-parent babies’ is not the title I would have chosen for the treatment,” the clinic director says. “But if the press had not given it such an attractive title, the news of what we’re doing probably would not have had such an impact.”

Indeed, “three-parent baby” is easier to remember than “mitochondrial replacement treatment” (MRT), a relatively new procedure offered to couples who want to reduce the chance of passing certain genetic diseases onto their children.

It is controversial because the embryo takes eggs from two mothers.

Pregnancies through MRT, which is banned in the U.S., are achieved by transferring the nucleus from a mother’s egg to a donor egg, which in turn had its nucleus removed. The new egg is then fertilized by the father’s sperm and ultimately placed in the mother’s uterus.

Mexico City’s New Hope is a branch of a namesake New York City fertility clinic founded by John Zhang in 2014. Critics say New Hope picked Mexico merely because of its weak regulatory framework.

Dr. Chávez-Badiola, a gynecologist and obstetrician trained in Mexico and the United Kingdom, told Fox News he hopes to apply MRT to 20 pregnancies in the first half of 2017. He would not disclose, however, how many three-way pregnancies are underway at this time.

The first “three-parent” baby was conceived in Mexico’s New Hope in 2015 but delivered in New York City last year. He was born to a Jordanian couple at risk of reproducing a rare disorder called Leigh disease, an incurable that can lead to a child’s death within years from birth.

The Jordanian couple was treated in the New Hope clinic in Mexico by a U.S. team led by Dr. Zhang. So far, the boy appears to be healthy, according to New Hope, and the successful procedure led Chávez-Badiola and his peers to the conclusion that their work should be extended to a larger number of couples in Mexico.

It isn’t the first mitochondrial replacement technique ever developed. Earlier procedures applied in the 1990s yielded good results, but were different — they transferred healthy mitochondria to the mother’s egg. New Hope’s technique is called “spindle nuclear transfer” and involves cutting-edge technology and equipment rarely seen in developing countries.

Aside from the morals, critics of MRT believe it is still far too early to consider the procedure to be safe. They worry that some defected mitochondria could be transferred with the mother’s nucleus into the donor cell. According to the science magazine Nature, some also worry that New Hope has rushed into the wider application of the procedure.

The clinic, located in Polanco, one of the swankiest neighborhoods of the Mexican capital, is currently waiting for enough patients to achieve Chávez-Badiola’s ambitious goal of 20 pregnancies. So far, he is principally counting on patients from abroad because Mexican couples are harder to find.

“There are families in Mexico suspected of having mitochondrial diseases, but as far as I know there isn’t anyone to offer them the means to diagnose,” he said.

Nor is money a problem, at least in theory. According to Chávez-Badiola, the procedure isn’t more expensive than a regular IVF-treatment. “We first want to know if the technique can be replicated and give us the results we’re hoping for,” he said. “Right now we’d be willing to absorb the extra costs, as it’s a treatment that stems from extraordinary technology.”

Chávez-Badiola acknowledges the criticisms, but counters them with the argument that he and his colleagues are on the vanguard of medical research, which always causes “some discomfort.”

“Mitochondrial diseases aren’t diseases that have been known for centuries. They’re diagnosed through technologies that are relatively recent,” he told Fox News. “I believe that, if you’re going to study such a thing, studying it alone has the potential of changing the way the medical profession acts.”