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.”

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.”

Story about married couple discovering they were twins during IVF appears to be fake

Story about married couple discovering they were twins during IVF appears to be fake

Story Provided by Fox News Health and The Sun.

A viral story about a married couple who struggled to conceive only to discover they were twins when they went through IVF appears to be a hoax.

The story, originally from a suspected fake news website called the Mississippi Herald, claims the unnamed couple underwent the treatment to help them have a baby.

Doctors at the fertility lab noticed their DNA was abnormally similar, it was claimed, and lab technicians believed the pair may be unwitting cousins, but soon ruled that out because the DNA was too similar.

The story was picked up by a number of news websites, including the Sun, but it has since emerged it’s likely to be a hoax.

The Mississippi Herald website was only registered in November, reports the Mirror, and contains no reporter bylines, physical address or contact details beyond an online form.

Sun Online has attempted to contact the website for clarification.

Fake news can look legitimate, but the stories behind the headlines are entirely fictional.

Hundreds of fake news sites have been set up, some producing false stories to entertain and amuse – others to peddle their own agendas.

BINTO brings fertility products and knowledge to women’s doorsteps

BINTO brings fertility products and knowledge to women’s doorsteps

Article on BINTO Provided by Philly Voice.

A new company in Philadelphia wants to start a conversation surrounding fertility, an issue that’s often treated as taboo, by literally bringing it to women’s doorsteps.

BINTO, which stands for Bun In The Oven, is a subscription-based box of individualized, medically approved women’s health and fertility products that are mailed to customers on a month-to-month basis.

The products vary from woman to woman and from month to month, depending on the customer’s life stages and personal experiences. They range from pre-pregnancy products and menstrual support to prenatal and postnatal care and infertility support if necessary.

Founder and CEO Suzie Welsh, a certified nurse from Philadelphia and a former employee at a fertility health center associated with the University of Pennsylvania Health System, where the idea for the business was born, said as a fertility care nurse she often met with women seeking expert advice on products and information and feeling overwhelmed.

BINTO aims to take away that stress by sending women the best of the products they need, like prenatal vitamins, chemical-free menstrual products and multivitamins, as well as by providing easy-to-read women’s health and fertility information online.

“We hope to carry women through from their first period to fertility, to prenatal and beyond,” Welsh said.

Fertility apps: The ‘next wave’ in solving global family planning crisis

Fertility apps: The ‘next wave’ in solving global family planning crisis

Article on Fertility Apps Provided by Humanosphere.

Every year, lack of access to contraception causes about 85 million unplanned pregnancies and a host of negative associated health outcomes. One expert said this global health crisis can be mitigated with apps that allow women to understand and track their fertility.

The challenge to provide universal contraceptive access is an old problem, but there are new challenges. A few were created by the Trump administration, which reinstated – and expanded – the Global Gag Rule, freezing government funding to many foreign NGOs providing family planning, maternal and child health, nutrition and other critical health services.

Earlier this month, Trump’s administration also decided to cut government funding to the U.N. Population Fund, which provides family planning, sexual and reproductive health assistance and other services to 9 million people in humanitarian settings.

Global family planning expert Leslie Heyer is one of many advocates who warns that the funding cuts will have devastating consequences for women and their families, especially in the developing world. When women don’t have the ability to plan their pregnancies, she said, they and their unborn babies suffer higher physical and mental health risks, higher risk of abuse, and lower education levels for themselves and for their children.

“It keeps people in poverty, it puts people in poverty,” Heyer said in an interview with Humanosphere. “There are all these issues that come with unplanned pregnancy. They end up affecting everyone in the family, and they end up affecting everyone in the community.”

Heyer is the founder of Cycle Technologies, a provider of family-planning tools to women worldwide. Some of Cycle’s methods – like CycleBeads and Dot – provide forms of contraception requiring nothing more than a mobile phone.

Heyer said these digital options can be accessible, cost-effective alternatives to traditional contraceptive methods, which are often reliant on fragile supply systems and subjected to restrictions under policymakers.

“Mobile technology’s becoming sort of the next wave for fertility awareness methods, we’re able to go more directly to the end user,” Heyer said. “So in some ways, we’re sort of circumventing those more traditional programs.”

She explained that fertility awareness apps are now more accurate than ever, thanks to sophisticated algorithms that deliver information that women can use to understand when they are fertile and to plan their pregnancies when they are ready. Such methods have been approved as modern contraceptive methods by the World Health Organization.

Cycle Technologies officials said their products have been used by more than 6 million women in more than 60 countries.

Considering the millions of the world’s women still without access to contraception, however, Heyer said the loss of support from Washington is “definitely worrisome.” Mobile technology can make a huge dent in the family planning service gap, she said, but it can’t be the only solution. Many women need other methods of contraception – IUDs, injectables or condoms – based on their individual needs.

The first step, she added, is to get women to the forefront of the conversation about contraceptive access.

“Unfortunately, women are sort of the punching bag in a political movement here,” she said. “We need to be leading the process and the decisions about contraceptive access … rather than allowing these decisions to be made by a bunch of men that, quite frankly, may not have a full appreciation of these issues.”

A Baby or Your Money Back: All About Fertility Clinic Package Deals

A Baby or Your Money Back: All About Fertility Clinic Package Deals

Article on Fertility Clinic Package Deals provided by the New York Times.

Trying to have a baby with the aid of modern reproductive technology can feel like visiting a gambling parlor with the highest possible stakes. So consider the pitch that many fertility clinics now put in front of people like Kristi and Carleton Chambers.

After several miscarriages, the Leesburg, Va., couple took their doctors up on an offer to hand over $50,000 — $20,000 more than what they might have paid for the in vitro fertilization and other services that they needed at the time. In return, the clinic promised multiple procedures until they gave birth, and if it didn’t work, they would get a full refund.

The catch? If they made a baby on the first try, the practice would keep all their money. That is exactly what happened — to their great joy. After their baby boy was born, the couple eventually signed up for a similar deal and ended up with twins.

Welcome to the fertility casino, which frequently presents the rarest of scenarios: A commercial entity offers a potentially money-losing proposition to customers in exchange for a generous supply of in vitro fertilization procedures. People pay tens of thousands of dollars for the privilege, and when they come out with a newborn in their arms they’re often thrilled to be on the losing end financially.

So who wins? The house. Doctors (and third-party companies that help manage these programs and may take on any financial risk) keep careful track of their data. So they set prices at profitable points given the odds.

Here’s how the house can stack the deck: By admitting only people who have a better-than-even chance of bearing a child early in the process. Those people, however, may not need to pay extra for such a plan, given that their clinics picked them precisely because they were such good bets.

“It’s kind of like the clinic bets on your success, and you bet on your failure,” said Sarah Burke, a Pittsburgh woman who became a parent after enrolling in such a program.

Some of the overall performance numbers of fertility clinics are available in federal databases, but at my request, FertilityIQ, an information clearinghouse and doctor-review service, recently gathered some additional data.

Of the 54 people it found who had enrolled in a baby-or-your-money-back program, 30 of them achieved success not just in the first I.V.F. “cycle” (when doctors retrieve eggs) but on the first transfer — that is, the first time, after retrieval, that doctors attempt to implant an embryo or embryos they created with those eggs. A total of 67 percent were successful in the first cycle, which is at least 20 percentage points or so higher than the birthrate that similarly aged women nationwide experience in any I.V.F. cycle.

So are those two sets of women comparable? Not exactly.

While we shouldn’t make too much out of a sample size this small, FertilityIQ’s founders, Jake Anderson and Deborah Bialis, believe that doctors cherry-pick patients who have a high likelihood of success. According to Mr. Anderson and Ms. Bialis, a married couple who were themselves treated for infertility before becoming parents, medical professionals screen the harder cases out — say, people with more problematic diagnoses or those who are older or have a high body mass index.

That’s what happened to Johanna Hernandez of Marana, Ariz., who — after two miscarriages and struggles with I.V.F. — couldn’t get into a program that offered multiple rounds and a refund. “We’re in such a precarious position,” she said. “At the beginning, there’s no way to know that you’re going to need these programs. But at the end, they just won’t help you.”

Ms. Hernandez and her husband paid for additional à la carte treatment, had one more miscarriage along the way and now have a baby boy.

Another way for doctors to improve the odds of producing more babies would be to implant more embryos during each transfer. The American Society for Reproductive Medicine frowns on this, given the additional risks that come with twins and triplets. It has also warned of this possibility in a position paper on the package deals and refund programs, which are known in the industry as “risk-sharing.”

In FertilityIQ’s group of 30 successful subjects, however, 87 percent of the women had two or more embryos implanted during their one and only transfer, which is about 10 percentage points higher than the overall national average. Several parents I interviewed this week said that they did not feel pressured to have multiple embryos implanted, but the commercial temptation to do so in these programs is certainly there.

The head-spinning questions that all of these matters of money, biology and feelings inspire make some doctors wary. At the New York University Langone Fertility Center, one of the busiest in the United States, there are no package deals.

Dr. Alan S. Berkeley, a physician and the clinic’s director, gave several reasons for this. He noted that with each passing year, more people have at least some insurance coverage for infertility, which means that fewer patients would be tempted by a package deal to save them money if they were biologically unlucky. At the same time, treatment and embryo testing have improved, reducing the likelihood of multiple failed transfer attempts and the expense that comes with them.

But Dr. Berkeley and his colleagues also struggle with the language around shared-risk programs and packages of various sorts.

“What you really have here is a patient self-insurance group,” he said. “They band together, and the ones that get pregnant quickly overpay significantly to insure the ones who don’t,” the people who wind up getting refunds.

If a fertility clinic were to present it that way, it would pass muster with Dr. Berkeley (even though it might draw a raised eyebrow from state insurance commissioners who don’t like unlicensed people selling unregulated insurance). “It’s just that in my experience, programs don’t put it quite as bluntly as I just did,” he said.

Nevertheless, plenty of people who have used the programs are glad they were available. The baby-or-your-money-back offering is a popular one, while another type of deal might include, say, a few I.V.F. cycles at a discount if you paid upfront. In that arrangement, there generally is no refund if you do not have a baby, but you might get a partial refund if you have a baby on the first try.

A company called ARC Fertility helps run package deals like these. From a data set of hundreds (it would not be more specific), it said that 47 percent of women in the newest iteration of its program had received a partial refund or were on track to, having had a baby (21 percent) or gotten pregnant (26 percent currently).

Another company, IntegraMed, which does business as Attain Fertility, notes on its website that 80 percent of the people who complete one particular program have a baby. How long does that take? How many people do not complete it, and for what reason? A company representative said that no executive was available to speak.

With most packages, there are often many things that you still have to pay for out of pocket, including prescription drugs and certain tests. And definitions of success may vary, with a small number of clinics defining it merely as seeing a fetal heartbeat or by using some other criteria.

Ms. Burke, the Pittsburgh mother, sized up the large sum of money for a refund program and, together with her husband, considered it this way: If they couldn’t have a child after several attempts, they would get their money back and use it for adoption, or — if they ultimately decided not to have children — for travel. If they needed a few tries at I.V.F. to have a baby, they would have spent less on the refund plan than they would have on à la carte purchases.

And if they got pregnant on the first cycle? Well, that’s what happened.

“You get used to failure after failure, so we were thinking that we were never going to get anything other than what we were already used to,” Ms. Burke said. “We’d dealt with so much heartbreak, and I’ve never been happier to make a bet and be proven wrong.”

All this talk of gambling feels misplaced to some people. “Calling it a bet makes it sound like the endgame is me possibly not having a baby,” said Ms. Hernandez, the mother in Arizona. “But that’s not the case for people in my position. If one way doesn’t work, you will find another, whether it’s donor eggs or adoption. You don’t want to allow yourself to lose.”

Besides, there are sometimes odds that are so long that they never appear in anyone’s book of bets. Ms. Chambers, the Virginia mother, who is a physician assistant, blew through one employer’s lifetime infertility insurance coverage cap — and then some — in the course of giving birth to three children in 21 months using donor eggs.

She figured she was done once her twins were born. But when they were 9 months old and she was 42, she got pregnant the old-fashioned way, on Christmas no less. And on the way to becoming a mother of four, she had some instructions for the medical professionals who would be attending to her: “I told them that I couldn’t believe that I was going to say this, but please tie my tubes,” she recalled. “I’m all miracled out.”

 

3 things that can impact fertility

3 things that can impact fertility

Article provided by Good4Utah.com.

Andrew K. Moore, MD, Board Certified Reproductive Endocrinologist & Infertility Specialist from Reproductive Care Center is talking beyond infertility and how health of both the mother and the father impacts infertility.

Field of fertility treatment has advanced more rapidly than any other field of medicine over past 30 years, so that now, vast majority of infertile couples coming in for treatment can have hope that they will be able to have children.

Thus, focus of treatment is shifting to not only achieving pregnancy, but also maximizing the health of each pregnancy

“One healthy baby” is goal: one baby at a time, healthy pregnancy for mom and baby sets the stage for a healthy life. Nutrition, healthy weight, and mental well-being of parents around the time of conception are very important.

Overweight and obesity have been rapidly increasing over past 50 years. Every woman, if she gains enough weight, will stop ovulating. This is due to Aromatase enzyme and Insulin hormone. Being overweight also decreases sperm production.

Women who do not ovulate due to increased body weight are often diagnosed with condition called “PCOS” or “Polycystic Ovary Syndrome”, which happens to be the most common reason for infertility. (15-25% of all infertility is affected by weight and ovulation problems).