Identical Twins and IVF; here’s the latest information on “womb-mates”

As fertility treatment continues to help more women/couples achieve their family building goals, we have continued to see the risk of twins decline. IVF has helped drive up fertility treatment while also helping reduce the risk of twins. That’s occurred mainly through efforts to encourage Elective Single Embryo Transfer (ESET). At our center, nearly 90% of our patients agree to ESET and we feel that this strategy has actually helped us achieve among the highest live birth rates attainable.

Twins 3D image

Even with ESET however, twin pregnancies do occur. That is primarily due to a single embryo splitting. In fact, sometimes an embryo can split and become a triplet pregnancy. Whenever an embryo splits; the resulting babies are genetically the same and therefore referred to as “identical twins.” Identical twins are naturally conceived in about 0.45% of pregnancies. Recently a large analysis of 7 years worth of data helped clarify the incidence of identical twin from embryo splitting in IVF.

Japan performs the highest number of IVF cycles per capita than any other nation. In Japan, they have shifted to single embryo transfer in about 80% of their treatment cycles. This recently made it possible for a group of researchers to review 937,848 single embryo transfer cycles to determine how frequently embryos appear to split following IVF. Their conclusions were as follows:

  • The risk of multiple pregnancy after single embryo transfer is 1.60%
    • This results in a risk of twins that is 1.56% following single embryo transfer
    • The risk of triplets when one embryo is used is about 0.04%
  • About 1.36% of embryos appear to split while the remaining number of multiples are believed to be a combination of natural conception along with single embryo transfer—this is the reason that we discourage intercourse following an embryo transfer.
  • Embryos are more likely to split if they were created by eggs from younger women and those with unexplained infertility.
  • Pregnancies resulting from embryo splitting are at higher risk of miscarriage

In summary, with today’s improved technology for freezing embryos, it is safest to transfer one embryo at a time to optimize live birth rate and reduce the risk of multiple pregnancy.

Fertile thoughts,

~Robert

Implantation Failure and Infertility; new things to consider

There are many critical steps to helping initiate a successful pregnancy. The key to success is to optimize each milestone along the way. So after we’ve identified at least one healthy embryo, we direct our efforts to creating the optimal environment for implantation.

Blastocyst

A recent study reviewed 2 years worth of data collected  at 33 fertility treatment centers in Canada. In total, over 40,000 completed cycles of IVF were reviewed. They found that in women undergoing Frozen Embryo Transfer (FET), pregnancy rates declined progressively if the endometrial lining was thinner than 7 mm on ultrasound evaluation at the time of final pre-FET measurement. This had long been suspected, but had never been looked at in such a comprehensive data base.

 

At our center, when we visualize a thin endometrial lining we activate a series of options to try to gain more information and possibly overcome this obstacle to implantation. First, we consider newer—more definitive methods—for assessing the uterine lining. As the study cited above revealed, some patients can have a receptive uterine lining that is as thin at 4 mm—less then half the cut-off used by some fertility centers! The Endometrial Receptivity Assay is a modern test that measures the dynamic relationship between 248 genes involved in creating the ideal “window for implantation.” By using this test, we’ve been able assist many women that routinely produce a thin but functional endometrial lining proceed to embryo transfer with confidence or personalize their protocol to shift the date of the embryo transfer appropriately.

 

Another useful tool for us has been to add hGH to the protocol for women at risk of implantation failure. In a large randomized clinical trial, it was shown that women given hGH had achieved a pregnancy rate that was almost SEVEN TIMES HIGHER than those that did not receive this therapy. So many women that would have previously been redirected to use a gestational carrier—can actually carry and deliver their own pregnancy.

 

As always, each individual case is different. But if you think you may be at risk of implantation failure it isimportant for you to remain aware of the emerging research into this often overlooked problem.

 

Stay informed,

~Robert

 

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Guest Blog: How To Support your IVF Journey by Kate Potvin

As we near the launch of our new integrative approach to supporting your fertility treatment through diet/exercise and lifestyle adjustments, we are partnering with various experts like Kate Potvin to not only provide recommendations but give you tools to actually implement them as well.                         ~Robert

Kate Potvins Website

I know you want a baby more than anything and I know you’d do almost anything to have one.

 

So what if I told you there were a few very simple things you could do that would improve your chances of winning the baby lottery?

 

Here’s the thing: our bodies are actually very beautiful, and well oiled machines that thrive in optimal conditions. Sometimes things get out of whack and just don’t work quite the way we want them to, and medical intervention is necessary. And that’s okay.

 

But we can still do some things to help support our bodies’ natural balance and increase our odds that IVF will be successful, and this idea that small changes can make a big impact is the foundation of my signature program Flourish.

 

So here 5 simple things you can do to support your IVF journey:

 

  1. Eat regular meals

I know many of us are super busy so we end up eating in the car, at our desk, or maybe not at all! But eating regular meals at regular times can help keep our blood sugar level and keeps our stress levels down. If we don’t eat, and our bodies think we’re starving, it creates a hormonal cascade in our body that definitely does not support fertility. If you’re a grazer and snack all day, try to limit your eating to 3 meals, again to create consistency for your body. Be sure to include high-quality protein and fats with every meal to help you stay full!

 

  1. Take time to pause

Our lives can be stressful, but they don’t need to be, if we pay attention every so often and learn how to use stress in a positive way. You’re never going to eliminate stress from your life, but learning to create pauses or time-outs during your day to slow down and breathe can go a long way toward managing your stress levels. Choose 3 times during the day and set a timer to go off on your phone. When the timer goes off, stop what you’re doing, close your eyes and take 20 deep, full belly breaths. That’s it. Then go back to work or whatever you’re doing, but I’m betting you’ll feel a little calmer!

 

  1. Cultivate a positive mindset

It’s so easy to get discouraged when month after month the pregnancy tests are negative. But keeping a positive mindset is so important for our physical and emotional wellbeing. I know this is easier said than done, so don’t get down on yourself for feeling blue sometimes. I recommend keeping a gratitude or positivity journal. Every evening write down 5 positive things that happened, or 5 things you feel grateful for. They can be really simple, like the woman who complimented your shoes at the grocery store, or the rainbow you saw on your drive home. Simply remembering and savoring these small moments will help you find more positivity during the hard times.

 

  1. Power down

Sleep is so important for healthy hormone function and many of us just don’t get enough! And one of the major culprits is that phone you’re holding right now in your hot little hand. Blue light from our screens actually prevents our brains from releasing melatonin, a hormone that tells us it’s time for bed. Even if your phone has a yellow-shift setting, all the images and scrolling are really stimulating for our brains, and don’t help us feel sleepy. Set a timer and power down your device or put it in airplane mode about an hour before bed. Then do something old-fashioned like read a book! You’ll be catching the zzzz’s in no time!

 

  1. Support your body with exercise

Moving our bodies helps support healthy blood flow and hormone balance. But if you’re trying to conceive, you might want to tone it down a bit. A recent study has shown that moderate exercise like walking or yoga are best options when you’re trying to get pregnant. Think about activities that nourish you and help you feel energized afterward, instead of depleted. Try a yoga for fertility class at your local studio or online with my special Fertility Yoga series on Yoga Studio App.

 

Remember that you need to nurture yourself so that your body can nurture a growing baby. All of these tips are super easy to implement and can have a positive effect on your overall health, increasing your odds of a successful IVF cycle.

 

Looking for more ways to support your body and mind through your fertility journey? Join my 12-week Flourish Fertility program and learn how to create new, nourishing habits that will optimize your fertility. You’ll not only learn my best diet and lifestyle tips, but you’ll learn how to actually implement them and stick with your new routines. Plus, learn my most important mindset shifts that will help you feel more resilient through the ups and downs of this journey. Learn more here.

 

—-

Kate Potvin is a fertility coach and yoga teacher who believes in taking a mind-body approach to healing. She empowers women to take charge of their own fertility journey on her website katepotvin.com and on instagram @flourishfertility. Learn her 10 Secrets for Happier Hormones here [katepotvin.com/happyhormones]

 

Guest Blog: From One Patient-To-Another–an offer of support

Blog link

Hi, my name is Lisa and I recently went through IVF.  I became a mother at the age of 40 and am blessed to have our miracle baby girl who is now 10 months old. Having been through this process I understand how overwhelming everything can seem at first.  Here are a few things I learned along the way and encourage others to consider if they are beginning their first cycle.

 

  • The opportunity to be connected with other women who had either gone through infertility treatments or were going through it at that time—–

It was by chance I had a few other friends who were also experiencing infertility challenges, and I was fortunate to form my own mini support group. My openness about what I was going through enabled me to be connected by a local friend to a support group she knew of based in NYC.  The value of sisterhood support I had was immeasurable.  I encourage you to seek out support groups and would suggest searching online for local ones in your city.

 

  • To be informed of resources and specialists who could support you along this journey—-

I learned of a highly regarded acupuncturist from a technician during one of my ultrasound appointments; I wish I had been able to start seeing him sooner because of the valuable information he shared. Throughout my IVF journey I learned of many other individuals who were invaluable to me through their gifts of energy work and healing through art. Be open to healers, coaches, and therapists who may be able to help guide you on this path.

 

  • Support for the emotional rollercoaster you go through—-

There is little attention given to the varying challenges you experience being on all the medications; No one really addresses the emotional impact.  I believe it’s one of the most important factors in giving yourself the best chance of everything working out; If you’re not in a good mindset and able to roll through the low periods then it makes this process that much harder.  You need strategies to help yourself through feelings such as depression, shame, loneliness, anger, hopelessness, desperation and fear.  Try your best to continue doing things that bring you joy and your body, heart and mind will thank you.

 

  • No one prepares you for the setbacks you may experience, as it doesn’t always happen in the timeframe you may hope—–

Little did I know I would have to have 3 surgeries after my second egg retrieval to prepare my body for our embryo transfer; It was one whole year of waiting. During those months and months of waiting as I healed I learned that there were many things I could not control, but there was a whole lot I COULD control. Try not to be too rigid when things are “supposed” to happen. Everything is happening in the exact timing that is needed to help you get to your ultimate destination.

 

I feel so passionate about helping individuals through this process.  Women don’t need to go through this process alone, and partners are in need of support too.  My background as an Occupational Therapist helped prepare me in ways I couldn’t have imagined.  I want to empower others on their journey to parenthood, with the help of reproductive medicine, through sharing in my own success strategies and tools.  For further support you may contact me at www.IVFManifestingAMiracle.com where you will also find my personal blog. Cheering you all on your path to manifesting your miracles.
Lisa White, OTR/L
Occupational Therapist & IVF Mentor

Infertility hurts! For many that pain is due to endometriosis

Many women that are trying to conceive suffer with pelvic pain on a regular basis. Oftentimes, they had previously gone on birth control pills to help manage this discomfort. For obvious reasons, that isn’t an option compatible with getting pregnant. It’s important to know that there are other options.

Pelvic Pain

One of the most common reasons for pelvic pain in women with fertility problems is due to endometriosis. In fact, one study found that one of every three women with infertility has this condition. Paradoxically, the best way to treat endometriosis is to become pregnant. Yet the presence of endometriosis is associated with infertility. It is possible that the inflammation causing the pain also makes it an unhealthy environment for eggs and sperm. However, the drugs commonly used to treat inflammation can reduce your chances of becoming pregnant.

 

A recent analysis has revealed that one of the best ways to reduce pain in women with endometriosis might be through acupuncture. Better still, acupuncture can also provide other potential benefits for patients trying to become pregnant like improved pelvic blood flow and a reduction in stress hormone levels.

 

In previous blog posts we have also described the potential benefit of a naturally produced supplement called pycnogenol. We have had many patients take this supplement and achieve partial to complete relief of pelvic pain. It may even help boost your odds of becoming pregnant!

 

As always, please talk to your provider before starting any treatment to get their input on whether or not it is appropriate for you.

 

Stay informed,

~Robert

 

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Current Estimate of Vitamin D’s Influence on Fertility and Miscarriage Rate

We have reviewed many previous studies on the why the hormone referred to as Vitamin D is so important to pregnancy. However, a new analysis resulted in a news release from the National Institute of Health. Simply put they stated the following findings:

  • Women with adequate vitamin D levels were 10% more likely to become pregnant
  • Pregnant women with sufficient vitamin D were 15% more likely to have a live birth

Simply put, now that we fully appreciate that vitamin D is a hormone produced in our skin—it makes even more sense that women insure that they have sufficient levels during their reproductive years.

 

If you’ve never had your levels tested, consider consulting your provider to discuss this simple life hack.

Shine on,

~Robert

 

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Recharging Egg Health for Women Trying to Conceive; the role of CoEnzyme Q10

One challenge to diagnosing and managing fertility problems is our inability to estimate the healthfulness of any woman’s eggs. We know that as women age; egg quality declines. But that doesn’t really help us know the viability of the eggs that someone has now. Even more bothersome is nobody fully understands the physiology of immature eggs—the ones not yet fertilized. But we do know that they require a lot of energy.

CoQ10

CoEnzyme Q10 (CoQ10) is an essential aspect of the part of the egg that generates power (mitochondria). This enzyme helps our cells convert carbohydrates and fats into energy. It also helps protect our cells from the enzymes that cause them to breakdown—something that most of any woman’s eggs are destined to do. CoQ10 is also a potent anti-oxidant that can help protect the DNA in the egg from damage. These are three vital functions.

 

Although your body makes most of the CoQ10 you need; we do get some from our diet as well. The richest dietary sources are meat, chicken and fish as well as soybeans, canola oil and nuts. Unfortunately there is no easy way to measure which women have adequate CoQ10 and those that would benefit from more. There is no simple test. However, a recent study did provide some insights into the potential benefit of CoQ10 supplementation for fertility patients going through treatment.

 

A prospective, randomized study followed 186 women that were considered to have a reduced chance of achieving a successful pregnancy through IVF due to them being classified as having a decreased ovarian reserve. Half were placed on CoQ10 supplements beginning about 60 days before their egg retrieval. They found that the women placed on CoQ10 had a higher number of eggs retrieved, a higher fertilization rate and produced better quality embryos. Another randomized study found improved ovarian response and higher pregnancy rates in women with PCOS given a smaller dose of CoQ10 during ovulation induction treatment.

 

So if you’re trying to conceive, consider whether or not you may benefit from this important supplement. This may be especially important if you’re older than 35 years of age, have a low ovarian reserve, history of previous treatment failure or have PCOS. If you’re looking for a reliable brand of this supplement, here’s the one that I typically recommend to my patients: https://theralogix.com/products/neoq10-coenzyme-q10-supplement

 

Stay healthy,

~Robert

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado