One Baby at a Time

Our blog is dedicated to what we can do to optimize fertility and help with the ultimate goal of bringing home a healthy child. Although there are lots of ways to build a family, many patients use IVF. In IVF, we use medications to grow multiple eggs at the same time with the hope of developing multiple embryos in the lab. Once we have a healthy embryo, we use embryo transfer to get our patients pregnant.

 

One baby at a time is always the safest thing for mom and baby.

 

When IVF first started, the success rates were low, so it was common for clinics to place multiple embryos back in with the hope of one of them sticking. Now that our field’s success rates are much better, we need to step back and look at the goal that our patients ask us to help them with on the initial patient consultation: building a healthy family.

 

Although success rates vary based on individual clinics, I work for a clinic that has the highest live birth rate in the nation. This means that the majority of patients get pregnant and bring home a healthy child later that year from the first embryo transfer. This also means that if we put back two embryos, there will be twins, but possibly even more, like triplets or even quadruplets.

 

One baby at a time is always the safest thing for mom and baby.

 

Multiple pregnancies, like twins, are higher risk for just about everything. Children from a multiple pregnancy are higher risk being stillborn, having a birth defect, developing autism, prolonged admission to the neonatal ICU, and cerebral palsy than single babies. For moms of multiples, they are at higher risk of developing severe complications including life-threatening conditions like pre-eclampsia, diabetes of pregnancy, and delivering preterm.

 

One baby at a time is always the safest thing for mom and baby.

 

Infertility treatments like IVF are expensive, both emotionally and financially. Putting back more than one embryo at a time will not save you money. It won’t get you that healthy family sooner. In fact, multiple studieshave shown that because of the higher risks of complications to mom and baby, these pregnanciescost much more than one pregnancy at a time.

 

That is why, in our practice, the majority of patients get one embryo transferred at a time. The average number of embryos transferred in our practice is 1.1. We are very proud of this! Other clinics are doing this across the countrytoo. Together, we are helping develop a generation of healthier moms and babies.

 

Take home points:

  • One baby at a time is always the safest thing for mom and baby.
  • Talk to your doctor if you have more questions

Doing an IVF cycle? A Mediterranean diet can help!

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Couples often ask me: “What else can we do to make this IVF cycle successful?” The first answer, is to pick the right lab. I’m fortunate to work with an amazing group of embryologists so I encourage my patients to consider the next step: using your diet and lifestyle to stack the odds in your favor. As we have discussed before in the blog, what you eat and what you do can absolutely impact your fertility and overall health. New research demonstrates that your diet, in particular, can impact your success with IVF.

 

As many of my patients know, I encourage a plant-based diet to enhance your fertility naturally. The problem with many of these studies that we have previously reviewed is that people who eat a plant-based diet are more likely to be thin and the following question emerges: “Is diet really impacting your fertility or does this have to do with your weight?” A new study helps us address this question.

 

In this study, women who had a normal weight (BMI < 30 kg/m2) underwent IVF in Greece. Women who ate a Mediterranean diet were more likely to get pregnant and bring home a healthy child compared to women who did not eat a Mediterranean diet. Women who ate better were almost 3 times as likely to bring home a child than women who did not eat a Mediterranean diet! The results suggest that dietary modifications may help increase the chances of a successful pregnancy and delivering a live baby for women undergoing IVF treatment.

 

What this study doesn’t answer, however, is when these dietary changes need to be implemented in order to have the full benefits on your fertility. My advice is simple: the sooner the better. The healthier you are when you start an IVF cycle, the more likely you are to get the full benefits of diet on your fertility. However, if you have a time crunch with regards to your fertility, with diagnoses such as diminished ovarian reserve, it may not be in your best interest to delay starting treatment. Talk to your doctor for more information about what the best next steps are for you.

 

Take home points:

  • Your diet can impact your chance of having success with IVF
  • Consider implementing a Mediterranean diet
  • Talk to your doctor for more information to help select the best diet for your goals

Considering IVF? Limit your exposure to DEHP.

Phthalates are a group of chemicals found in many types of plastics in a variety of consumer products. We have previously discussed the negative impact of phthalates on fertility. A recent study adds to this: phthalates negatively impact an IVF cycle. Women are disproportionally impacted by phthalate exposure.

 

In this study, women with high levels of phthalates had fewer eggs at the time of egg retrieval, fewer fertilized eggs, and fewer top quality embryos. This group suggests that DEHP, a specific type of phthalate, may impair early IVF outcomes, specifically targeting the oocyte. If you are thinking of undergoing IVF this year, I encourage you to investigate what you can do to optimize your IVF cycle by limited your exposure to phthalates!

 

What you can do:

IVF might not be enough

I am incredibly proud to work at a REI clinic that has the highest live birth rate in the country. A recent study, however, suggests that IVF may not be enough. Lifestyle and the environment can impact your IVF success rates, even at a top notch REI clinic.

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In this study, levels of pesticides and common pollutants were measured in the fluid that was obtained from the ovary during an egg retrieval. They found that higher levels of Pretilachlor, β-cyfluthrin, PCB 28 and 180 was associated with fewer eggs at retrieval, lower fertilization rates, and impaired embryo development. They also found that high PCB and pesticide concentrations negatively affected embryological outcomes. This study provides evidence that these harmful chemicals are found in the fluid surrounding individual eggs and are associated with decreased success with IVF. This suggests that if you want the very best chances of success with IVF, you should consider optimizing your lifestyle to minimize exposure to these harmful chemicals.

 

What you can do:

  • Learn how to minimize your exposure to PCBs and pesticides
  • Make a plan to optimize your health before you invest in an IVF cycle
  • Talk to your doctor about a timeline for implementing these changes

Egg Quality: new insights into why human eggs don’t age well

It has long been accepted that the primary reason that human eggs don’t age well is due to a dysfunction in when and how the chromosomes separate. This reduced chance of becoming pregnant associated with aging as well as the increased miscarriage rates. A new paper has now demonstrated that it’s not just the DNA separation that declines with time but also how the chromosomes are actually sorted and divided.

Within each egg are cable-like structures called microtubules. These microtubules not only help the egg maintain its shape but also are integral in sorting/separating the DNA. They are also in charge of cell division after fertilization is complete. In fact, some of the most powerful cancer fighting drugs are used to deliberately damage microtubules in order to prevent cancers from growing. This new information provides us with further insight into another important aspect of egg quality.

Although we don’t currently have any specific recommendations on what we can do to improve microtubule function; this information does provide us with more diagnostic information for patients that are going through In Vitro Fertilization (IVF). IVF is not only the treatment that provides patients with the highest pregnancy rates but when performed in a high quality setting; it also provides important diagnostic information. There is no accurate test for egg quality except to put a healthy sperm inside and see if/how well the process of fertilization and development takes place. We routinely use this information in discussing treatment options for patients that do not successfully conceive in their first IVF cycle at our center.

Fertile thoughts,

~Robert

Robert Greene, MD, FACOG

Conceptions Reproductive Associates

Daylight Savings Time May Lower Chances of IVF Success for Some: Study

At our center, we have long held that your circadian rhythm–how your biology responds to the day-night cycle–impacts your fertility. This is one of the many reasons we focus on optimizing vitamin D levels, melatonin (when necessary) and paying careful attention to our embryo transfer schedules. In case your fertility center hasn’t figured out how important that this is, check out the following recent study on miscarriage risk associated with time shifts.  https://consumer.healthday.com/infertility-information-22/infertility-news-412/daylight-savings-time-may-lower-chances-of-ivf-success-for-some-study-719514.html

The kids are all right: Children with 3-way DNA are healthy

One of the emerging therapies in advanced reproductive techniques involves combining the parts of a healthy egg donor to rejuvenate or correct deficiencies in a woman’s own egg. When a sperm is then added, the resulting person can actually contain the DNA of three people rather than two. Although this technology is currently not available for use in the USA–the first babies have been born in England through this technique. Interestingly, there were 17 babies born in the USA using this technique more than a decade and a half ago. This procedure was then banned due to potential health concerns in the children that resulted. We now have a follow up report on these original children who are now teenagers. Most importantly, this update is reassuring that although caution is recommended, this procedure does seem safe and reasonable for continued investigation.

https://www.statnews.com/2016/10/26/children-3-way-dna/

Exclusive: World’s first baby born with new “3 parent” technique | New Scientist

This headline is a bit misleading in that a similar technique was used in the 1990’s before it was decided that we need to proceed more cautiously in mixing DNA. Currently, the technique described is not available for couples treated in the USA and is only approved for use in treating specific genetic conditions. However, this is an exciting breakthrough that may prove to be useful in areas of reproductive medicine.   https://www.newscientist.com/article/2107219-exclusive-worlds-first-baby-born-with-new-3-parent-technique/

In IVF, frozen embryos may lead to more live births than fresh embryos – LA Times

This news will come as no suprise to our patients as we have been demonstrating this for years. It is good to have yet another study that further supports this recommendation. The cautionary note here for patients is to check with their center on the method of freezing used in their lab–if it not the modern rapid-freeze technique called vitrification  then you might be better served by a fresh transfer.  http://www.latimes.com/science/sciencenow/la-sci-sn-ivf-frozen-embryos-20160809-snap-story.html

Early Pregnancy Loss; simple changes to reduce your risk

 

One of the most challenging problems to diagnose and treat for couples trying to conceive is the problem of recurrent early pregnancy loss (REPL). As fertility specialists, we spend a tremendous amount of time and energy making sure that we control all of the variables that might improve the chances that a pregnancy gets a healthy start. New evidence shows that women can—and should—make some simple changes in their lifestyle to also improve their chances for a successful outcome.

 

A study presented at the 2015 meeting of the American Society for Reproductive Medicine recently highlighted the potential impact of a chemical called phthalates on the pregnancies of women going through IVF. This was part of a study called the EARTH study; an investigation on how environmental and lifestyle can impact reproductive health. They measured phthalate levels in the urine of about 250 women going through fertility treatment and then followed these levels in nearly 300 pregnancies. What they found was that women going through fertility treatment that had higher levels of this chemical in their body had a much higher chance of miscarrying then the fertility patients with lower levels. In fact, their risk could be as much as three to four times higher—depending upon their level of exposure.

 

An important aspect of modern research is to pose the question of “why?” In this case, the question would be “why would phthalates increase the risk of miscarriage.” The answer to that question is by interfering with the ability of ovary to support the development of the early pregnancy. Specifically, after an egg is released from the ovary; the cells that remain at the site of the egg’s origin form a hormone producing unit called a corpus luteum (CL). The function of this CL is to help get the pregnancy off to a strong start until the placenta is large enough to take over hormone production. In 2014 a well designed study found that phthalates directly interfere with the ability of the CL to perform this critical role.

 

A recent multi-centered clinical study found that women pursuing Advanced Reproductive Treatments (ART) like IVF had lower levels of phthalate in their body than infertility patients pursuing other forms of treatment. The believed explanation for this finding was that patients undergoing IVF may pursue healthier lifestyle choices. For instance, it is estimated that at least 90% of the phthalates in our bodies are due to dietary intake. By reducing processed foods and decreasing consumption of animal fats, phthalate levels fall rapidly. In fact, our bodies are able to eliminate phthalates after only 6 to 12 hours. So it is only through the continued exposure that these chemicals persist in the bloodstream. So by making better choices, patients may be able to reduce their risk of miscarriage by 75%.

 

Here are some easy steps that you can take to begin reducing your phthalate level today:

  • Only use nail polishes that are phthalate free—most add a phthalate called DBP to reduce chipping
  • Don’t microwave or cook your food in plastic containers or use plastic utensils to eat hot foods—heat leaches this chemical out of the plastics and into food—the easiest pathway into your body
  • Avoid plastic bottles—seek out glass or metal instead. When you must use plastic seek out bottles with the #2, #4 and #5 in the recycle triangle
  • Avoid perfumes and scented products—phthalates (DEP) are used to prolong fragrances
  • Don’t use air fresheners—most contain phthalates
  • Avoid vinyl containing products—many products like lawn furniture, rain coats or shower curtains can not only release phthalates that can be inhaled but they can also be absorbed through the skin as well.