Enhancing Fertility

Unfortunately, the number of cases of SARS-CoV-2 is increasing—not just here in Colorado but in most of the country and other parts of the world as well. Additionally, we’re heading into flu season which further complicates our ability to keep our patients, our staff and our families healthy. Ironically-from the perspective of a fertility center-this combination is often being referred to as a Twin-demic.

Below is a link to our latest videoblog updating you on the current public health status. In the meantime, please take precautions:

• Wear an appropriate mask in public settings
• Avoid large public gatherings
• Do not come into our office if you’re ill or have been exposed
• Consider a supplement to support your immune system like TheraVir

Here’s a link:  https://youtu.be/nRtX6NVIQ_s  (about 20 minutes)

Stay informed,

~Robert

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Previously, we discussed what the current means of embryo testing is and what insights it provides about the DNA. In this clinical conversation, we review the way embryos are described based upon their development and their description.

If you’ve completed an IVF cycle and are now getting ready to prepare for an embryo transfer, your embryologist will tell which embryo(s) they recommend for transfer. Although there is a lot that goes into this recommend, there is a shorthand description that they use to summarize each embryo. That is the “embryo grade.”

• 0:45        How important is embryo grading?
• 4:15        Summary of the current (most popular) grading system
• 8:35        Correlation between embryo grade and implantation rate
• 12:30     Lisa’s experience—a real life example shared
• 14:00     Genetic testing vs grading
• 15:30     Transferring more than one embryo of different grades

This video is about 20 minutes long. Here are a few key points if you don’t want to listen to the entire post:

Here’s a link:  https://youtu.be/xQFXCe-BVak  (about 20 minutes)

Stay informed,

~Robert

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Modern IVF—when practiced with the most current technology—is not only more effective than ever before but can also be diagnostic. One of the tools that really provides some of the greatest insight is the use of genetic testing. Not all centers use these tools and there are several different ways to perform genetic testing. There are many opinions on what is best. Here is a recent conversation that I had with Fertility Coach and previous patient, Lisa White:  https://youtu.be/xs97X9_4gdM

In case you don’t have 30 minutes to spare—here are some key points in the conversation:

• 00:47—Clarification of Acronyms
• 02:00—What do I recommend and why
• 05:00—Description of the process
• 07:50—Who should consider genetic testing?
• 11:40—Alternatives to transferring abnormal embryos
• 13:50—How often do patients choose not to have testing (at our center)?
• 14:30—False-Positive and False-Negative vs. “embryos repairing themselves”
• 16:00—What are costs or potential savings:
• 18:00—Lisa’s personal experience (an example)
• 19:00—Some of the additional diagnostic information that can possibly be attained
• 21:00—What about people using an egg donor?
• 26:00—How is this different than “embryo grading”?

We hope that this conversation answers some of your questions so that you can guide your treatment choices.

Stay informed,

~Robert

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

Most fertility treatment targets the female partner. In fact, many of the male partners feel helpless during treatment. Often viewing themselves as “problem solvers,” it is common for men to as if they are bystanders during fertility treatment. As a result, many questions aren’t asked and potentially useful advice is often withheld.

In order to overcome this information gap, we’ve recorded a video conversation where we try to address the most common questions that have come up regarding male fertility testing and treatment. Topics that we cover in this video include:

• Testing including explanation of semen analysis
• Diet/lifestyle tips as well as supplements
• Potential role of sperm freezing (you may not have considered)
• Dispelling popular myths
  • Boxers vs briefs
  • Caffeine
• Role of ICSI (sperm injection into the egg) in modern IVF
• Emotional support for men

Here’s a link: https://youtu.be/PvzqQorMB1g (about 40 minutes)

Stay informed,

~Robert

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

One aspect of fertility treatment that exacerbates the frustration of many couples is the uncertainty. They often don’t have a specific reason for their problem—even after their testing is completed. They also don’t understand the typical challenges that everyone faces on a monthly basis. Without this information, it can be difficult to create realistic expectations. I believe it also makes the most logical and simple recommendations seem very appealing.

Basic Fertility care is often introduced as ovulation induction (OI)—using medication to regulate the menstrual cycle and optimize the timing of the “fertile window.” This procedure is often combined with “sperm wash” where the partner’s specimen is processed to optimize its potential and then placing that into the woman’s uterus—known as intrauterine insemination (IUI). This treatment has been available for decades. There have been few changes in how this is done over the last 10 years.

I reviewed the subject of OI/IUI back in 2015 and those studies are still very relevant. So please check that out as well. More recently, we have had a couple of publications that provide even more data for us to guide patients through these important decisions. Please consider the watching the following video blog for a quick (less than 10 minute) summary ( https://youtu.be/GwmbkIpw3ek ) .  In case you can’t access the link, here is a brief summary of findings;

• Ovulation Induction with intercourse wasn’t much better than trying to conceive naturally
• Insemination without ovulation induction had success rates comparable to natural conception
• In considering OI/IUI
  • Success rates drop dramatically after three or four attempts
  • Having more than two follicles is not recommended due to increased risk of multiple pregnancy
  • The timing of the insemination is more flexible than most anticipate
  • There is no greater benefit in having more than one insemination per cycle
  • For women over 40, success rates were modest and associated with a lower risk of multiple pregnancy—even when three or more follicles were available            

I hope that you find this information helpful and empowering as you consider your treatment options and plan your family.

With kindness and optimism

~Robert

Robert Greene, MD, FACOG

Conceptions Reproductive Associates of Colorado

References:

• Obstetrics and Gynecology 2020
• Fertility and Sterility 2020 Evidence based treatment review