As we prepare to celebrate Mother’s Day, I am reflecting upon the journey that my wife and I undertook to become parents. It may seem to an outsider that it was easy given that I’m a fertility specialist and I work in a top performing fertility center; but it wasn’t. In fact, my wife and I felt quite isolated. We didn’t openly talk about our efforts at the time because we didn’t want to invite the scrutiny of family and staff. So I understand how sequestered the process can feel. That’s why I so fully appreciate efforts like those of women like Lisa W. (in the photo above) that are not only willing to share their experience but also work to help others. I encourage you to check out her website and see if she can help support you in your efforts. It’s great to have someone you can talk to that’s been on the same path.
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.
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.
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.
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.
Robert Greene, MD, FACOG
Conceptions Reproductive Associates of Colorado
Thank you for the excellent feedback from our last string of posts: “Top 10 ways to minimize your exposure to toxic chemicals in our environment.”
One of the tips that was covered in this list is to eat lots of fruits and veggies. I recommended eating a variety and to choose organic selectively by using tools such as EWGs “Clean 15” and “Dirty 12.”
Human fertility rates are declining. Although this was thought to be due to lifestyle changes and societal changes, could our environment be playing a role? Could environmental contaminants like pesticides in our food be contributing to infertility?
This study in China showed that women with high levels of organophosphate or pyrethroids exposure (common pesticides) took longer to conceive and were more likely to have infertility than couples that had lower levels of exposure.
What you can do:
- Wash your produce for at least 20 seconds to minimize your exposure to pesticides.
- Eat organic when you can and strategically by utilizing resources like EWG’s dirty list: certain items are worth the money of switching to organic (“Dirty 12”) more than other produce (“Clean 15”)
For decades, infertility patients have been told to avoid caffeine consumption when trying to conceive and during fertility treatments. As we have previously reviewed, moderate caffeine consumption is ok, and could even help! New data is showing us that what you put in your coffee, could be more dangerous than the caffeine itself
We have previously discussed this topic: You are what you drink. This study looked at couples doing IVF and found that women who drank beverages with artificial sweeteners had lower pregnancy rates than women who did not consume these beverages. Similarly, any type of soft drink consumption (regular vs diet) was associated with worse outcomes: poor embryo development in the lab and lower pregnancy rates.
If you are doing IVF, avoid using artificial sweeteners or consuming soft drinks in order to optimize your chances of success.
Take home points:
- Men and women should avoid sugary drinks when trying to conceive, but particularly if they are using IVF
- Using artificial sweeteners is not necessarily a safe alternative to sugary drinks
- If you can’t completely eliminate sugary drinks, consider limiting your intake to <1 beverage a day.
For the next 10 days, I posted daily tips for how you can minimize your exposure to toxic chemicals in our environment. 💄💅🤢
How did I do with this list? What did I miss? What other topics would you like me to cover?
This picture was taken at my son’s kindergarten class. I was asked to talk about being a surgeon. My favorite part was when one of the kids asked if I had been in school for 99 years to become a doctor 😂
#infertilityjourney #infertility #ttc #topten#environment #healthyliving
For the next 10 days, I will be posting daily tips for how you can minimize your exposure to toxic chemicals in our environment. 💄💅🤢
10. Choose seafood wisely
Seafood is incredibly confusing. On the plus side, seafood has healthy omega 3 fatty acids. But then we learn about mercurcy contamination and things get complex. OBGYNs recommend seafood consumption based on a study that showed that expecting moms who regularly consumed seafood had smarter babies. Fish and shellfish are low in fat, high in protein and good sources of iodine, vitamin D and selenium, often deficient in the Western diet.
But decades of industrial activity have released mercury and other pollutants into oceans and waterways; those contaminants end up in seafood. My recommendation is that if you eat fish, consume one to two 4 ounce servings a week of one of EWG’s best bets like wild salmon.
#infertilityjourney #infertility #ttc #topten#environment #EWG