Archive for the “Fertility Treatments Abroad” Category

- Massive study outlines success for assisted reproductive technology

- Sublimis Argentina offers fertility treatments abroad such as IVF, ICSI and Egg Donation

East Lansing, Mich. — A groundbreaking study of nearly 250,000 U.S. women reveals live birth rates approaching natural fertility can be achieved using assisted reproductive technology, where eggs are removed from a woman’s ovaries, combined with sperm and then returned to the woman’s body.

The research, led by Michigan State University’s Barbara Luke and published in the New England Journal of Medicine, highlights what factors help or hinder getting pregnant using assisted reproductive technology, or ART. The results indicate that when there are favorable patient and embryo characteristics, live birth rates with ART can approach those of natural fertility.

“This is good news for women who are trying to have a child,” said Luke, a researcher in the College of Human Medicine’s Department of Obstetrics, Gynecology and Reproductive Biology.

The number of ART treatments has more than doubled in the past 10 years, and live birth rates traditionally have been reported per cycle, or per one course of treatment. While that is easily calculated and is the method used by national registries across the world, Luke’s team sought to estimate cumulative success rates with continued treatment.

“Women and families want to know the overall chances they will get pregnant, not necessarily whether they will get pregnant during a specific cycle,” Luke said.

Data were obtained from the Society for Assisted Reproductive Technology’s Clinic Outcome Reporting System for women undergoing treatment between 2004 and 2009. The system contains data on more than 90 percent of all clinics performing ART treatments in the United States.

Fertility Treatments Abroad

The study of 246,740 women revealed 57 percent of women achieved a live birth via ART treatment, and 30 percent of all ART cycles resulted in a live birth. Success rates declined with increasing age for women using their own eggs, especially for those ages 38 years and older, but not for women using donor eggs.

The estimated natural fertility rate of the general population is about 20 percent per month, and estimated rates of conceiving spontaneously are 45 percent, 65 percent and 85 percent after three, six and 12 months, respectively.

The study looked at factors such as patient age, diagnosis, response to treatment, cryopreservation and the stage at which embryos were transferred. Two major factors that influence ART success are favorable patient characteristics (specifically age) and good embryo quality. Among older women, live birth rates can be substantially improved with continued treatment and a change to donor eggs.

“Although the decision to use donor eggs is a very personal one, these analyses provide information regarding the likelihood of a live birth using this option,” said Luke.

These results also could guide regulations governing health insurance coverage for infertility treatment. The number of treatment cycles covered by insurance is typically limited to two or three. The findings demonstrate that when using a woman’s own eggs, the success rates continue to rise beyond two to three cycles; additionally, the study may help providers and women decide when it is appropriate to change to donor eggs.

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Tests That Use DNA From Mother’s Blood to Determine Sex of Fetus Often Effective

As a noninvasive method of determining the sex of a fetus, tests using cell-free fetal DNA obtained from the mother’s blood after 7 weeks gestation performed well, while urine-based tests appear to be unreliable, according to a review and analysis of previous studies, reported in the August 10 issue of JAMA.

Noninvasive prenatal determination of fetal sex could provide an important alternative to invasive cytogenetic determination, which is currently the gold standard for determining sex and single-gene disorders. Amniocentesis has small but measurable rates of procedure-related pregnancy loss; and sonography can be performed as early as 11 weeks’ gestation to determine fetal sex, although not reliably, according to background information in the article. “The availability of a reliable noninvasive alternative to determine fetal sex would reduce unintended fetal losses and would presumably be welcomed by pregnant women carrying fetuses at risk for disorders,” the authors write.

Pregnant Mother and Son

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Diabetes and Obesity Combo a Major Red Flag in Pregnancy

Type 2 diabetes and obesity in pregnancy is a daunting duo, according to new research published this month in The Journal of Maternal-Fetal and Neonatal Medicine. The study shows that both conditions independently contribute to higher risks, opening the door to a wide range of pregnancy, delivery and newborn complications.

Study authors say the findings are important because obesity and type 2 diabetes are skyrocketing in women of childbearing age. A study in The Journal of the American Medical Association reports that between 2007 and 2008 the prevalence of obesity among adult women in the United States was more than 35 percent. A report from the Centers for Disease Control and Prevention states that approximately 11 percent of women above the age of 20 had diabetes in 2010.

Loralei Thornburg, M.D., senior study author and a high-risk pregnancy expert at the University of Rochester Medical Center, emphasizes that the research is needed now more than ever. “We’ve never seen the degree of obesity and type 2 diabetes in women that we are seeing right now, because for a very long time diabetes was a disease of an older population, so we rarely dealt with it in prenatal care. We hope this new knowledge will help physicians better understand and care for this rapidly expanding group of high-risk women.”

Fertility Treatments

While numerous studies have established that obesity, in the absence of diabetes, is associated with problems in pregnancy – preterm birth, birth trauma, blood loss and a prolonged hospital stay, to name a few – less is known about type 2 diabetes and what causes difficulties when the two conditions coexist. Researchers from Rochester wanted to determine if obesity alone accounts for the increased risks in this “dual-diagnosis” group, or if diabetes plays a role as well.

To determine the influence of obesity and type 2 diabetes when the conditions coexist in pregnancy, Thornburg and lead study author Kristin Knight, M.D., used clinical records and the hospital’s birth certificate database to identify 213 pairs of women who delivered babies at the Medical Center between 2000 and 2008. Each pair included a diabetic and a non-diabetic patient with approximately the same pre-pregnancy body mass index (BMI). The majority of women in the study were overweight, obese or morbidly obese.

“We matched the pairs pound for pound, because if obesity was the main problem, we’d see similar outcomes between women, whether they had diabetes or not. But if we saw different outcomes between pairs, we’d know the diabetes was impacting outcomes as well,” said Thornburg.

Using mathematical models and controlling for outside factors, such as age and tobacco use, researchers found that the patients with type 2 diabetes had overall worse pregnancy, delivery and newborn outcomes than their BMI-matched counterparts. Specifically, diabetic patients had higher rates of preeclampsia, cesarean delivery, shoulder dystocia, preterm delivery, large for gestational age infant, fetal anomaly and admission to the neonatal intensive care unit.

“Women and their physicians need to be aware that each condition on its own increases risk in pregnancy, so when they coexist the situation is even more worrisome,” said Knight, a maternal fetal medicine fellow at Rochester. “Pregnancy is a time of great change, and fortunately many women are very open to making modifications during this period in their life. Anything a woman can do to improve her condition, from controlling blood sugar and exercising, to eating nutritious foods and maintaining an optimal weight, will help her deliver a healthier baby.”

Knight originally focused her research on the effects of type 1 and type 2 diabetes on pregnancy. In a previous study, she found that women with type 2 diabetes, most of whom were also obese, had poorer outcomes. Consequently, her research turned to obese, type 2 diabetics and their experiences in pregnancy.

“If a woman enters pregnancy obese, but hasn’t developed type 2 diabetes, she is in a better place than if she had both,” concluded Thornburg.

In addition to Knight and Thornburg, Eva K. Pressman, M.D., and David N. Hackney, M.D., from the Medical Center, also participated in the research.

Note: Sublimis offers fertility treatments abroad and weight loss surgery in Argentina

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Study Shows Gastric Bypass May Reverse Infertility

- New hope for women with morbid obesity trying to get pregnant

- Sublimis Argentina offers affordable bariatric surgery abroad and fertility treatments abroad

Orlando, FL – Obesity has been linked to infertility and now a new study shows bariatric surgery may treat its most common cause, polycystic ovarian syndrome (PCOS), a hormonal imbalance that affects up to 10 percent of women of child-bearing age — 33 to 50 percent of whom are overweight or obese. The findings were presented here at the 28th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

“Not many patients come to a bariatric surgeon to treat infertility problems,” said Mohammad Jamal, MD, FACS, study co-author and Clinical Assistant Professor of Surgery at the University of Iowa Hospitals and Clinics in Iowa City. “But this study suggests that women with morbid obesity, who are infertile secondary to PCOS, may have a new surgical option. Many other studies have shown bariatric surgery can improve or resolve a multitude of diseases and conditions. It appears that infertility now joins that list.”

In the study, researchers from the University of Iowa Hospitals and Clinics report that 100 percent of the morbidly obese women who were diagnosed with PCOS related infertility, and desired children, became pregnant within three years following gastric bypass surgery.

A review of medical records of 566 morbidly obese women who had gastric bypass surgery over a period of nine years revealed 31 patients between the ages of 22 and 42 who had PCOS before surgery. Six post-menopausal patients, and five patients lost to follow-up, were excluded. The remaining 20 patients, average age 32, were contacted by telephone. Fourteen of them were fertile prior to surgery or did not desire to become pregnant after surgery.

 

Before and after bariatric surgery
- Before and after bariatric surgery

The remaining six women, who had been diagnosed with infertility before surgery, and still desired pregnancy, became pregnant within three years of gastric bypass surgery. Doctors advise women not to try to conceive until at least 18 months after bariatric surgery due to surgery-related changes that could affect fetal development.
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Study finds association between the number of eggs and live birth in IVF treatment

Note: Sublimis Medical Tourism offers affordable fertility treatments in Argentina

An analysis of over 400,000 IVF cycles in the UK has shown that doctors should aim to retrieve around 15 eggs from a woman’s ovaries in a single cycle in order to have the best chance of achieving a live birth after assisted reproduction technology.

The study, which is published online in Europe’s leading reproductive medicine journal Human Reproduction, found that there was a strong relationship between live birth rates and the number of eggs retrieved in one cycle. The live birth rate rose with an increasing number of eggs up to about 15; it levelled off between 15 and 20 eggs, and then steadily declined beyond 20 eggs.

One of the authors of the study, Dr Arri Coomarasamy, said: “This is the first study to look at the association between the number of eggs and live births. Some smaller studies have reported previously on the association between egg numbers and pregnancy rates, but not live births. This is also the first study to devise a graph that can be used by patients and clinicians to estimate the chances of a live birth for a given number of eggs.”

IVF Treatment in Argentina

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IVF Babies’ Birth Outcomes are Influenced by Treatment Type and Diagnosis of Infertility

In a new study published in Fertility and Sterility, researchers observed that differences in obstetrical outcomes for singleton pregnancies in patients using assisted reproductive technology (ART) depend on which techniques the patients used and their infertility diagnoses.  These findings indicate that the uterine environment is perhaps the most important influence on the key outcomes of birth weight and length of gestation in ART pregnancies.

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William Gibbons, MD and his colleagues Marcelle Cedars, MD and Roberta Ness, MD, MPH reviewed data collected by the Society for Assisted Reproductive Technologies (SART) for the years 2004 through 2006 and compared average birth weight and gestational age for singletons born as a result of standard IVF, IVF with donor eggs, and IVF with a gestational carrier.  The data were further analyzed in relation to the patient’s primary diagnosis and whether donor sperm or sperm from the patient’s partner were used.

They found that the birth weight associated with standard In Vitro Fertilization (in which the patient carried the embryo created with her own egg) was greater than that associated with donor egg cycles and less than that in gestational carrier cycles.  This finding held true even when other factors, including mother’s age, number of fetal heartbeats in the first trimester, and male factor were considered.  While a diagnosis of male factor infertility did not affect birth weight or gestational age, every “female” diagnosis was associated with lower birth weight and, except for “unexplained” infertility, a reduced gestational age.  Patients diagnosed with “uterine factor” had babies with the lowest birth weights and gestational ages.

The uterine environment as related to treatment type was also considered. In standard IVF an embryo is transferred to a woman who has just undergone controlled ovarian hyperstimulation, while in donor egg IVF and gestational carrier IVF, the embryo is transferred to a “natural” or unstimulated uterus.  Therefore the researchers looked at IVF utilizing frozen embryo transfer- in which an embryo created with a patient’s own egg is transferred to her own unstimulated uterus- for additional information. They found that babies born of frozen embryo transfer cycles had markedly greater birth weights than those born as a result of standard IVF.

R. Stan Williams, MD, President of the Society for Assisted Reproductive Technology, observed, “The study shows that many interrelated factors affect the health of babies conceived using ART.  Studies like this one increase our understanding and show us where further research may enable us to improve outcomes for our patients.”

Source: American Society for Reproductive Medicine

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Nobel Prize for the development of human In Vitro Fertilization

Robert Edwards is awarded the 2010 Nobel Prize for the development of human in vitro fertilization (IVF) therapy. His achievements have made it possible to treat infertility, a medical condition afflicting a large proportion of humanity including more than 10% of all couples worldwide.

As early as the 1950s, Edwards had the vision that IVF could be useful as a treatment for infertility. He worked systematically to realize his goal, discovered important principles for human fertilization, and succeeded in accomplishing fertilization of human egg cells in test tubes (or more precisely, cell culture dishes). His efforts were finally crowned by success on 25 July, 1978, when the world’s first “test tube baby” was born. During the following years, Edwards and his co-workers refined IVF technology and shared it with colleagues around the world.

Approximately four million individuals have so far been born following IVF. Many of them are now adult and some have already become parents. A new field of medicine has emerged, with Robert Edwards leading the process all the way from the fundamental discoveries to the current, successful IVF therapy. His contributions represent a milestone in the development of modern medicine.

Infertility – a medical and psychological problem

More than 10% of all couples worldwide are infertile. For many of them, this is a great disappointment and for some causes lifelong psychological trauma. Medicine has had limited opportunities to help these individuals in the past. Today, the situation is entirely different. In vitro fertilization (IVF) is an established therapy when sperm and egg cannot meet inside the body.

IVF Ilustration

Basic research bears fruit

The British scientist Robert Edwards began his fundamental research on the biology of fertilization in the 1950s. He soon realized that fertilization outside the body could represent a possible treatment of infertility. Other scientists had shown that egg cells from rabbits could be fertilized in test tubes when sperm was added, giving rise to offspring. Edwards decided to investigate if similar methods could be used to fertilize human egg cells.

It turned out that human eggs have an entirely different life cycle than those of rabbits.  In a series of experimental studies conducted together with several different co-workers, Edwards made a number of fundamental discoveries. He clarified how human eggs mature, how different hormones regulate their maturation, and at which time point the eggs are susceptible to the fertilizing sperm. He also determined the conditions under which sperm is activated and has the capacity to fertilize the egg. In 1969, his efforts met with success when, for the first time, a human egg was fertilized in a test tube.

In spite of this success, a major problem remained. The fertilized egg did not develop beyond a single cell division. Edwards suspected that eggs that had matured in the ovaries before they were removed for IVF would function better, and looked for possible ways to obtain such eggs in a safe way.

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