Our ongoing IVF pregnancy rate is 45 percent per blastocyst transfer for women 34 years old and under.
Until recently, couples worldwide faced a higher probability of triplets or more when undergoing in vitro fertilization because of the high number of 8-cell embryos transferred in hopes of achieving a single pregnancy. Today, thanks to breakthrough research in the culture medium needed to sustain a blastocyst, an embryo can be grown for three more days in the lab to the blastocyst stage, offering a more stable, higher quality embryo. As a result, fewer embryos are required for transfer. In fact, our Center routinely transfers only two blastocysts per patient.
As the first center in the Tristate to achieve pregnancies from fresh and frozen blastocysts, we have been working hard in our lab to perfect the culture medium required for blastocyst growth. Our long-term goal is to continue producing even higher quality blastocysts so only one blastocyst is needed to achieve pregnancy, significantly reducing multiple birth rates altogether.
We are excited to join other leading centers in the nation in routinely offering this technology to our patients, helping establish blastocyst transfer as an industry standard for IVF.
Click here for The Cincinnati Enquirer newspaper article on our Center's blastocyst technology.
Pre-Implantation Genetic Diagnosis
Pre-implantation genetics diagnosis (PGD) is the latest, most significant advancement and cutting edge technology in the reproductive industry to date. PGD technology can help a couple, who are at risk for passing on an inherited genetic disease and dramatically improve the odds of having a healthy child. It is recommended for families with a history of a specific genetic disease, or for women 35 years older with a history of multiple miscarriages. The number of genetic diseases potentially diagnosable by PGD is numerous but includes such disorders as Down syndrome, Turner syndrome, hemophilia A, Huntington disease, sickle cell, and Tay-Sachs disease.
PGD is done in conjunction with In Vitro Fertilization and/or intracytoplasmic sperm injection (ICSI). The procedure involves the microsurgical removal of one or two cell from each embryo, at the six to eight cell stage through a procedure call embryos biopsy. The chromosomes are counted and stained by a technique called fluorescence in situ hybridization (FISH) analysis to identify a disorder. The procedure is usually done three days after the egg retrieval. The embryo biopsy results are usually known within 24 hours. After the tests are completed, the embryos without the identified defects are transferred into the woman's uterus as in a standard IVF cycle.
Medical Director's view on Metformin drug and PCOS
An article in The Cincinnati Enquirer (Monday April 17, 2000) reported the preliminary research findings of Dr. Charles Glueck from the Jewish Hospital in Cincinnati. Dr. Glueck's work suggests that the medication Metformin (also known as Glucophage) may reduce the incidence of miscarriage in women with polycystic ovarian syndrome (PCOS). He found that of the women with PCOS who were taking Metformin, the miscarriage rate was 9%, compared to a 45% miscarriage rate in women not taking Metformin. He feels this medication may be helpful for women with PCOS seeking to conceive.
There is no doubt that Metformin is an important medication for women with type II diabetes, and women with PCOS with insulin resistance. However, PCOS is a very common disorder in women of reproductive age, and only some of them demonstrate insulin resistance. Thus the majority of women with PCOS are probably not candidates for Metformin.
Of concern: Dr. Glueck's study suggests that Metformin will reduce the miscarriage rate in women with PCOS to below the rate of the general population of women of reproductive age without PCOS (miscarriage rate ~30%).
This study is provocative, but should not be construed to suggest that Metformin is a magic medicine that will reduce miscarriage rates in women with PCOS. Rather, it should be the start of a large, randomized, placebo controlled, double blinded (neither patient or doctor knows whether the patient is on Metformin or placebo) study of women with well defined PCOS and insulin resistance. Until the above study is completed and published in a major medical journal, the data must be viewed as preliminary at best.
Center Joins a Handful of Centers in Freezing Human Sperm Using Hamster Egg Shells
In Spring 1999, Bethesda became one of the select few fertility centers in the country, and the first in the Tristate*, to freeze single sperm cells in the shells of hamster eggs. The process pushes the treatment of male-factor infertility nearly to the point of nonexistence.
Previously, men with exceptionally low sperm counts could only benefit from infertility techniques such as intracytoplasmic sperm injection if the sperm could be harvested at exactly the same time as a woman's egg could be retrieved. The man's precious few sperm could not, until now, be frozen and saved until an egg could be gathered. With so few sperm, the cells would be nearly impossible to find in the solution used to protect the sperm during freezing. Now, even one sperm can be safely stored for as long as needed.
The hamster zona technique begins with the placement of sperm cells into the zona (the outer layer of the egg -- similar to a shell) of hamster eggs. Prior to this, all the contents of the hamster eggs are removed in preparation for the sperm. After the sperm cells are safely inside the hamster zona, they are frozen. Weeks later, when an egg from the patient's wife can be retrieved, the sperm are thawed, removed from the hamster zona and placed into the human egg for fertilization.
*Bethesda achieved another Tristate first in May 2001 with its first birth from this new hamster zona procedure. Only one other center in the nation has achieved this accomplishment.
