GIVF Fertility eNews
February 2008

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World-renowned for its pioneering work in infertility and genetics, GIVF developed or perfected many of the treatments and techniques used today in other centers. 

Worldwide, GIVF is responsible for over 15,000 pregnancies.

Find out how we can help you. Call us today at 800.552.4363.


Special GIVF Offerings
First Trimester Screen
 
 
 Web Videos
 
 
 
"The Little Boy That Could"
 
Winner of the 2007 Ferring's My Little Miracle Essay Contest
 
By Maureen Brophy
 
The following essay, by a former GIVF patient, was one of twelve national essay winners.
 

Miracle Essay

Maureen Brophy with husband Christopher and children Connor and new younger sister Madison

As a young, healthy, newlywed couple the thought of fertility problems did not cross our minds. The assumption was that when we were ready we would have a family and live the stereotypical American dream. After over a year of trying unsuccessfully we were concerned because we were not pregnant. We decided to consult Genetics & IVF Institute in Fairfax, VA. We did an IUI which was unsuccessful and then moved onto IVF. During our first attempt with IVF we lost the pregnancy early on and were unsuccessful with the subsequent embryo transfer.

During the course of all of this it seemed as though everyone around us was having children or asking us when we were going to have children. We just could not understand why this was happening to us. We had been buying clothes and baby items for several years now and the harsh reality and despair that we may never see our baby started to sink in.

In December 2003 when all hope seemed to be lost we decided to do our last IVF cycle. I was home when the call came in and I could tell by the tone that it was not good news. The nurse told me that my pregnancy test was positive but that it was only 25.2.

My blood work was closely monitored and instead of going down my numbers were rising. I kept some cautious optimism though because this was the closest that I had ever been.

It was Christmas 2003 at this point. I had several bouts of bleeding and was devastated. On Christmas Eve my husband gave me a little pair of blue baby booties with the name "Connor". This was one of the names that we decided on over our four year struggle.

At the five week mark I had an ultrasound. The scan began and to everyone's disbelief there was a little blinking light on the screen. There was a heartbeat and everything looked as it should despite all of the complications. We were "officially" pregnant. We were given the due date of 09-13-2004 and we knew it would be a little boy. 09-13 is my Grandfather's birthday and he had passed away just months before. We felt that Pop had sent us down a little sign that everything was going to be alright.

The pregnancy was high risk but continued on well with close monitoring. At 13 weeks I was hospitalized with complications and this is when we found out that we had a son. When it seemed that everything was falling into place our family sustained a crushing blow. When I was 5 months pregnant my Dad was diagnosed with end stage lung cancer. We told my Dad that his first grandson was on the way but my Dad was too sick to hold on. He looked forward to the Little League games, and promised to be there for graduation and this first pitch but this was just not meant to be. We videotaped the ultrasounds and gave him pictures of his grandson. On July 22, 2004 my Dad passed away just 4 weeks before the birth of his grandson.

Several days after my Dad passed I was hospitalized for pre-term labor. I was discharged the day of his funeral and our son was doing well.

On 08-25-2004 we went to the hospital for a planned c-section. I had this warm and calm sense come over me in the operating room. I felt like my Dad was there taking care of me. After a few minutes the doctor held up this amazing little being and said, "Maureen, look up...here's your baby." The rush of emotion and relief was indescribable.

Connor Patrick Brophy came into this world and his birth could not have come at a better time for our family. This little 7 pound miracle that we had waited so long for replaced the tears of sadness with tears of joy. He was and is what has seen this family through its darkest hours. He was well worth the struggle and the 4 year wait and all of that just vanished when we saw him. This little miracle that had grown inside of me for 9 months had finally arrived and as perfect as we had imagined.

Connor definitely is the "Little Boy That Could" right from the start. He fought to be here despite the odds being against him because he needed to be here with us. He will be three at the end of August and this boy is amazing! He is always smiling or laughing heartily! He has a way of lighting up a room and working the crowd. No matter how hard things may seem he makes them better and our lives with him have blossomed into something that we never could have imagined. When he flashes that smile or says that he loves me my heart melts.

What's New at GIVF

GIVF RECORDS OVER 15,750 PREGNANCIES. As of year-end 2007 GIVF surpassed 15,750 pregnancies worldwide. For additional information visit www.givf.com or call (888) 834-2229 for an appointment.
 
GIVF DONOR EGG POOL EXCEEDS 170 DONORS. GIVF's donor egg program now offers the largest selection of fully screened and available donors in the country. Additionally, the donor egg success rate per retrieval for 2007 was 55.3% and 63.7% over the last six months. For additional information visit www.givf.com or call (888) 834-2229 for an appointment.
 
NATIONALLY RECOGNIZED MOLECULAR BIOLOGIST LECTURES AT GIVF. Dr. George Smith, a professor at Michigan State University, visited GIVF for a day in January and presented a lecture on critical genes and early embryo development.
 
GIVF DONOR EGG PROGRAM FEATURED ON NBC. Dr. Sunita Kulshrestha and a GIVF egg donor were interviewed by Doreen Gentzler of NBC news. For more information on the story about Donor Egg programs, click here.
 
 
Ask a Question
 
I had my tubes "tied" (or cut or "burnt") Is there a way I can still have a baby?

Many women have changes in their family and life situations years after tubal sterilization surgery and find they want to have a baby. The good news is that there may be several options for you!

IVF: IVF is often an excellent option for women who want to have a baby after tubal sterilization procedure because the Fallopian tubes are completely bypassed when IVF is used. Eggs are taken from your ovaries and inseminated with sperm while outside the body. The embryos that develop can then be placed in the uterus (womb) a few days later. IVF offers the chance for pregnancy without having to undergo an operation and maintaining contraception or birth control against future pregnancies after completion of your family.

Surgery: In some cases, surgical reversal or "reconnecting" the tubes is also an option. Surgery offers the option of attempting pregnancy naturally indefinitely without repeated treatments, but carries the rare risks of surgery. In some cases it is not successful depending on the type of tubal ligation or tubal damage done initially. The best choice for you will depend on your own unique situation. Speak to your doctor to determine which is the best treatment for you.

 
Polycystic Ovary Syndrome (PCOS)
 
By Sunita Kulshrestha, MD, FACOG
 
Dr. Sunita KulshresthaWhat is PCOS? PCOS is the most common female reproductive endocrine disorder, affecting between 5-10 percent of reproductive aged women. PCOS is a common cause of infertility, menstrual irregularity, hirsutism (excess hair growth) and acne.
 
What are the characteristics of PCOS? PCOS is defined as having at least 2 of the following three characteristics:
 
1)Chronic anovulation (lack of or irregular ovulation)
 
2)Chronic hyperandrogenism (excess male hormone production)
 
3)PCOS appearing ovaries
 
What are the effects of chronic anovulation? The most common symptom in PCOS and the cause of the associated infertility, is an ovulatory disturbance which causes irregular menstrual cycles. Women with PCOS typically have periods that occur more than thirty-five days apart or have fewer than eight periods a year. Some women do not even have periods as a result of the complete lack of ovulation.
 
Lack of ovulation provides fewer opportunities for sperm to encounter an egg and therefore fewer opportunities to achieve pregnancy. If ovulation is irregular, it may also become difficult to determine a woman's fertile window, which typically lasts only 24-48 hours.
 
Apart from fertility concerns, infrequent menstruation can increase the chance of endometrial hyperplasia (thickened lining of the uterus) and endometrial cancer.
 
What are the effects of hyperandrogenism? Hyperandrogenism is an excess of male hormones (like testosterone). Hyperandrogenism contributes to the ovulation disturbance that is seen and may also affect egg quality. In addition, hyperandrogenism contributes to hirsutism (excess hair growth), a condition in which coarse hairs are found on the face, chest, lower abdomen and back. Hyperandrogenism can also cause acne, oily skin and male pattern thinning or baldness of the scalp hair. Some women with PCOS can have laboratory evidence of excess androgens but they do not have hirsutism or acne.
 
What are polycystic appearing ovaries? Polycystic appearing ovaries are plump and contain multiple small follicles (fluid filled sacs that contain immature eggs). Twenty percent of women with normal menstrual cycles and fertility may have polycystic appearing ovaries. Therefore, additional criteria is needed to make the diagnosis of polycystic ovary syndrome.
 
What causes PCOS? The pathophysiologic defect (molecular cause) in PCOS is unknown. However, since it clusters in families, a genetic cause is likely. Additionally, environmental influences, such as weight, exercise and diet can modulate the severity of the symptoms.
 
How is weight and diet linked to PCOS? What is insulin resistance? Obesity is common in patients who have PCOS. However, weight is not a defining characteristic of PCOS as lean patients also have PCOS. A large percentage, but not all patients, who have PCOS have "insulin resistance". Insulin is a vital hormone that is primarily involved in glucose regulation. In insulin resistance, insulin does not function well and therefore in order to compensate, the body produces excess insulin. The excess insulin can increase the androgen levels that are produced by the ovaries, leading to hyperandrogenism and its associated effects.
 
Obesity independently increases insulin resistance and can exacerbate PCOS. Therefore weight loss (if overweight) and exercise can lower insulin resistance. Additionally, a diet with more complex carbohydrates (whole grains) can help insulin function.
 
Is PCOS associated with any other health effects? Women with PCOS, especially those with insulin resistance, are more likely to develop impaired glucose tolerance and diabetes. This can occur before the age of 40. Later in life, women are also more likely to develop high blood pressure, elevated cholesterol and triglycerides and coronary artery disease
 
Is there a classic appearance to PCOS? Are there tests that can diagnose PCOS? PCOS has a highly varied presentation. On one extreme, is the PCOS patient who is obese, has a few periods a year, and has highly visible and excess facial hair growth. On the other extreme is a lean patient who has no acne or hirsutism and has mild menstrual irregularity.
 
No specific test can definitely diagnose PCOS. The diagnosis is one of exclusion, which means your doctor must consider all of your signs and symptoms and then rule out other possible disorders that can cause a similar presentation. Common medical tests that can help make the diagnosis include a pelvic ultrasound to look at the ovaries, bloodwork to measure the level of androgens, testing of insulin and and glucose levels and checking thyroid function and the hormone prolactin.
 
What is the treatment for PCOS? The treatment varies based on whether or not a woman is trying to achieve a pregnancy. If she is interested in becoming pregnant, the management of PCOS begins with diet and exercise in order to achieve an ideal body weight. Medical treatment is available in order to bypass the defect in ovulation.
 
The initial ovulation induction agent is typically the medication, Clomiphene Citrate. This is an oral medication taken for 5 days each month. This medication supports the normal progression and development of the egg followed by ovulation, the release of the egg. Clomiphene can also help produce and release more than 1 egg and therefore the possibility of a multiple pregnancy does exist. Most patients do not have side effects from this medication. Those who do may experience mild headaches, mood swings, abdominal bloating, visual effects, hot flushes, and symptoms comparable to those felt in the premenstrual period. Clomiphene citrate restores normal ovulation in approximately 80% of patients with PCOS and its use can be combined either with natural timed coitus or with an intrauterine sperm insemination (IUI). Approximately 40% of patients who have PCOS and an ovulatory disturbance, deliver babies with the use of Clomid.
 
Patients who are resistant to Clomiphene (20% of patients) or unsuccessful with Clomid can benefit from the use of gonadotropins (injectable medication, most commonly the hormone follicle stimulating hormone (FSH). This treatment involves taking a daily injection (smaller than a blood draw needle) for approximately 7-10 days with close monitoring through bloodwork and vaginal ultrasounds. The gonadotropins can lead to a higher risk of multiple pregnancy since more eggs are produced. Therefore the monitoring is essential to minimize the risk of a high order multiple pregnancy (triplets or more). Most patients do not have side effects from this medication but those that do may experience mild abdominal bloating, headaches, mood swings and symptoms comparable to those felt in the premenstrual period. Ovulation induction with FSH is often performed in conjunction with an IUI.
 
For patients who are unsuccessful in achieving pregnancy with either method, in-vitro-fertilization (IVF) offers great success. IVF has the advantage of producing multiple eggs and embryos but at the same time minimizing and controlling the risk of a multiple pregnancy since the maximum number of pregnancies is generally related to the number of embryos replaced. In IVF, the medication protocol involves the same gonadotropin injections that are used in the FSH/IUI protocol but at a higher dosage and sometimes for longer duration. The eggs are collected in a procedure in an outpatient procedure called an egg retrieval. The eggs are fertilized in the dish and then transferred back into the uterus. IVF is the procedure of choice, if in addition to PCOS, there is a tubal/ pelvic or male factor involved as a cause of the couple's infertility since it can bypass all of these issues.
 
A commonly used adjunct to the ovulation induction medication used above is the medication, Metformin. Metformin is an oral medication that is used to restore insulin sensitivity. This in turn decreases insulin resistance, decreases insulin levels and decreases androgen levels. This in turn can lead to ovulation alone or promote the effectiveness and response to the ovulation induction regimen. Metformin is also used to treat impaired glucose tolerance and diabetes. Metformin use alone does not increase the risk of a multiple pregnancy. However, Metformin can cause gastrointestinal side effects that may limit its use.
 
Electrolysis, laser treatments, waxing and bleaching may be safely used to remove excess hair in patients who are interested in achieving pregnancy.
 
If a patient has PCOS and is not interested in achieving pregnancy, the use of oral contraceptives can restore normal menstrual cyclicity, prevent the development of endometrial hyperplasia and it can control ovarian androgen production thereby controlling hirsutism and acne. Other medications can also be used to control the hirsutism and acne if a patient is not at risk for getting pregnant (Spironolactone, Vaniqa).
 
The ideal medication protocol is individualized and personalized based on a patient's unique needs. If you are a patient with PCOS, please speak to your doctor to determine which is the best treatment for you.

Copyright 2008 Genetics & IVF Institute