GIVF Fertility eNews
January 2009

GIVF - 25 Years of Excellence

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 18,000 pregnancies.

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

 
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Special GIVF Offerings
First Trimester Screen  
 
 
 Web Videos
 
 
Disclosure in Anonymous Donor Egg IVF
 
Laurence C. Udoff, MD, FACOG
 
Dr. UdoffI am often asked what part of my job I find the most gratifying. Though in general, I consider it a privilege to play a role in the care of all of my patients, working with donor egg IVF patients offers special rewards for both the patient and the caregiver. In most situations, the use of donor egg IVF has the most dramatic impact on a patient's chance for conception. In many cases a patient may be told there is little to no chance for success without donor egg IVF. With donor egg IVF, clinical pregnancy rates per attempt are 60-70%. It is usually the most successful form of treatment we can offer. Though a miracle for many, it is clearly not the right choice for everyone. There are many issues to consider, as obviously the donor egg recipient and "birth mother" is not the "genetic mother." There are also the issues of disclosure with anonymous egg donation. Do you tell friends, family and the child the identity of the "genetic mother?"
 
To address this often difficult question, a review article was recently published that closely examined the issue of disclosure in assisted reproduction involving donor sperm or donor egg IVF. This article summarized recent studies that assessed the impact of disclosure on egg or sperm donors, intended parents and offspring. The following represents excerpts of the study findings related to intended parents and offspring in donor egg IVF cycles. The impact of disclosure on egg and sperm donors has not yet become a major issue in the United States. However, in countries such as the United Kingdom where a donor registry is in place and a voluntary exchange and contact registry is proposed, the number of available donors is declining.
 
Two recent studies have been published examining how donor egg recipients make decisions about disclosure. In the first study, 79 couples undergoing donor egg IVF underwent an in-depth interview regarding how they dealt with disclosure issues. In approximately half of the couples interviewed, there was a difference in opinion regarding whether or not to tell friends, family or the child that the pregnancy was a result of donor egg IVF. Interestingly, by the end of the study, 95% of couples were able to reach a united decision about disclosure. This suggests that it is fairly common for a couple to initially disagree about disclosure in the setting of donor egg IVF. However, using a host of resources including professional counseling, the vast majority of couples reach an agreement. In the second study, in-depth interviews were conducted with women who conceived through the use of donor egg IVF. From these interviews, two main themes were noted. One was described as "engaging in selective disclosure"- patients would decide what information to disclose and to whom. The other theme was described as "responsibility toward the resulting child." For women that disclosed, this meant the right of the child to know. Non-disclosing and undecided women voiced concerns about the negative impact on parental relationships and possible social stigma and did not see a benefit from disclosing to offspring.
 
Regarding what is best for the child conceived through donor egg IVF, very few studies have adequately addressed this issue. Golombok and colleagues evaluated 48 families with a child conceived through donor egg IVF (also included were children born through donor sperm and naturally conceived children for comparison). They noted that 54% of families with children conceived through donor sperm or donor egg IVF intended to disclose, 46% did not plan to disclose or were undecided. No differences in parent-child relationships were noted between those families that did not disclose and those that did. However, study conclusions were limited as the children were only 2 years old. Subsequent reports from this group have evaluated families and their children at age 4-5 and 12 years old. At an approximate age of 4- years old, children conceived through donor egg IVF were not experiencing increased levels of psychological problems. At age 12, a time at which psychological problems might be expected to develop based on the experience of adopted children, donor egg children continued to show no evidence of psychological problems as assessed by direct interview and questionnaires. Interestingly, at the time of the study, only 6 out of the 17 families studied had already told, or planned to tell their child that they were conceived through donor egg. 
 
Though the issue of disclosure can be a difficult one, patients should be comforted in knowing that research to date has not been able to document any adverse affects on the family or the child, regardless of how a patient approaches the issues of disclosure. However, it must be noted that this research is still in the preliminary stages and that hopefully, future studies will provide more definitive data.
 
This article, with a complete list of references, is available on http://www.givf.com/library/
 

GIVF Presents a Donor Egg IVF Seminar 

Saturday, February 7th 

Bethesda Hyatt Hotel
10 am to 12 noon - Seminar
12-2pm- Q & A Session
 
 
 
Laurence Udoff, MD, FACOG will discuss the latest advances using donor egg IVF including success rates and the importance of selecting a fully-screened egg donor.

Harvey Stern, MD, PhD, will discuss details of the donor screening process and why donor egg IVF is an extremely successful way to build your family.

Phyllis Martin, MEd, LPC will discuss the psychological issues unique to donor egg IVF including disclosure.

Call 703-698-7355 to RSVP or visit www.givf.com/register to register online.  Seminar reservations are preferred but not required.  Refreshments and parking validation provided.

In celebration of GIVF's 25th Anniversary, one Donor Egg IVF cycle* will be given away to a seminar participant at the February 7th seminar.  All seminar participants will be offered a 10% discount on the base fee of a Donor Egg IVF cycle. With over 190 donors, GIVF offers the nation's largest selection of fully screened, immediately available egg donors.
 
 
 
 
* Medical eligibility criteria apply.
 
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What's New at GIVF

GIVF Announces New Affordable Options 
 
MULTICYCLE PACKAGES Choose from two great values for IVF treatment offering multiple fresh cycles in discounted packages. For standard IVF treatment GIVF offers special packages of three fresh cycle options: one for patients up to the age of 35 and an alternative package of three fresh cycles for patients between the ages of 36 and 38.  GIVF also offers access to the largest pool of fully-screened and immediately available egg donors in the country through an attractive package that provides two fresh donor egg IVF cycles. For more details about the features of these packages please click here.
 
SHARED INTEREST IVF™ GIVF has made its Pregnancy Guarantee™ refund program even better. The new Pregnancy Guarantee™ allows patients to purchase up to four fresh IVF cycles or four fresh donor egg IVF cycles at a discounted price and receive a refund if the treatment program does not result in a live birth. Patients who prepay for the Pregnancy Guarantee™ treatment receive 5% APR on the amount of any refund. Patients interested in exploring the Pregnancy Guarantee™ program should click here.
 
FREE INTEREST IVF™ For a limited time, GIVF is making interest-free financing available to qualified patients for single cycle and Multicycle options for either standard IVF or donor egg IVF. Interest-free financing will be available for six, twelve or eighteen months. In order to qualify for this special rate, which is being offered to celebrate GIVF's 25th Anniversary, the patient must qualify for financing and must schedule a time for the consultation by February 28, 2009, although the actual physician consultation itself can take place after that date. Interested patients should call (800) 552-4363 or click here to request an appointment.
 
FREE OFFICE CONSULTS In recognition of GIVF's 25th Anniversary, GIVF also is offering free office consultations for either standard IVF or donor egg IVF with a Board-certified Reproductive Endocrinologist.  To qualify, patients must have scheduled a time for the consultation by February 28, 2009, although the actual in-person meeting with the physician can take place after that date. Those interested should call (800) 552-4363 or click here to request an appointment.
 
 

 
PCOS SEMINAR. GIVF is planning a seminar focused on Polycystic Ovary Syndrome and its relationship to infertility. The seminar will take place in March at a date to be announced later. If you would be interested in attending the seminar please visit www.givf.com/register to register for information and announcements about this event.
 
 
 
Ask a Question  
 
I've been hearing a lot about egg freezing and vitrification lately. Would you explain a little bit about that?
 
In the last several years, significant advances have been made in the ability to cryopreserve (freeze) oocytes (eggs). While we have been freezing embryos successfully for more than 20 years, freezing oocytes had proven to be a more difficult technique for embryologists. Over the past several years, however, thanks to the advent of Intracytoplasmic Sperm Injection (ICSI) and some refinements in freezing techniques, we have been able to successfully freeze and thaw oocytes with rates of success that are similar to the success we achieve freezing embryos. These efforts were pioneered in Japan and in some European countries such as Italy, where laws governing the freezing of embryos have become quite restrictive.
 
One of the methods that has been used successfully around the world, including right here at the Genetics & IVF Institute, is vitrification. Vitrification is actually an older method for rapidly freezing cells which has been recently revived to great advantage in the IVF laboratory. Most recent data points to vitrification as the preferred method for freezing both oocytes and blastocyst stage embryos. GIVF now has two ongoing pregnancies from oocyte vitrification and we have adopted vitrification for freezing blastocysts.
 
The question we are often asked is: why freeze oocytes? There are three fundamental reasons: 1) fertility preservation; 2) donor oocyte banking; and 3) certain potential ethical advantages. Fertility preservation may be attempted for one of two reasons, either for a patient with cancer or another disease who wants to preserve oocytes, or in some cases ovarian tissue, prior to receiving treatment, or for younger women who want to freeze and store oocytes for use later in their lives when they are ready to begin their families. Freezing donor oocytes has the potential to make the process of donor egg IVF considerably easier. It will obviate the need to synchronize donor and recipient cycles, and has the potential to make the process much more efficient for everyone involved and for making donor oocyte treatment more available.
 
A few advanced infertility practices such as GIVF are investigating the possibilities for donor egg banking. In the future, we probably will see oocyte banking become a reality, just like sperm banking. A GIVF donor egg bank will be initiated soon. More information about this new and exciting program is available in this edition of eNews and on our website.
 
Freezing oocytes rather than embryos may ease decisionmaking for patients concerned about the disposition of "extra" embryos after IVF cycles. While freezing oocytes is still not an appropriate alternative for most couples, it may become a viable option in the future. Just like embryo freezing, ICSI and countless other new techniques before it, oocyte freezing has a bright future and the potential to revolutionize the practice of IVF.
 
 

Polycystic Ovary Syndrome

Ervin E. Jones, MD, PhD, HCLD, FACOG
 
Dr. JonesPolycystic ovary syndrome is the most common cause of infertility due to disorders of ovulation in reproductive age women. Abnormal menstrual cycle is often the earliest manifestation of ovulatory deficiency in these women. The fertility rate among women with polycystic ovary syndrome is approximately 2.5 fold less than that of normal reproductive age women. Polycystic ovary syndrome is also the most common endocrine disorder of the reproductive age woman and, therefore, carries considerable metabolic risk.
 
A syndrome is a constellation of symptoms and signs indicative of a disorder or disease. Polycystic ovary syndrome, as originally described by Stein and Leventhal in 1935, is a complex disorder of young women consisting of amenorrhea (lack of menstruation), hirsutism (increased hair growth) and obesity. There has been ongoing debate regarding the definition and diagnosis of polycystic ovary syndrome since it was originally described. The most widely used definition is the presence of excessive male hormones and irregular or complete absence of ovulation after exclusion of other known disorders. The Rotterdam consensus conference of 2003 characterized two types that are inclusive of the spectrum of this disorder. Type I polycystic ovary syndrome is described as the presence of excessive male hormones with polycystic ovaries and normal ovulation. Type II polycystic ovary syndrome is described as polycystic ovaries and irregular ovulation without evidence of excessive male hormones. Viewed differently, polycystic ovary syndrome can be defined as two subgroups of women with polycystic ovaries -- those with evidence of excessive male hormones who ovulate and those without evidence of excessive male hormones who do not ovulate. The presence of polycystic ovaries alone does not constitute polycystic ovary syndrome.
 
Polycystic ovary syndrome may also be an early manifestation of excessive insulin secretion that may cause cardiovascular and metabolic complications later in life. Polycystic ovaries can be detected in up to 70.4% of women reporting both abnormal growth of hair and abnormal or a complete lack of menstruation.
 
The diagnosis of polycystic ovary syndrome is primarily achieved through clinical history and physical findings. The principal features are increased hair growth or other biochemical evidence of excess male hormone production, which also includes acne, male pattern baldness and male pattern hair growth. Irregular menstrual bleeding is a key presentation in the infertile women with polycystic ovary syndrome.
 
Associated findings include insulin resistance, increased insulin secretion and obesity. On ultrasound, the ovaries may be enlarged and contain numerous small follicles arranged either in a chain bead pattern just beneath the surface or distributed throughout the substance of the ovary. Some investigators have also described abnormal blood flow to the ovaries in women with polycystic ovarian syndrome. Hormone tests will assist the physician in making the diagnosis. Over secretion of the pituitary hormones LH and FSH, which tell the ovary how to work, is a key finding in some, but not all, patients with polycystic ovary syndrome. Increased production of male hormones produced by the ovary is another cardinal finding in patients with polycystic ovarian syndrome. Measurements of glucose and insulin levels, as well as a lipid profile, are highly recommended in obese individuals.
 
Treatment must, obviously, depend on the desires of the individual patient. Women with polycystic ovary syndrome exhibit exaggerated responses to ovarian stimulation, abnormal egg development, implantation failure, and pregnancy loss. If the patient is concerned about menstrual irregularity and wishes to become pregnant, controlled ovarian stimulation with ovulation inducing drugs including clomiphene citrate, gonadotrophin or a combination of these combined with intrauterine insemination should be first line options for treatment. Clinical strategies that improve pregnancy outcome and minimize pregnancy loss in women with polycystic ovary syndrome must be sought. Correction of follicle growth to improve fertility, optimization of follicular responsiveness to gonadotropin therapy, and enhancement of pregnancy outcome either by controlled ovarian stimulation or in vitro fertilization must be the clinician's first goal.
 
With proper diagnosis and treatment, women with polycystic ovary syndrome may enjoy more regular menstrual cycles, overcome the troubling symptoms of the condition and become pregnant if they wish to have a baby.

Copyright 2009 Genetics & IVF Institute