GIVF Fertility eNews
 March 2010

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What is Personal Egg BankingTM?

 Elective Egg Freezing
Laurence C. Udoff, MD, FACOG
Frequently I discuss with patients the concept of age related decreased ovarian reserve and its negative impact on the chances of conception. Most of the time, the patient will have the same response: "I wish I had tried to conceive when I was younger." This usually leads to a realization that there were good reasons to defer trying to conceive until now. I have observed that many patients with age related infertility feel very frustrated that they did not fully understand the impact of age on conception.
Over the last several years, egg freezing (elective oocyte cryopreservation) has been touted as the solution to this dilemma. A patient could simply have her eggs retrieved and frozen when she is younger. She could then have more freedom over her reproductive choices and pursue a career or other life goals, knowing that her "fertile" eggs are waiting for her when she is ready.
Until recently, my standard reply regarding egg freezing was that it was an experimental procedure with limited success in only a few select programs around the world. Obstacles to success with egg freezing included problems with ice crystal formation that led to intracellular damage and poor egg survival rates upon thawing. However, the use of techniques such as vitrification have led to a dramatic improvement in post-vitrification oocyte survival, fertilization rates, and pregnancy rates. Most importantly, these successes are being reported by many different centers worldwide. The reproducibility of current techniques from center to center is a tremendous break through and heralds the advancement of egg freezing from a status of highly experimental to an emerging technology.
There have been approximately 1,000 births reported worldwide from egg freezing.  Based on those reports, combined with our own successes, GIVF is pleased to offer this option to younger women.  Personal Egg Banking from GIVF is a means of improving their chances of conception if they plan to delay childbearing. The experience so far with frozen eggs would predict that a patient in her 40s would significantly improve her chances of a successful pregnancy if she were able to use eggs that were frozen at a younger age (e.g. 30s).
A major part of offering Personal Egg Banking to women who plan to delay conception is appropriate counseling. Key points to appreciate include:
1) Egg freezing requires ovarian stimulation and egg retrieval. Current protocols require the freezing of multiple mature eggs to have a realistic chance of conception. In a natural menstrual cycle, only one egg is matured each month. Therefore, patients undergoing elective oocyte cryopreservation are given medications to mature multiple eggs in a single cycle (same treatment protocols as infertile IVF patients). To appropriately time the egg retrieval, frequent office visits are required for blood tests and transvaginal ultrasound to monitor the development of the eggs. The eggs are retrieved by placing a needle through the back of the vagina into the ovary. This is an outpatient procedure performed in the office under anesthesia.
2) Freezing eggs is not a guarantee of future pregnancy. Since egg freezing is an emerging technology, it is difficult to accurately assess the chance for pregnancy and delivery. Based on published data, largely from donor egg cycles, it is estimated that a single egg that is warmed from the vitrification method has a 4% chance of resulting in a live birth.  These rates may be lower in women over the age of 32 since fertility is known to decline with advancing age and age is not the only determinant of egg quality. More recent reports and our own current experience suggest live birth rates will improve as techniques and protocols are refined, but are expected to remain low due to the inherent limited potential of a single egg producing a successful birth.  
3) Not every woman is a good candidate for egg freezing. Women who already have significantly decreased ovarian reserve (poor egg quality) may not benefit from egg freezing. At GIVF, we are not recommending egg freezing for patients over 40 years old, or if ovarian reserve testing is significantly abnormal. Additionally, young women (under age 30) need to carefully consider whether freezing eggs will be of later benefit to them. These women are more likely to conceive without assistance because they have many more years to conceive naturally.
A significant percentage of infertility is simply due to the modern trend of women choosing to delay childbearing.  Elective oocyte cryopreservation, or Personal Egg Banking, represents a significant advancement over current options for women who plan to delay conception. As with all assisted reproductive techniques (e.g IVF, ICSI), further study and experience will clarify the risks and benefits of egg freezing. At GIVF, we are excited to offer this option and welcome the opportunity to discuss the hopes, promises, and realities of elective oocyte cryopreservation.
If you would like to learn more about Personal Egg Banking at GIVF, please don't hesitate to schedule a consultation or request more information or click to call.

What's New at GIVF


For a limited time only, GIVF is offering a Single IVF Cycle Pregnancy Guarantee.  Get pregnant and take home your baby or receive a full refund.

Why wait?  We're so confident we'll help you get pregnant and take home your baby, we're guaranteeing your success or a 100% refundLearn More.

*Medical eligibility criteria apply, must be 36 or younger when treatment begins.  Refund applies to the base fee only.  Offer ends May 31, 2010. 
Attend a free IVF patient seminar from 10 am until noon on Saturday, April 10, 2010 at the Hilton McLean at Tysons Corner. A  single IVF cycle will be given away free at the seminar.
All attendees will receive a 15% discount off the base fee for a single cycle, multicycle, or Pregnancy Guarantee™ IVF cycle contract signed after April 10, 2010. Medical eligibility criteria apply. One discount is available per couple or individual. To register and learn more, click here.
GIVF now offers on-site consultations with a board certified urologist who specializes in male infertility. Call (703) 698-7355 or click to schedule an appointment.
"Fan" us on Facebook and keep up with the latest news!
Congratulations to GIVF Drs. Lincoln, Kulshrestha, Udoff, and Jones for making Northern Virginia magazine's 2010 Top-Rated Doctors list! 
Your Questions Answered
What is Turner Syndrome? 

Sunita Kulshrestha, MD, FACOG
Turner syndrome is a genetic condition that affects females. Rather than having inherited two normal X chromosomes, one copy of the X chromosome is missing or significantly altered.  Turner syndrome is one of the most common chromosomal abnormalities in pregnancies but the majority of conceptions end in a miscarriage.  The incidence of Turner syndrome in live births is 1 in 2,000-5,000.  
Signs and symptoms of Turner syndrome may vary significantly.  In some young girls, a number of physical features and poor growth are apparent early in life. For others, the presence of Turner syndrome may not become apparent until the onset of puberty with abnormal pubertal or sexual development.  The majority of women with Turner syndrome have ovarian failure and thus infertility or premature menopause.  In addition to these abnormalities, patients with Turner syndrome can also have hearing loss and abnormalities involving the heart, kidney, endocrine system, gastrointestinal system, and skeletal system.
Occasionally, patients with Turner syndrome achieve pregnancy spontaneously or with assistance, but these pregnancies are high risk pregnancies for the mother and need to be followed closely.  

Advances in Male Fertility
Ash Kshirsagar, MD

Infertility is a challenge that burdens roughly 1 in 5 couples.  It can be a very sensitive and emotionally frustrating issue causing stress in an otherwise healthy relationship.  Guilt, resentment, and inadequacy can surface impairing the intimacy between a couple and hinder the support a couple needs from one another in facing such an issue.  Historically, the focus and burden of infertility treatments has focused on the female partner. 
Of all infertile couples, the reason for the infertility will lie within the male in about 10-15% of the cases.  Because of this, a new field of medicine has emerged that is known as Male Infertility.  A male infertility specialist is a urologist who has received additional formal training (a fellowship) to learn how to treat men with fertility problems.  Fortunately, recent advances in this field can offer men hope of fathering their own biological children.
The major advances in the field focus on accurate diagnosis and use of the newest technology to improve success of finding sperm.  The accurate assessment of men with infertility problems includes ensuring the male doesn't have a hormone imbalance or underlying medical condition impairing sperm production. Additionally, a detailed review of prescription medications must be done to check for unwanted interaction with medications and sperm production.

Using the latest genetic testing, one can predict which men are candidates for surgical sperm retrieval and which men are not.  In the assessment of the male, we can also determine with greater than 90% accuracy which men have a blockage in their tubes.
The main advantage that a male fertility specialist can offer is using the most cutting-edge technology: this resides in using a true operating microscope to improve outcomes for patients while decreasing complications.  An operating microscope is a free standing real microscope that is used during surgery to treat conditions such as a varicocele (the most common cause of infertility in men) or to find sperm in men who were otherwise thought to have none.  The operating microscope provides 15 times the magnification compared to that of the human eye.  Studies have shown that when an operating microscope is used, complications such as bleeding decrease and success rates in finding sperm increase substantially.  This translates to finding sperm in men who were otherwise resigned to the thought they would never have their own biological children.
Using the operating microscope, the male infertility specialist can also improve the success rates of vasectomy reversal surgeries to over 90%.  The vasectomy reversal is one of the most technically challenging surgeries a urologist performs.  A male fertility specialist has received dedicated formal training in microscopic surgery for this specific surgery.  During the surgery, the two ends of the vas are sewn back to each other using sutures finer than a human hair.  Given the delicate nature of the surgery, studies have shown that a surgeon who implements the latest technology of the operating microscope can provide the best success rates for patients.

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