Saturday, March 23, 2013

BioloSys: Vitamin B12 Follicular Fluid levels are higher in ...

BioloSys: Vitamin B12 Follicular Fluid levels are higher in ...:  The objectives of this study out of  the Department of Obstetrics & Gynecology, University of Saarland, Homburg/Saar, Germany were to i...

BioloSys: A diet rich in monounsaturated fats may increase ...

BioloSys: A diet rich in monounsaturated fats may increase ...: There are various types of dietary fats: Saturated fat.  This is a type of fat that comes mainly from animal sources of food. Saturate...

BioloSys: Dairy products and fertility: does milk help or ha...

BioloSys: Dairy products and fertility: does milk help or ha...: I believe that the verdict is quiet clear that dairy may have negative effects on health. Dairy is full of saturated fat and is linked to h...

BioloSys: What causes Low Sperm Count? The environment is pl...

BioloSys: What causes Low Sperm Count? The environment is pl...: What causes Low Sperm Count? Are average  Sperm count levels for men going down?  Many studies over the years have suggested that  t that ...

Thursday, March 21, 2013

Why is the prevalence of autism increasing? 1 in 54 Boys has Autism Spectrum Disorder

The CDC released a report on the prevalence of autism in the US population and the numbers are scary. According to the CDC

 1 in 88 children (11.3 per 1,000) has been identified with an autism spectrum disorder (ASD).
  • This marks a 23% increase since our last report in 2009. And, a 78% increase since our first report in 2007. Some of the increase is due to the way children are identified, diagnosed and served in their local communities, although exactly how much is due to these factors in unknown.
  • The number of children identified with ASDs varied widely across the 14 ADDM Network sites, from 1 in 47 (21.2 per 1,000) to 1 in 210 (4.8 per 1,000).
  • ASDs are almost 5 times more common among boys (1 in 54) than among girls (1 in 252).
Source : CDC

The CDC rightfully points out that it is possible that " some of this increase is due to greater awareness and better identification". However, this finding explains only part of the increase over time, as more children are being identified in all groups.

We recently discussed on this blog the fact that advanced paternal age could be a major factor. I believe that more research should be focused on this area as well as environmental factors.

Source: CDC

Monday, March 18, 2013

Whaty is the chance of fertility after removal of a fallopian tube for Ectopic pregnancy?

Does treatment for the resolution of ectopic pregnancy (EP) affect subsequent spontaneous fertility ? This is an important question that many patient ask when confronthed with the possibility of losing a fallopian tube because of an extopic pregnancy.

Two different treatments are available in the case of an ectopic : medical  and surgical.
The medical treatment consists in using a drug called Methotrexate. Methotrexate  induces the placental part of the pregnancy to reabsorb. 
Unfortunately Methotrexate does not always work or, in some cases , patients may not be candidates for methotrexate if the pregnancy is too advanced.

In this case surgery is an option > The surgery in some cases may involve removing the tube.

Well, the good news is that this randomized study shows that , regardless of the approach , the chance of success is still very good.

Cumulative fertility curves were not significantly different between medical treatment and conservative surgery. HR was 0.85 (0.59–1.22) P = 0.37. The 2-year rates of IUP were 67% after medical treatment and 71% after conservative surgery. Arm 2 ( More advanced ectopic NDR) : cumulative fertility curves were not significantly different between conservative and radical surgery. HR was 1.06 (0.69–1.63) P = 0.78. The 2-year rates of IUP were 70% after conservative surgery and 64% after radical surgery.

Source : Human Reproduction

You can find the article : here 

Thursday, August 30, 2012

Does moderate alcohol consumption affect fertility?

Multiple studies have been conducted  for both men and women over the years for both men and women.

here is my simple summary.


Drinks Per Week Percentage Reduction in monthly fecundity
women  0-2 probably ok

0-5 gray zone
               5-10 Reduction of 30%

11-15 50 % reduction


0-10 probably ok

10-15 30% reduction

>15 30% or more reduction

does injuring the endometrium ( with D&C or endometrial biopsy) improve ivf rates?

this is a topic that has been hotly debated over the years. The rationale behind performing a biopsy or a quick scraping of the uterus prior to IVF is that the healing that follows the scraping improves the immune profile.
2 aprroaches hve been takent to achieve this : the first is to do an endometrial biopsy on day 21 the cycle preceding the  IVF cycle , the second approach is to do a biopsy  on the day of egg retrieval. A total of 5 well designed studies was analyzed by the physicians from  Cochran database. the Cochrane Database is a non for profit. " Cochrane Reviews are unique because they are both produced by, and are relevant to, everyone interested in the effects of human health care. Based on the best available evidence.........Practitioners can find out if an intervention is effective in a specific clinical context."

The result of the review is that if the "scraping" was performed at time of retrieval , this resulted in decreased pregnancy rates . If the procedure was performed the preceding cycle resulted in  increased pregnancy and increased live birth rates.

Endometrial Injury in the luteal phase of the cycle preceding IVF  seems to improve IVF outcome , this procedure can be offered to increase chances for pregnancy when previous IVF attempts have failed.

You can locate the study here

Wednesday, August 29, 2012

Severe Diet Doesn’t Prolong Life: monkey study

There is a general belief , based on mouse studies , that severe calorie restriction extends survival. This belief was seriously debunked by a study published today in the journal Nature. The researchers in the study followed 121 monkeys , of which 49 are still alive, randomly distributed between two groups : normal and calorie restricted.
The conclusion of the study is that there was no difference in survival between the 2 groups.
you can find the study here. While you read the study I'm ordering Mcdonalds.

Monday, August 27, 2012

Thin endometrial lining: how thin is too thin?

The lining  thickness is probably one of the most important parameters that predict the success of an IVF cycle

The uterine lining is the part of the uterus that sheds every months with  every menstrual cycle. It is the area where the embryo implants.
    There is some debate about "how thin is too thin", as well as to "how thick is too thick". In general, 8-13 mm is good, less than 6 is potentially a problem, and greater than 15 or so might possibly reduce chances for successful pregnancy.
    Additional factors can affect the lining , such as polyps, fibroids or adhesions.

    cd4/cd8 ratio and miscarriage , abortion

     It is difficult to make a general statement without looking at the subgroups. But  one study suggests that an increased ration ( cd4 increased and cd8 decreased) may be indicative of an increased risk of miscarriage.

    "A significantly higher CD4/CD8 ratio was found in the postabortion group in relation to the control group (1.65 vs. 1.24) (P = .01). Women with pregnancy complications in their next pregnancy had a lower absolute value for total lymphocytes (P = .02), T lymphocytes (P = .04), absolute CD8 lymphocytes (P = .01) and percentage of CD8 lymphocytes (P = .02) and a higher percentage of CD4 lymphocytes (P = .03) and higher CD4/CD8 ratio (P = .02) than women who had not experienced any pregnancy complications."
    Women with previous spontaneous abortions have a tendency to have an immunologic profile expected in a rejection phenomenon with an increased cd4/cd8 profile.

    find reference here

    Sunday, August 26, 2012

    Is progesterone elevation on the day of human chorionic gonadotrophin administration associated with the probability of pregnancy in in vitro fertilization?

    This  is an important question. IVF cycles are  monitored with serial measurements of estrogen ,  LH ,and Progesterone. At times , towards the last day of stimulation  we observe a slight rise of progesterone. some have questioned whether this progesterone level increase ( slight increase  not majour ovulation increases of 2 or 3) reduces the chance of pregnancy.

    The short answer to this question is "the best available evidence does not support an association between progesterone elevation on the day of hCG administration and the probability of clinical pregnancy in women undergoing ovarian stimulation with GnRH analogues and gonadotrophins for IVF".

    This is based on a large meta analysis that you can find here

    Friday, August 24, 2012

    Slow Embryonic Heatbeat / fetal heart rate/ fetal heart beat in early pregnancy: what is a normal heartbeat rate?

     One of the most difficult moments for a patient who has suffered for either infertility or miscarriages is to find out ,  at the first pregnancy ultrasound ,that something is not entirely normal.

    An example of this is  when on , one of the early ultrasounds,  the heart beat of the embryo ( baby) is observed as being too slow.

    Fetal heart rate  ( or embryonic heart rate) in the first trimester depends on the gestational week. It increases since 6 to 9 weeks and decreases after 10 weeks. The highest values of fetal heart rate  are observed between 9 and 10 weeks of gestation. The risk of early pregnancy loss increases significantly in case of detecting slow FHR.

    but what is a normal value for embryonic heart rate / fetal heart rate?

    In one study  At 6 weeks, mean embryonic heart rate was 116 +/- 21 beats per minute , then slowly increased, reaching mean 172 +/- 9 beats per minute  at 10 weeks. At 11 weeks the mean fetal heart rate  achieved the level of 165 +/- 7 beats per minute.

    Embryonic heart rates below 90 beats per minute at 6 to 8 weeks of gestation have been shown to be associated with a high likelihood of subsequent first trimester demise.

    what the actual risk of  risk of pregnancy  loss or miscarriage  was quantified in one study as:  first trimester survival rate was 61.6% for slow early heart rates ( less than  100 beats per minute  at  6.2 weeks or less ,  less than120 beats per minute at 6.3 to 7.0 weeks), lower than the survival rate  with normal heart rates.

    In another study the rates of first-trimester demise were 60.6% for pregnancies with slow heart rates at 6.0-7.0 weeks), 17.4% for those with borderline heart rates , and 9.1% for those with normal heart rates.

    As mentioned above  boundary between slow and normal heart rates has not been established, however, and different studies have yelded different numbers. But these studies  suggest that lower limit of normal is 100 beats per minute up to 6.2 weeks' gestation and 120 bpm at 6.3-7.0 weeks.

    Wednesday, August 22, 2012

    Father's age discovered to be linked to Autism : article

    The prevalence of autism diagnosis has been climbing steadily since the 70's. Part of this rise in diagnosis has been atributed to more sensitive testing and increased awareness about the condition. This explains about half of the increase.

    Over the years many theories have been proposed, but not proven,  for such increased including environmental toxicants and iatrogenic (such as vaccines).

    A recent article published in Nature brings forward one of the most solid theories  for a possible  cause of autism : increased paternal age.

    This study, carried out in Iceland by a croup of geneticists provides some of the first solid scientific evidence for a true increase in  autism.
    When comparing the average paternal age in the study group in Iceland  the researchers observed that the average age of fatherhood rose from 28 to 33 between 1980 and 2011.

    Similarly  children born in 2011 will harbour 70 new mutations, compared with 60 for a children  born in 1980.
    The majority such mutations are harmless, but the researchers in Iceland identified some that  are linked to conditions such as autism.

    The real issue now is that since it is likely that  autism is multifunctional a prenatal test is very far away in the future,and may not be definitive ( it may only suggest increased risk).

    So what is an older perspective father to do? Difficult question. This article in the New York Times tries to give some answers.

    You can find the original Nature article here

    Wednesday, June 20, 2012

    Lesley Brown, mother of first IVF baby, Louise Brown dies.

    She was 64 year old. I guess we  could say this sad moment marks the change of an era.
    32 years ago   scientists held their breath as they waited for news of the world's first test tube baby. When Louise Brown was born - so was IVF treatment. The doctor who gave us Louise Brown recalled looking at her in the Petri dish, and said, she was beautiful then and she’s beautiful now.”

    Today, more than three million babies have been born around the world thanks to the technology which was pioneered in Britain.and Louise Brown has a baby of her own.

    If you have an interest in the  history of the science of IVF i strongly recommend you watch the NPR documentary about another  famous IVF story : the story of  Doris Del-Zio , who could have  been the first woman in the world to conceive a baby through in vitro fertilization or IVF.

    But things went differently.......... after the embryos were created ,  the  chairman of the Department of  OB/GYN at Columbia, Raymond Vande Wiele, went into the embryology lab at night and destroyed the embryos because he was afraid of the possible repercussions . This would have been the first IVF baby ever!


    Wednesday, June 13, 2012

    Low Sperm Count? No significant association was found with smoking and alcohol consumption, the use of recreational drugs, a high BMI or having a history of mumps or fever: study.

    The study, which is published in the journal Human Reproduction, compared 900 men with low sperm counts to 1,300 with high sperm counts. Turns out, use of drugs, tobacco, and alcohol had little effect when comparing the populations, nor did being overweight.
    The only thing that made a big difference was how snug pants and underwear were.

    The study did not take into account the factors that , i believe , are the most important for male fertility: environmental exposure to toxicant chemical agents such as pesticides.

    abstract below

    Modifiable and non-modifiable risk factors for poor semen quality: a case-referent study

    1. Participating Centres of Chaps-uk
    + Author Affiliations
    1. 1Centre for Occupational and Environmental Health, School of Community-Based Medicine, Faculty of Medical and Human Sciences, University of Manchester, Manchester M13 9PL, UK
    2. 2Health Methodology Research Group, University of Manchester, Manchester, UK
    3. 3Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, Sheffield, UK
    4. 4Division of Occupational Medicine, University of Alberta, Alberta, Canada
    1. *Correspondence address. Tel: +44-161-275-5232; Fax: +44-161-275-5595; E-mail:
    • Received January 6, 2012.
    • Revision received March 23, 2012.
    • Accepted April 26, 2012.


    STUDY QUESTION Are common lifestyle factors associated with low-motile sperm concentration (MSC)?
    SUMMARY ANSWER Common lifestyle choices make little contribution to the risk of low MSC.
    WHAT IS KNOWN AND WHAT THIS PAPER ADDS Reviews of male subfertility often highlight how aspects of men's adult lifestyle can significantly increase their risk of subfertility but the strength of supporting evidence is weak. In this study, although low MSC was associated with a history of testicular surgery, being in manual work, not wearing loose underwear and black ethnicity, no relation was found to consumption of alcohol, use of tobacco or recreational drugs or high body mass index (BMI). These results suggest that delaying assisted conception to make changes to lifestyle is unlikely to enhance conception.
    DESIGN Unmatched case-referent study with 780 cases and 1469 referents. Cases had a low-MSC relative to the time since last ejaculation (<12 × 106 for 3 days of abstinence). Exposures included self-reported exposures to alcohol, tobacco, recreational drugs as well as occupational and other factors.
    PARTICIPANTS AND SETTING Eligible men, aged 18 or above, were part of a couple who had been attempting conception without success following at least 12 months of unprotected intercourse and also had no knowledge of any semen analysis. They were recruited from 14 fertility clinics across the UK during a 37-month period from 1 January 1999.
    MAIN RESULTS AND THE ROLE OF CHANCE Risk factors for low MSC, after adjustment for centre and confounding factors, included a history of testicular surgery [odds ratio = 2.39, 95% confidence interval (CI): 1.75, 3.28], being in manual work [odds ratio (OR) = 1.28, 95% CI: 1.07, 1.53] or not working (OR = 1.78, 95% CI: 1.22, 2.59) and having black ethnicity (OR = 1.99, 95% CI: 1.10, 3.63). Conversely, men who wore boxer shorts (OR = 0.76, 95% CI: 0.64, 0.92) or who had a previous conception (OR = 0.71, 95% CI: 0.60, 0.85) were less likely to be a case. No significant association was found with smoking and alcohol consumption, the use of recreational drugs, a high BMI or having a history of mumps or fever.
    BIAS, CONFOUNDING AND OTHER REASONS FOR CAUTION Data were collected blind to outcome, and exposure information should not have been subject to reporting bias. Among men attending the various clinics less than half met the study eligibility criteria and among those who did, two out of five were not recruited. It is not known whether any of those who refused to take part did so because they had a lifestyle they did not want subjected to investigation. Although the power of the study was sufficient to draw conclusions about common lifestyle choices, it cannot comment on exposures that are perhaps rare and poorly reported: the finding that use of street drugs was unrelated to low MSC cannot be assumed to apply to all such drugs and all patterns of use. The case definition did not consider sperm morphology or sperm DNA integrity.
    GENERALIZABILITY TO OTHER POPULATIONS All participating clinics saw patients at no cost (under the UK National Health Service) and the study population may differ from those in countries without such provision. Even within the UK, low-income couples may choose not to undertake any investigation believing that they would subsequently be unable to afford treatment.
    STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the UK Health and Safety Executive, the UK Department of Environment, Transport and the Regions, the UK Department of Health (grant code DoH 1216760) and the European Chemical Industry Council (grant code EMSG19). No competing interests declared. 

    Tuesday, May 15, 2012

    risks of sperm donation : nyt article

    Very interesting article today on the NYT.  It's a case of birth of a child affected with cystic fibrosis from sperm donation.  It appears that the sperm sample was 20 years old and was not appropriately tested.

    As usual the NYT article is very sensationalistic. I consider this failure of appropriately testing the sperm donor unforgivable but  it is important to note that the article does not clarify if the case was due to an error in the lab that tested the blood : in this case this would have nothing to do with sperm donation but with quality control at the genetic lab . 
    The article fails to point out one very important fact: the incidence of cystic fibrosis in the United States is 1 in 3600.  It is estimated that about 60,000 babies are born from sperm donation in the United States every year. This is the first case that we hear of in many years (although there may be a handful of others).  Nevertheless it is very likely that the risk of acquiring a genetic disorder from a sperm donor is hundreds of times less than in the “wild”. Unfortunately it is not zero.  

    As i went through the comments to the nyt article i happened to read this  from an egg donor:
     I read this article with personal interest because I was an egg donor. I did it about 20 years ago in graduate school. I did it for the money. I felt good about it because I believe I helped women to have children and also experience pregnancy and childbirth. I believe I helped women/couples who truly wanted to take on the responsibility of parenthood.

    I was tested thoroughly based on what was available at the time. I didn't lie about my diverse, mutt-like pan-European background for fear of being rejected. I didn't lie about the few hereditary things I knew about. I admitted having had my teeth and nose straightened. I was actually thrilled to learn that, so far as testing could tell, I was not a carrier of any known hereditary disorders.

    Within five years of my donation, I had my own children. They are healthy and thriving. Are they perfect? Nope. While I am glad to be anonymous and I don't in any way consider myself a parent to any genetic offspring from my donation, I would willingly acknowledge the connection to provide a genetic blue print or to support any kind of serious health concern that might arise in a person conceived by my donation (just not the crooked teeth or nose).

    Should the sperm banks and fertility clinics keep records and be held accountable for their work? Absolutely. Can we expect perfection? Nope. Babies are still miracles and we must love them as they are.

    I think these words summarize very well my experience with oocyte donors. 

    Reproductive Technologies (ivf , icsi ) and the Risk of Birth Defects

    A large Australian study has reviewed the birth outcomes  in babies conceived with assisted reproductive technologies.
    Contrary to the sensationalistic article in the New York Times   the study found no increase in risk for conventional IVF.  Some increased risk was associated with ICSI but the risk was not present when frozen embryos generated with ICSI were used .This finding does not make much sense to me  suggesting that the final conclusion may be confounded by outside factors.

    The main take home fact is that simply having suffered from infertility will increase a couple's risk for birth defects regardless of the treatment and this may be true even for children conceived later without the help of assisted reproduction.

    See abstract of the article below:


    Reproductive Technologies and the Risk of Birth Defects

    Michael J. Davies, M.P.H., Ph.D., Vivienne M. Moore, M.P.H., Ph.D., Kristyn J. Willson, B.Sc., Phillipa Van Essen, M.P.H., Kevin Priest, B.Sc., Heather Scott, B.Mgmt., Eric A. Haan, M.B., B.S., and Annabelle Chan, M.B., B.S, D.P.H.
    N Engl J Med 2012; 366:1803-1813May 10, 2012


    The extent to which birth defects after infertility treatment may be explained by underlying parental factors is uncertain.


    We linked a census of treatment with assisted reproductive technology in South Australia to a registry of births and terminations with a gestation period of at least 20 weeks or a birth weight of at least 400 g and registries of birth defects (including cerebral palsy and terminations for defects at any gestational period). We compared risks of birth defects (diagnosed before a child's fifth birthday) among pregnancies in women who received treatment with assisted reproductive technology, spontaneous pregnancies (i.e., without assisted conception) in women who had a previous birth with assisted conception, pregnancies in women with a record of infertility but no treatment with assisted reproductive technology, and pregnancies in women with no record of infertility.


    Of the 308,974 births, 6163 resulted from assisted conception. The unadjusted odds ratio for any birth defect in pregnancies involving assisted conception (513 defects, 8.3%) as compared with pregnancies not involving assisted conception (17,546 defects, 5.8%) was 1.47 (95% confidence interval [CI], 1.33 to 1.62); the multivariate-adjusted odds ratio was 1.28 (95% CI, 1.16 to 1.41). The corresponding odds ratios with in vitro fertilization (IVF) (165 birth defects, 7.2%) were 1.26 (95% CI, 1.07 to 1.48) and 1.07 (95% CI, 0.90 to 1.26), and the odds ratios with intracytoplasmic sperm injection (ICSI) (139 defects, 9.9%) were 1.77 (95% CI, 1.47 to 2.12) and 1.57 (95% CI, 1.30 to 1.90). A history of infertility, either with or without assisted conception, was also significantly associated with birth defects.


    The increased risk of birth defects associated with IVF was no longer significant after adjustment for parental factors. The risk of birth defects associated with ICSI remained increased after multivariate adjustment, although the possibility of residual confounding cannot be excluded. (Funded by the National Health and Medical Research Council and the Australian Research Council.)

    Monday, January 09, 2012

    Prognosis following in vitro fertilization-embryo transfer (IVF-ET) in patients with elevated day 2 or 3 serum follicle stimulating hormone (FSH) is better in younger vs older patients: Article

    Here is a summary of a paper by Check et. al. puvblished in Clin Exp Obstet Gynecol 2002; 29:42-4.
    Please note that the article is old (2000) and therefore pregnancy rates are expected to be higher in 2012. Overall the result is meaningful though. also note that the pregnancy rates in the study are per transfer and therefore do not include cancelled transfers. Also live birth  rates are expected to be lower.

    IVF success/transfer
    FSH <12
    FSH >12
    Age  <38
    Age >38

    Thursday, December 29, 2011

    Ivf Prognosis based on FSH and AMH levels

    IVF Prognosis
    FSH normal
    FSH abnormal (high)
    AMH normal
    AMH abnormal (low)
    Very Reduced

    This table summarizes oocyte production based on (day 3) FSH and AMH (Anti Mullerian Hormone ) values. It appears , based on the study (referenced below) that AMH is the better predictor.  Please note that this table is relevant up to the age of 42yo. After 42 the disparity between FSH and AMH does not seem to matter and patients with "good" FSH levels do better , regardless of AMH values.

    Gleicher N, Weghofer A, Barad DH. Discordances between follicle stimulating
    hormone (FSH) and anti-Müllerian hormone (AMH) in female infertility. Reprod Biol
    Endocrinol. 2010 Jun 17;8:64. PubMed PMID: 20565808; PubMed Central PMCID:

    Wednesday, June 22, 2011

    What is the best protocol for poor responders in IVF? Long protocol, estrogen priming , microdose lupron , short protocol with antagonist, low dose , mini ivf  or clomid  plus gonadotropins?

    The answer is none of the above , or more appropriately ,  any of the above! I have attended a myriad or conferences , conventions and debates on this topic and the conclusion has always been the same!

    Often patients come to see me and tell me that they  have read online that a certain protocol is much better . this statement is unsubstantiated by facts.  In fact when one looks at the actual studies the evidence is that these are allover the place , which basically means that there is no better protocol.

    Many of these protocols  end up being associated with certain centers. Typical example is the estrogen priming protocol frequently used at Cornell. Many patients read about it and ask for the protocol and I have nothing against trying something different.

    Ultimately my perspective is that if all protocols are pretty much equivalent , the  reasonable way to go is minimal stimulation. Mostly for 2 reasons : less hormones in your body and less money out of your pocket to buy crazy expensive drugs like Gonal F , Follistim  , Bravelle or Menopure.

    Link to a great  scientific article about this topic here (it's a pdf file)


    Wednesday, May 04, 2011

    What is a "good" FSH level? Age Specific FSH levels

    Serum follicle stimulating hormone (FSH) level is  measured on day three ( or 2 or 4) of the menstrual cycle. (First day of period flow is counted as day one. Spotting is not considered start of period.) If a lower value occurs from later testing, the highest value is considered the most predictive. FSH assays can differ somewhat so reference ranges as to what is normal, premenopausal or menopausal should be based on ranges provided by the laboratory doing the testing. Estradiol (E2) should also be measured as women who ovulate early may have elevated E2 levels above 80 pg/mL (due to early follicle recruitment, possibly due to a low serum inhibin B level) which will mask an elevated FSH level and give a false negative result.

    High FSH strongly predicts poor IVF response in older women, less so in younger women. One study showed an elevated basal day-three FSH is correlated with diminished ovarian reserve in women aged over 35 years and is associated with poor pregnancy rates after treatment of ovulation induction(6% versus 42%).

    This study by Gleicher et al assessed what normal values for FSH should be according to age. As you can see below the normal values are way below what  we normally tell patients: less than 9  mIU/ml .

    Since normal b-FSH levels rise with female age, these levels should represent a more accurate represent- tation of ovarian function than currently used universal cut-off levels for all ages. Women who exceed their age-specific cut off levels, should be suspected of demon- strating PREMATURE OVARIAN AGING and should, therefore, immediately, be directed towards further diagnostic evaluation.


    < 33 Years              33-37 Years                   38-40 Years           ≥ 41 Years
    < 7.0 mIU/ml        < 7.9 mIU/ml                 < 8.4 mIU/ml      < 8.5 mIU/ml

    abstract below  (source fertility and sterility)
    We evaluated a study group of 434 consecutive patients under age 41 years with baseline (b-) FSH levels of <12 mIU/ml (considered to represent “normal” ovarian function), who underwent ovarian stimulation for IVF with an ovarian stimulation protocol consisting of long GnRH-agonist or antagonist suppression and modal gonadotropin stimulation of 300IU of FSH/HMG per day. We assessed IVF cycle outcomes, including oocyte yields, based on age-specific b-FSH levels, defined as levels ≤ the 95% confidence interval of the mean (95% C.I.) for each age group. In the literature production of fewer than 5 oocytes in response to ovulation induction is considered to be evidence of ovarian resistance. We consider women under the age of 41 who produce fewer than 5 oocytes to have POA. Women with b-FSH levels above the 95% CI for their respective age groups were considered to be at increased risk of premature ovarian aging (POA). A logistic regression model for the presence of fewer than 5 oocytes at retrieval was performed using SPSS for Windows15.0. Continuous variables are presented as mean ±1 SE.

    Lower IVF Pregnancy Rates Widely Reported in Patients of African Origin May Be Consequence of Genetic Predisposition towards Autoimmunity

     It has long been known that ivf success rates differ amongst different races/ethnic groups. This new study suggests that predisposition to autoimmune disease may be the cause for these differences.

    Despite general improvement in outcomes of fertility treatments, disparities between races/ethnicities have actually increased. Prevalence of infertility also differs in that African women experience infertility more frequently than Caucasians and Asians. Causes for these differences have remained largely unknown.
    This new study, just published in the prestigious medical journal PLoS One (, was conducted by the Center for Human Reproduction (CHR) in New York, NY, and involved 339 Caucasian, Asian and African women. As previously widely reported in the medical literature, African patients demonstrated significantly lower IVF pregnancy rates, compared to Asian and Caucasian patients, even after controlling for age and BMI. African patients also demonstrated the highest rates of the recently described FMR1 (fragile X mental retardation) gene sub-genotype het-norm/low, which the same group of researchers previously reported to be statistically highly associated with autoimmunity. Asian women, with lowest prevalence of het-norm/low experienced the highest pregnancy rates after IVF.


    Saturday, April 30, 2011

    Myth: You Cannot Pursue Treatment and Consider Yourself a Believer/Religious

    Interesting article on  here are few highlights:

     his myth plays out in two ways. One is that accepting help or treatment somehow implies a lack of faith in God. As if infertility is a sign from God that you are not worthy of carrying a pregnancy or becoming a parent, and therefore, finding and accepting help is wrong.

    The other way this myth plays out is that fertility treatments are religiously unacceptable, specifically IVF. Some religious groups believe that conception should never occur outside of the body, or they fear that embryos will be destroyed or indefinitely frozen.
    This is especially a problem for fertility challenged Catholics, and for Christians who oppose intentional destruction or freezing of embryos.


    No one really knows what God thinks, and bad things happen to good people for reasons we do not understand. No one can say whether what happens is "meant to be" or not.
    Accepting fertility treatment is no different than accepting help for any other medical problem. If you would accept herbs, drugs, or medical treatment for your non-fertility problems, there's no logical reason to turn it away for infertility. Remember that Rachel of the Bible took a fertility herb of her time.
    There are options for fertility treatment that may help avoid whatever religious or ethical problems you have. Remember that 85 to 90% of infertile couples can be treated with drugs, surgery, or other low tech treatments, and IVF may not even be necessary.

    Link here

    Wednesday, April 27, 2011

    Recent Pregnancy Rates at our center.

    As many people ask I am reporting the recent pregnancy outcomes at AFS. Please remember that the rates reported here represent ongoing pregnancy rates . Delivery rates are, of course, not yet available , and will, as always, be reported to and through the national CDC and SART databases. Clinical pregnancy rates are reported with reference point embryo transfer (pregnancy rate/embryo transfer) and not cycle start, meaning that only patients who reach embryo transfer are counted.

    Please note delivery rates can be anticipated to be  lower than ongoing pregnancy rates, since additional pregnancy losses can be expected. 
    It's important to note that  our approach to fertilty is to do less before more and that the majority of our patient conceive without undergoing IVF.  Only the patient that fail all other treatments undergo IVF.  This approach selects the most difficult cases.
    Contrary to what most centers do , we do not  any type of patient selection. Patients with very abnormal FSH levels who have been rejected by other centers have been able to cycle with us. This approach means that in the end our overall pregnancy rates in the past have  been  lower than in centers who practice patient selection. I have never cared about this as i always prefer to do the right thing  for the patient rather  than withdrawing treatment  for my self interest . nevertheless i am proud of these results that will be updated fequently