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Pacific Fertility Center

55 Francisco Street,
Suite 500
San Francisco,
CA 94133
TEL: 888-834-3095
FAX: 415-834-3080
www.InfertilityDoctor.com
Info@PacificFertility.com



Our Promise

As a unified team, guided by the highest ethical standards, we provide our patients with the best quality, individualized, compassionate fertility care.
Science Pulse    ASRM 2004 Conference: Key Findings


Each year physicians and staff of Pacific Fertility Center attend the annual conference of the American Society for Reproductive Medicine (ASRM), a non-profit member-based organization established for the advancement of reproductive medicine. This gathering draws thousands of professionals from around the world to share advances in the field. Over 1600 abstracts were submitted for inclusion in the 2004 program. Our physicians Drs. Schriock and Chenette, and Lab Director Joe Conaghan have summarized a few topics here, based on the research's relevance to clinical practice.

Same Success for Single Embryo Transfer
Some countries have mandated single embryo transfers (SET) in order to reduce the high rate of multiple-births from IVF treatment. Sweden's rule was set into place January 1, 2003. A retrospective study has examined 1664 fresh IVF/ICSI/ET cycles before, during and after the transition to the new policy. Patients were of similar maternal age (mean 33.3-33.4), similar demographic characteristics and embryo quality scores.

The study revealed no difference in overall clinical pregnancy rate (33.3%, 32.8%, 33.8%) among those women studied. (Note that their mean age is less than the average age of PFC's patients. Age is a key factor in the success or failure of IVF.) But the rate of twinning drastically reduced as a result of the new law prohibiting more than one embryo transfer (8.8% vs. 22.6% prior, and 16.3% during transition to the new policy). Sweden's new policy appears to be resulting in a significant reduction of multiple births in young patients, while not impacting the overall clinical pregnancy rate.

Obesity Reduces Pregnancy Outcome
An extensive study has revealed that patients with a high body mass index (BMI), the method of measuring normal weight range, face a significant obstacle to getting pregnant. Specifically, researchers at the Beth Israel Deaconess Medical Center in Boston identified a 60% reduction in pregnancy rates in those with high BMI, or very obese, compared to those with a moderate to low BMI.

Researchers analyzed the records of 6,827 fresh non-donor cycles in which patients' BMI had been recorded. The group was divided into five different weight categories, the maximum being a BMI 35 -39 kg/m2- considered obese. Researchers found no significant difference among participants with respect to the number of mature follicles observed, oocytes retrieved, mature oocytes produced, cycle number per patient and number of embryos transferred. However, they noticed significantly lower implantation rates and clinical pregnancy rates in those with a BMI >35 kg/m2 compared to all other BMI groups.

Progesterone Supplementation Not Needed
A group of researchers at the Carolinas Medical Center in Charlotte examined two groups of IVF patients to determine significant difference in pregnancy rates between those who continued progesterone supplements into the 12th week of pregnancy vs. those who had not. 237 patients categorized as the "long group" received 25mg intramuscular dose of progesterone the day of retrieval followed by a daily dose of 50mg IM until the pregnancy test and then daily through the first trimester. Another group of 121 patients, the "short group" continued same dose progesterone but only until the pregnancy test.

The study revealed similar conception rates for both groups. There was no significant difference in delivery rates when comparing all patients with a positive pregnancy test. However, both groups showed a similar degree of pregnancy loss, but at different times. Researchers concluded that long progesterone supplementation may support early pregnancy development through viability at 7 weeks but does not improve overall survival through the first trimester, showing more of a trend of delaying, not preventing miscarriage. For this reason, progesterone support of early pregnancy does not appear to be justified.

FDA Changes Ahead
Starting in May 2004, the Food and Drug Administration will be taking an active role in overseeing all aspects of health and safety of IVF clinical laboratory procedures, which are currently regulated by states. The changes are expected to increase the number of, and frequency of tests that patients will be required to undergo. Fertility Flash will publish a more extensive summary of this topic and how it will impact rates/procedures at PFC in one of our Spring 2005 issues. If you have any questions in the meantime, feel free to email us.

Drs. Chenette and Schriock attended the 2004 ASRM convention along with Lab Director Joe Conaghan and other PFC staff members. PFC's medical team is continually evaluating the latest research. Our patients' welfare is PFC's first priority. With this in mind, be assured we do not include new technologies and treatments unless they are backed with solid, evidenced-based research.


Conception Health    Resources at Your Fingertips


Undergoing infertility treatment can be overwhelming for some patients. The time and energy that is needed, both physically and emotionally can drain even the staunchest crusader. To cope most effectively with the stresses of infertility treatment you will need support. While friends and family will prove to be invaluable allies, there is nothing like connecting with like-minded individuals who might also be going through your very experience.

Not surprisingly, the Internet offers an abundance of resources for infertility support. A Google search for "infertility support" garners 7880 hits! The topic of infertility "emotional support" nets 46,500 sites. Even narrowing the search with a specific diagnosis, such as "endometriosis support," 13,300 responses does not seem like much of an improvement. When you are feeling lonely and isolated because of your infertility the last thing you need to do is wade through thousands of sites.

So, we at Pacific Fertility Center have waded through them for you. Here are some of the most helpful sites with a bit about what you might find. Many of these can be directly accessed from our website at InfertilityDoctor.com. These sites may also link you to other sites.

We would like to offer a warning about chat rooms. While it is amazing how many women share their experience and offer you words of encouragement via Internet chat groups, please be wary of fellow infertility patients offering medical advice based on personal experiences, anecdotal evidence and/or fuzzy research. It is important to realize that while your medical situation may be “similar” to someone else's, the details of your case are what make the difference. Your physician is the best resource of sound medical advice.

ACOG.org American College of Obstetricians and Gynecologists - Excellent patient education pamphlets, books and updates on legislation affecting women's healthcare.

www.cdc.gov/ncbddd/bd/abc.htm ABCs of having a healthy pregnancy - Centers for Disease control and Prevention: National Center on Birth Defects and Developmental Disabilities' informative website.

theAfa.org American Fertility Association - Education, referrals, research, support, chat room.

ASRM.org American Society for Reproductive Medicine - Patient section offers fact sheets on infertility and adoption. ASRM is the nation's largest professional organization of fertility experts.

b4pregnancy.org Information and resources concerning healthy lifestyle changes in separation for pregnancy.

Childofmydreams.com Resource for infertility and adoption.

DCNetwork.org The Donor Conception Network - A British network of parents with children conceived with donated sperm, eggs or embryos, adult offspring and those contemplating or undergoing treatment.

Ferre.org Ferre Institute - Resource and information on medical genetics, infertility, adoption, including special sections for those of color, LGBT and other cultural issues.

Fertilehope.org Fertile Hope - Information, support and hope to cancer patients facing infertility.

Hopeforfertility.com HOPE for Fertility - Volunteer emotional support for fertility and adoption challenges.

Hygeia.org Hygeia® - Support for Perinatal Loss and Bereavement

MissingGRACE.org Missing GRACE - International support and resources for infertility, loss, and adoption. Grieve, Restore, Arise, Commemorate & Educate.

Protectyourfertility.org Protect Your Fertility - Information for women and men about infertility produced by the American Society for Reproductive Medicine.

Resolve.org RESOLVE - National education, support and advocacy groups for infertility and adoption. Local chapters

Seronofertility.com and Fertilityneighborhood.com Pharmaceutical company sponsored sites with informational options including news sites.

Singlemothers.org Single Mothers by Choice or Chance - Support network for single mothers with local chapters.

-- Peggy Orlin, MFT


Ask the Experts    Frozen Embryos: What are My Choices?


Q.
We have frozen embryos at PFC that we would like to donate to research. Now that California has passed the Stem Cell Research Initiative, how would this affect the donation process?

A.
The status of your frozen embryos at PFC will not change as a result of this new initiative. Currently, all patients with frozen embryos in storage at PFC are contacted by us on an annual basis to reconfirm their wishes for their embryos for the upcoming year.

All patients are given 5 choices:
1. Return to PFC for a frozen embryo transfer
2. Continue storage (a $400.00 annual storage fee payment is remitted)
3. Thaw and discard all remaining embryos
4. Donate embryos to another party (known or anonymous donation)
5. Donate embryos for medical research

If option #5 is chosen, we will transport the embryos in a liquid nitrogen carrier tank to one of several scientists (primarily at UCSF) for use in their research. Our patient's privacy is maintained because we only give UCSF an identifying number with each set of embryos.

Currently, we are working with several researchers who are attempting to develop embryonic stem cells under non-federally funded research grants. The new state initiative may provide these scientists and others with more funding to continue and expand their studies. With the added state funding, their research could contribute to the body of knowledge about how undifferentiated human cells become specific tissues, hopefully leading to the development of specific tissues to treat diseases and conditions such as Parkinson's, Alzheimer's, diabetes and spinal cord injury.

--Carolyn Givens, MD


Patient Odyssey    One of Those Babies!

After trying "au natural" for several years, we were told to try clomid a few times... no luck. We were then told to try IUI but we decided against it. We always felt we had plenty of time but Daphne, my wife, had turned 36, and we knew we had to get serious.

Following a battery of tests, our picture went from bad to bleak. First we learned that my sperm count is lower than average, so I felt horrible. Then we learned that Daphne has endometriosis. So it was her turn to feel bad. You sort of feel like you're letting the other one down.

Our OB/GYN decided we needed a specialized facility, and referred us to Pacific Fertility Center.

One of our toughest days was our first trip to San Francisco, a four-hour drive. We didn't know anyone there. We went through the convolutions of testing and more testing and deciding to undergo IVF. And then minor surgery. This was in the middle of the holidays; Daphne felt sick, and we began thinking of all the expenses we had incurred just to get to that point. We felt like our lives were out of control. Standing on Pier 39, I wondered whether we could continue, and I said, "I don't know if we can do this!" Daphne just looked haunted. She didn't say a word.

Daphne was so meant to be a mother. At one point I started feeling desperate for her. Another mother in line at a grocery store yelled at her child, taking it all for granted. It just made us wonder why? Why them and not us? It made Daphne absolutely miserable.

During these tough times we would be comforted when we entered the doors of the center and felt a sense protection, as if people were putting their arms around us. We began to turn it around and started enjoying ourselves in the City while dealing with medication shots and appointments. We didn't look back - and then it came time for the retrieval.

Just before Daphne was to receive the anesthesia, Dr. Schriock, with his soft-spoken mild manner came over to check in with us, and held her hand. That really touched her. If you're going to go through something like this, you couldn't ask for somebody more understanding. Whether they know it or not, the PFC physicians and nurses, and Joe come across as caring people before professionals, even though I know they're experts.

We didn't break any records; I think we barely made 10 embryos, but that gave us enough to use and freeze. Plus, they looked good.

After an agonizing wait, the news on our IVF cycle was negative.

We were disheartened, but Daphne quickly rebounded and we went right into our 2nd cycle - a frozen transfer. Again, the transfer, the waiting and again, negative.

Those were very black days. You feel part of a populace, but everyone is moving on and you're not. You feel so alone. We were struggling so hard on an activity that should have been so natural. We were hostages to so many unknown factors.

We went on and did a 3rd try, again using our frozen embryos. We were fully prepared to be disappointed. After the transfer and the wait, the testing lab in Fresno drew her blood and by the time we got to our home close to Yosemite, the phone rang almost immediately. I was ready, standing next to my wife, forming the words that would comfort her, but instead she looked at me and gave me a thumbs-up!

From that time on, we were even more guarded than before... at least for a while. We were almost too afraid to tell people but we surprise-visited Daphne's parents with a cake that said "We're Pregnant!"

Tessa is now nearly two. Of course, you see children, and you know they're considered perfect. But Tessa is the most photographed and beautiful baby, and she has a personality that just won't stop.

We're hoping to give Tessa a sibling soon with our remaining frozen embryos.

I now look back and see it kind of empirically - Tessa was one of the strongest embryos, and since being born, she hasn't had any problems: no sniffles, no flu, not even a hiccup. So we didn't just get a baby, she really is one of those babies! -- Randy Cohlan



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-- Best regards from all of us at Pacific Fertility Center.


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