IVF Patients

How many weeks pregnant am I?

 

Many IVF patients get very confused about how the doctor calculates the age of their pregnancy (= gestational age, in medical jargon). Logically, shouldn't it be from the day of the embryo transfer? After all, it's only after the embryos are transferred that a woman can be considered to be pregnant!

However, doctors are not always logical, and we usually use the menstrual age when talking about the length of the pregnancy. This is because obstetricians usually see women who have got pregnant after having sex in their bedroom. Very few of them will know the exact date they ovulated, which is why we use the menstrual age in clinical practice. This does not change just because you have had an IVF pregnancy - the clinical rules remain the same!

This creates a lot of confusion in patient's minds - especially when they are trying to make sense of their ultrasound scan results or their HCG levels.

Remember that your OB is always talking about the menstrual age - not the age of theembryo ! This is purely for clinical convenience and is a well-accepted universal convention.

So how do you convert the date of embryo transfer to menstrual age. This is very simple! The key reproductive event you need to focus on is ovulation! It makes much more sense to talk about the pregnancy in terms of DPO (days post ovulation), rather than the menstrual age or the day of the embryo transfer. This is because we can use this landmark for all situations (including IUI pregnancies; and for Day 3 embryo transfers and Day 5 embryo transfers aswell !)

Since every IVF patient knows the date they ovulated (= the day of egg collection), it's easy to calculate your menstrual age. Just subtract 14 from your date of ovulation. This is your "corrected LMP" (last menstrual period).

(Corrected) LMP = Date of egg collection minus 14

The reason we do this is simple - it's because text books assume the follicular phase is exactly 14 days! Once you know your corrected LMP, its then easy to use this as the anchor, based on which your OB can calculate your gestational age.

This means that the menstrual age will always be 14 days more than the actual age of the embryo.

Confused? Let's look at an example.

Let's suppose your LMP was 5 Jan; and your egg collection was done on 24 Jan (let’s assume you took a long time to grow eggs); and your embryo transfer was done on 29 Jan (Day 5 transfer). The HCG pregnancy test will be usually done about 14 days post ovulation (DPO), which is 7 Feb. If it's positive - say 120mIU/ml, the doctor will confirm you are pregnant! This means that even though you are only 14 DPO ( and your embryo's age is only 14 days ) , he will calculate your corrected LMP as 10 Jan ( date of ovulation , 24 Jan, minus 14 days) - which means your clinical gestational age ( or menstrual age) will become 4 weeks ( 28 days) ! Once you understand this “2 week gap" and the rationale behind it, you'll find it much easier to date your pregnancy!

Donor Eggs and Egg donation

We run an active egg donation program which is a very useful treatment option for older women; women with ovarian failure; and those who have failed many IVF cycles as a result of having poor quality embryos.

While it's true that the idea of using donor eggs can be very difficult to accept, it's a treatment option which has a very high success rate! It also offers many advantages. You get to experience pregnancy; bond with your baby; and your child will have your name on its birth certificate, so that the fact that you have used donor eggs is something which no one else needs to know. It's thanks to donor egg technology that we are now seeing a spurt of celebs who are 40+ who are giving birth to twins and triplets!

We will be happy to help you find an egg donor. We have many healthy young fertile Indian women ( all of whom are less than 30 years of age , have been medically tested for their fertility ; and screened for infectious diseases such as hepatitis and AIDS ) on our egg donor panel, who have been fully evaluated.

IVF Treatment to Begin for Khloe Kardashian

Khloe Kardashian in her desperate bid to have a baby has begun to prepare for in-vitro fertilization (IVF) treatment, claim magazine reports.

Khloe has publicly spoken of her desire to start a family with basketball player Lamar Odom, yet in their two years of marriage there has been no baby joy so far for the couple.

"She is desperate for a baby with Lamar and will do whatever it takes," the Daily Mail quoted a friend of the couple as telling Us Weekly magazine.

"They have faith the IVF will work," the friend added.
Sister Kourtney's announcement last week that she was expecting her second baby with boyfriend Scott Disick, only highlighted the fact that Khloe is not yet pregnant herself.

"She's thrilled for Kourtney, but she's really sensitive," another source said.

"And it's hard to see your sister get something you want so badly," the source said.

The 32-year-old is feeling under pressure to get pregnant.

"People keep saying "Why aren't you pregnant yet?" she had said.

"That's what scares me, when people are like, "Did you go to the doctor? Do you know if everything's working?" It's nerve-racking. Sometimes I feel like I'm letting everyone down," she had said.

The Kardashian and Jenner family have also offered their support to Khloe, with little sisters Kendall and Kylie also hoping for a niece or nephew.

"They always say "You've got to have a baby. It'll be so cute and tall, and we'll babysit,

"I'm like 'You've got to get off my back,'" she said.

Even family matriarch Kris Jenner has had words of reassurance for her third daughter, despite once calling her daughters 'stingy' for not providing more grandchildren.

"Maybe she thought I was having a bad day," Khloe recalled.

"But she starts telling me that when she and Bruce first met, they were trying to have kids and it took her five years to get pregnant with Kendall.

"She was just like 'With certain people, it just takes a minute.'"

However, whenever Khloe and Lamar have children, the star won't be carrying on her mother's tradition of names beginning with 'K'.

"I definitely want some L names," she added.

About IVF Treatment

The one thing every patient needs to know about IVF treatment

IVF can be a complex process and selecting a doctor can be quite a challenge! Infertile couples are often frustrated and depressed and most will choose an IVF clinic based on a recommendation by a friend or a referral by a doctor. This is not always the best method and you can end up getting stuck in a poor quality clinic, thus reducing your chances of success. Even worse, many clinics do precious little do educate or inform their patients and patients don't know what questions to ask their doctor.

Also, IVF cycles can fail for many reasons. Sometimes the problem is poor quality eggs - but often it is a poor quality clinic!

Here's the single most important thing you should check, to be sure you are getting good quality treatment.

Insist that your clinic provide you with photos of your embryos! A good clinic will provide this routinely. This is tangible evidence that they have delivered you with a high quality service - after all, the key output of an IVF clinic is the embryos they produce.

What do bad clinics do?

- They do not provide photos of your embryos
- They fob you off with specious excuses (our camera is not working is very popular)

- They just tell you verbally that the embryos are Grade A
- They "show" you the embryos under the microscope. Unfortunately, for most patients, these just look like blobs - and patients are not sophisticated enough to differentiate between good embryos and bad embryos.

Whenever a patient comes to me for a second opinion after a failed IVF cycle , I ask them just one question - show me the photos of your embryos. This allows me to judge objectively how good or bad the IVF lab is - and bad IVF clinics have bad IVF labs!

Improve IVF Pregnancy Rates

Does CAT help to improve IVF pregnancy rates?

 

IVF patients are always on the lookout for innovations which will improve their chances of success. For example, many IVF patients ask us whether we do IMSI or CAT. These are techniques which have been aggressively promoted in the press, but do not really help the patient at all.

IVF doctors have always been frustrated by the fact that though we are quite good at growing embryos in the lab, most of these embryos do not become babies. Embryo implantation is an inefficient process, and trying to ensure that every embryo we transfer becomes a baby is the "holy grail" for all IVF specialists , which is why we use techniques such as blastocyst transfer and laser assisted hatching, to try to facilitate the implantation process .

One logical way to increase success rates is to try to improve lab quality conditions, so that in vitro conditions match in vivo conditions as closely as possible. So what are differences between growing embryos in a plastic dish in the IVF lab and in the human body?

In the body, the embryo is bathed in nutrients provided by the cells lining the fallopian tube until it reaches the uterus. In the lab, we grow embryos in plastic dishes containing culture medium, which contains a mixture of chemicals which are cleverly designed to support the growth of embryos.

In the past, in order to help embryos to grow in vitro, doctors would add the patient's serum to the culture medium. The hope was that this serum contained (unidentified) biological growth factors, which would help the embryos to grow well. However, we learned that along with growth factors, the serum also contained embryo-toxic factors, which could actually inhibit the development of the embryo, and we stopped adding serum to the culture medium. Meanwhile, as we learned more about the biochemistry of the early embryo, manufacturers tweaked the chemical composition of the culture medium (using a mix and match of amino acids), so that it because more embryo friendly, and could support the growth of embryos more efficiently.

A lot of research in the early days involved co-culture, and you can find lots of references to this if you do a Medline search for IVF co-culture. Basically, this involved culturing the embryo on a bed of "feeder cells", so that these cells could support the growth of the embryo. Ideally, the feeder cells should be the cells lining the fallopian tube, but these were very difficult to grow, which is why doctors tried using endometrial cells for co-culture; as well cumulus cells ( which were collected from the follicular fluid at the time of egg collection). Using cumulus cells for co-culture is a very simple technique and seems very appealing. This is what was christened CAT or cumulus aided transfer. Unfortunately, the success rates with CAT are no better, which is why the technique never caught on and few IVF clinics now offer this option. After all, every clinic wants to improve their success rates, and if such a simple technique worked, then everyone would use it.

So why don't we (and the vast majority of IVF clinics all over the world) offer CAT?

On closer analysis, it's quite easy to see why CAT does not help. For one thing, in real life, the cumulus cells do not nurture the embryo in vitro. After fertilisation, the cumulus cells disperse, so that the embryo is floating free in the fallopian tube and is not surrounded by cumulus cells in vivo. Also, transferring the cumulus cells along with the embryo into the uterus makes little logical sense because cumulus cells belong in the ovarian follicle - not in the uterus! In the uterus, the cumulus cells are "foreign" and are unlikely to help in embryo implantation! 

Caveat emptor - let the patient beware! More is not always better - and often established techniques are much better than newer ones!

IVF is Arrogant

Conception Via Sex in Marriage Alone is 'Acceptable', IVF is 'Arrogant': Pope

Pope Benedict XVI has asked wedded couples to shun non-natural methods of conception since sex between a husband and wife is the solely acceptable way to conceive.

He said that methods like in vitro fertilization (IVF) for getting pregnant were simply 'arrogance' as he spoke at the end of a three-day Vatican conference on infertility in Rome.

The Pope reiterated the Church's stance against artificial procreation, and told scientists and fertility experts that matrimony was the 'only place worthy of the call to existence of a new human being'.

"The human and Christian dignity of procreation, in fact, doesn't consist in a 'product', but in its link to the conjugal act, an expression of the love of the spouses of their union, not only biological but also spiritual," the Daily Mail quoted Benedict as saying.

He told the specialists in his audience to resist "the fascination of the technology of artificial fertility", warning against "easy income, or even worse, the arrogance of taking the place of the Creator".

He suggested that this was the attitude that underlies the field of artificial procreation.

Sperm or egg donation and methods such like IVF are banned for members of the Catholic Church.

The emphasis on science and "the logic of profit seem today to dominate the field of infertility and human procreation", the Pope said.

But he added that the Church encourages medical research into infertility.


Source-ANI

Blocked Tubes: What Can Be Done?

Blocked tubes can be a common condition, which can have a significant impact upon many women and couples.

Having blocked tubes makes it more difficult to become pregnant.

When the tubes are blocked then the sperm and egg can not easily meet and pregnancy will never occur. Occasionally pregnancy will occur with partially blocked tubes but the fertilized egg will become trapped in the blockage as it tries to enter the uterus. This can result in an ectopic pregnancy.

There are two common reasons women develop blocked fallopian tubes and there are several advanced surgical procedures which can correct or reverse tubal blockage and allow a woman to become pregnant again.

How Do Tubes Get Blocked?

Tubes can become intentionally blocked after a tubal ligation procedure or tubes can become unintentionally blocked because of scar tissue. 

The most common reason for tubal blockage is tubal ligation surgery.

Blocked Tubes After Surgery

When a patient request a tubal ligation procedure she is asking her doctor to intentionally block her tubes in the hopes that she will prevent future pregnancy. There are many different procedures to block fallopian tubes and once the tubes are blocked then future pregnancy will be very unlikely unless the blockage is surgically corrected. 

Often women will regret having their tubes blocked and will want to have additional children. Thankfully tubal ligation reversal allows women the ability to surgically unblock blocked fallopian tubes.

The second most common reason for having blocked tubes is having tubal scar tissue.

Blocked Tubes After Tubal Scar Tissue

Fallopian tubes can become unintentionally blocked after a woman develops scar tissue inside the fallopian tubes or around the fallopian tubes.  Scar tissue can develop and block tubes after abdominal infections,  pelvic infections (PID), endometriosis, ectopic (tubal) pregnancies, and salpingitis isthmica nodosa (SIN). 

Treatments For Blocked Fallopian Tubes

Fallopian tubes can be surgically unblocked with tubal surgery. The type of tubal surgery to unblock a tube depends on how the tubal blockage was caused and where along the tube the blockage occurs. The chance of pregnancy will be excellent for most women.

Tubal surgery can provide women with tubal blockage an alternative treatment to in-vitro fertilization (IVF).