Dr. Randy Morris M.D. on FOX News - Public figures lie about using egg d...

Dr. Randy Morris M.D. is interviewed about the growing trend of celebrities using egg donation .
An interview with fertility expert Randy Morris M.D. criticizing public figures who promote their pregnancies but don't admit to the fact that they used egg donation
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Dr. Randy Morris M.D. featured on WGN-TV In vitro Maturation

Dr. Randy Morris MD is interviewed on WGN-TV in Chicago about the new technology known as #IVM or In vitro maturation

#DrMorris is the medical director of #IVF1 and the medical director at the Naperville #Fertility Center. He is an Assoc. Professor at the University of Chicago.

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#IVF
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Dr. Randy Morris M.D. discusses In Vitro Maturation - CBS Early show

Dr. Randy S. Morris M.D. is well known as the physician who was responsible for the first #pregnancy in the United States using the technology known as In Vitro Maturation or #IVM. This is his interview on the CBS Early show.

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#invitro
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Treating thryoid antibodies in pregnancy

The effects of selenium in pregnancy were recently evaluated in a study performed in Italy. This study is of interest to me since we have been using selenium to reduce thryoid antibody levels in women with recurrent miscarriage. Selenium has been found in well controlled studies to reduce thryoid antibody levels but it has neve been evaluated in a pregnant population before.


Approximately 150 pregnant with with elevated levels of one group of thyroid antibodies were split into two equal groups. One group received 200 micrograms of selenium and the other group received placebo. During pregnancy and post-partum, more women who took the placebo were more likely to show evidence of thyroid malfunction and need thyroid hormone supplementation.


The levels of thyroid antibodies were reduced in women who took selenium.


Although this study still does not prove that selenium will reduce the risk of miscarriage in these patients, it does indicate that the antibody lowering effects are similar to that seen in non pregnant patients. It also appears to be safe during pregnancy.

IVF Children are Taller and Have Better Cholesterol Profiles

A number of studies have been performed to determine whether children conceived as a result of IVF have any greater health risks than children conceived in other ways. Some studies indicate that IVF children may be at greater risk for complications during pregnancy and birth defects. Other studies argue that IVF children may be smaller at birth than other children.

A recent study conducted with New Zealand school-aged children compared 50 children conceived as a result of IVF to 60 who were conceived naturally. The children were aged 7 to 9 at the time of the study.

The authors of this study found that 15% of the IVF group was smaller at birth than expected for their gestational age. However...


To learn more about this study click below:
IVF children taller

Assisted zonae hatching - AZH - does not increase IVF Success in women with endometriosis

Assisted hatching or AZH is a procedure occasionally used in IVF treatment cycles. There has been great controversy regarding whether AZH increases the chances for an IVF pregnancy. Numerous studies have been conducted over the years. Some studies have suggested that there is a higher chance for pregnancy using AZH while others showed no improvement whatsoever.



The zonae is a hard protein shell that surrounds the embryo. During IVF cycles, the zonae can be seen under the microscope. Before an embryo can implant into the uterine lining, the embryo must break out of the zonae. This is known as hatching. It has been hypothesized that some embryos may have a more difficult time implanting because they cannot break out of the zonae. During IVF, the process of hatching can be assisted by either thinning the zonae or making a small gap.



Recently, a study was performed to determine whether women with endometriosis who underwent treatment with IVF would have a better chance to conceive with AZH than women who did not have AZH.



To learn more about this study click below:
IVF in Endometriosis Study

Stress does not reduce the success of IVF

During IVF treatment, patients frequently ask about the relationship between psychological stress and IVF success. They often express concern that their own stress might have a negative influence on the outcome of IVF. Furthermore, support groups have advanced the notion that stress reduction can result in greater IVF success. Groups offering stress reduction services have been actively promoting themselves by citing the results of small scale studies pointing to the benefit of their own services towards improving the success of IVF (at a price of course).



A recent study of 166 infertile women looked at whether stress affected the success of IVF. All of the women in this study were treated using a standard IVF treatment regimen. The women answered extensive questionnaires concerning psychological factors. The first questionnaire was filled in one month before the onset of IVF treatment and the second questionnaire was completed one hour before the egg retrieval.



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Stress and IVF success

PCOS Treatment with Zocor

Zocor-simvastatin is a medication typically used to treat high cholesterol. Recent evidence suggests that Zocor may be a useful treatment for PCOS – polycystic ovary syndrome.

PCOS Study

A recent study presented at the annual meeting of the Society for Gynecologic Investigation is the first to look at the effects of these medications in women with PCOS. Women with PCOS are often found to have high cholesterol and triglycerides.

The PCOS patients in the study were first placed on birth control pills. This was necessary because Zocor and related medications known collectively as statins, are contraindicated in pregnancy. One half of the PCOS patients also received Zocor.

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PCOS and Epilepsy Treatment

Women with epilepsy who are treated with a medication called valproate (Depakote) have a higher incidence of PCOS symtpoms. There is some evidence to suggest that the higher the dose of Depakote used, the greater the chance for developing PCOS. Stopping valproate therefore may improve signs and symptoms of PCOS.

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Egg Donation May Complicate Pregnancies

Egg donation uses the technology of in vitro fertilization - IVF to obtain eggs from one woman, the egg donor, fertilize them in the laboratory and then place the embryos into another woman, the recipient. Egg donation is most commonly used when the recipient is older and thus less likely to get pregnant using her own eggs.

Egg Donation, Complications and Age

Egg donation pregnancies have lower rates of complications such as miscarriage and Down's Syndrome since the egg donor is younger and therefore produces embryos with a lower rate of chromosomal abnormalities and thus lower rates of these problems. Some complications of pregnancy do not change with egg donation. These are problems that are based on the age of the recipient. As women age, they have a higher incidence of complications such as gestational diabetes, pregnancy induced hypertension, intrauterine growth restriction. Older women also deliver by cesarean section more commonly. The increased risks have been thought to occur equally whether or not a woman used egg donation to acheive the pregnancy.

Egg Donation Study

A recent study presented at the annual meeting of the Pacific Coast Obstetrical and Gynecological Society has suggested for the first time that women who conceive by egg donation may be at higher risk for pregnancy induced hypertension (PIH).

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Medical Treatment of Varicocele

Last updated / published 4/15/2005

Varicocele and infertility

Varicocele is a finding in men where enlarged or dilated veins occur in the blood vessels of the scrotum. Normally the scrotal veins have valves that regulate the blood flow. However, in some cases, the valves are absent or defective and the blood does not circulate out of the testicles efficiently. This results in swelling of the veins above and behind the testicles. 85% of varicoceles develop in the left testicle.

It is estimated that varicoceles are present in about 20% of the normal male population and up to 40% of an infertile population. It is uncertain how varicoceles may cause infertility. Some evidence points to the increased temperature of the blood raising the temperature of the testes, which then damages the sperm. Heat can damage or destroy sperm. The increased temperature may also impede production of new, healthy sperm. Another theory is that in men with varicocele, the testicular fluid which carries sperm has an increased concentration of chemicals which can damage sperm. The chemicals are called reactive oxygen species or ROS.

Previously, varicoceles have been treated using various types of surgical procedures.

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Smoking reduces IVF Pregnancy Rates

In a study about to be published in the journal Human Reproduction, infertile women who smoke were found to have lower pregnancy rates and higher miscarriage rates during treatment with in vitro fertilization - IVF.

Smoking reduced IVF pregnancy rates

Danish researchers looked at 8,457 women aged 20 to 40 who had had in vitro fertilization treatment. The patients were divided into four groups, depending on the cause of each couple's fertility problems; male fertility disorder, fallopian tube problems, other clinical explanations - such as polycystic ovaries or endometriosis, or unexplained fertility problems.

Overall, the live birth rate for smokers was 28% lower than non-smokers. Among women with unexplained infertility, the live birth rate was a third lower for smokers, at 13% compared to 20% for non-smokers. This is the same effects as would be seen for women who were ten years older. In other words, a 35 year old woman who smokes would have the pregnancy rate a 45 year old.

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Folic acid does not increase risk for twins

A recent study has disproved the notion that the use of folic acid supplementation increases the risk for twinnning.

Folic Acid prevents birth defects

For some time now, I have been recommending that women who are attempting to become pregnant should take 1000 micrograms of folic acid daily to reduce the risk of having a baby with birth defects. The birth defects are known as neural tube defects and include such problems as spina bifida and anencephaly. Recent data have shown that since these recommendations have gone into effect that the rate of neural tube defects has dropped significantly.

Folic acid, also called folate is a B vitamin found in foods such as spinach and other leafy greens, beans and orange juice. Despite the addition of folic acid to many breakfast cereals, breads and other grains, many women have a difficult time getting the required amound on a daily basis. Thus, prenatal vitamins containing folic acid have been recommended. In the United States, fortifiaction of foods has been required since 1998.

Folic acid and twinning

Some studies have suggested that the rate of twinning has risen since the introduction of fortification. The largest effect was reported in a Swedish study that reported a 45% increase in multiple gestation if a woman use folic acid before pregnancy. However, several studies since 1999 have attributed the increase risk to the greater use of fertility treatments and not from the use of folic acid itself.

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Blood test to predict tubal damage

A recent study published in the journal Fertility and Sterilityindicates that a combination of inexpensive blood tests can predict the presence or absence of tubal damafe from chlamydia infection with fairly good accuracy.

Chlamydia Background information

Chlamydia is a common sexually transmitted infection (STI) caused by the bacterium, Chlamydia trachomatis. Chlamydia infection is extremely common. Chlamydia is the most common sexually transmitted infection in the United States. The Center for Disease Control estimated that 2.8 million Americans are infected with chlamydia each year.

Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can also be passed from an infected mother to her baby during childbirth. Any sexually active person can be infected with chlamydia. The greater the number of sex partners, the greater the risk of infection.

About 75% of infected women and about 50% of infected men have no symptoms of chlaymida infection. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure. Women who do have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. If the infection spreads from the cervix to the fallopian tubes some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods.

Chlamydia can cause infertility

In women, untreated infection can spread into the fallopian tubes and cause the tubes to become blocked at the very ends (distal tubal obstruction). They can also develop scar tissue around the fallopian tubes that makes it more difficult for the tube to "pick up" the egg at the time of ovulation. The problems can lead to infertility and an increased risk for ectopic (tubal) pregnancy.

Distal tubal obstruction can be detected by performing a hysterosalpingogram. Pelvic adhesions, however, can only be detected by undergoing a surgical procedure to look inside of the abdominal cavity. This is usuaully done using a technique called laparoscopy where a fiber optic telescope is inserted through the belly button under general anesthesia. Since laparoscopy is a much more invasive procedure, it is desirable to avoid it whenever possible.

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New FDA regulations will hurt egg and embryo donation

On May 25, 2005, new FDA guidelines for the donation of human cells, tissues, and cellular and tissue-based products (HCT/Ps), will go into effect. Reproductive tissue such as sperm, eggs and embryos will be affected by these testing guidelines.

Sperm which are frozen and quarantined for several months already will not be adverseley affected. However, eggs, which are currently donated "fresh" and embryos that are designated for cryopreservation will be significantly affected.

7-Day Testing Requirement

The new FDA guidelines require donor testing for a number of communicable diseases such as HIV (AIDS) and hepatitis seven days prior to (oocyte) egg retrieval . This 7-day window poses a large problem. Most women who are taking fertility medications for in vitro fertilization - IVF cycles need 9 to 10 days before the hCG trigger injection. The (oocyte) egg retrieval follows two days later. The same time course applies to egg donors.

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Americans support preimplantation genetic diagnosis - PGD

These are the results of what is the largest public opinion survey ever conducted of American attitudes toward preimplantation genetic diagnosis -PGD. The study conducted by the Genetic and Public Ploicy Center shows that more than 67% of Americans approve of preimplantation genetic diagnosis - PGD of embryos during in vitro fertilization - IVF procedures to select those embryos free of a fatal disease-causing gene mutation's.

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2/18/2005 Infertility increases risk of neonatal death

A study just published in the British Medical Journal indicates that couples who take longer to conceive, are at greater risk for having babies that die. This is a very important study.

The study looked at Danish women who were enrolled in a large cohort study. The authors studied 27,329 births over a three year period. Only first born births were counted. In that group there were 66 babies who died within the first 28 days. This is known as the neonatal death rate. (The neonatal period is from birth to 28 days).

The mothers had been interviewed during their pregnancies and asked about pregnancy planning and other factors. Women who reported having planned or partly planned their pregnancy were asked how long it had taken them to conceive. If the answer was six months or longer, they were further asked whether they had
received infertility treatment.

They were then separated into 5 groups based on how long it took them to conceive:

Two months or less;

3-12 months;

More than 12 months but with no infertility treatment;

More than12 months and also had fertility treatment

Those women who had unplanned pregnancies (weren't trying)

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Study: Blastocyst transfer for repeated IVF failures

An ongoing debate in the treatment of infertility is how to manage patients who have failed to conceive after multiple In vitro Fertilization - IVF failures.
A recent study out of Spain, published in the medical journal Fertility and Sterility attempted to determine whether using blastocyst transfer may work better for these patients.

Some Definitions:

Cleavage stage embryo: An embryo which has begun to divide. Cleavage stage transfers are typically performed on the third day after egg retrieval. This is known as a Day 3 transfer

Blastocyst stage embryo: An embryo which has divided into hundreds of cells. The cells have separated into those that represent the fetus (inner cell mass) and those cells which will go on to produce other tissues like placenta (trophoblast).

Part of the problem with cleavage stage embryos is that it is more difficult to determine which ones have the greatest likelihood for implantation. Even if they look healthy under a microscope, they may not develop well after the third day. To compensate for this shortcoming, in vitro Fertilization - IVF programs will increase the number of embryos they place in the uterus. This will occasionally work but it also increases the chances for a multiple pregnancy.

By waiting for 5 or six days, the in vitro Fertilization - IVF laboratory staff can better pick those embryos which are likely to produce a pregnancy. Typically, less embryos are required and this will also reduce the multiple pregnancy rate.

In this recent study, the researchers identified 148 women who had failed to conceive after at least three in vitro Fertilization - IVF failures. The patients underwent another In vitro Fertilization - IVF attempt but this time planning to use blastocyst transfer. They compared the pregnancy rate for patients who had > blastocysts develop by Day 5 to those in which > blastocysts developed only by day 6.

91% of the patients had at least one blastocyst to transfer and 73% had at least two. For those patients who had Day 5 > blastocysts, the pregnancy rate was 38%. For those who had a day 6 transfer, the rate was only 11%

What does this study show? Well, you could conclude the doing a > blastocyst transfer is a reasonable treatment option even for women with repeated in vitro fertilization - IVF failures. We cannot say that doing a blastocysttransfer would have worked better than simply performing another cleavage stage transfer because there was no cleavage stage control group. A major shortcoming of this study.

We can also state that at least in patients with recurrent in vitro fertilization - IVF failure, that a Day 5 transfer seems to work better than a day 6 transfer.

As far as studies go, this one is pretty weak.

Single embryo transfer in IVF- in vitro fertilization- may be equal to transfer of 2 embryos

The chance for pregnancy in in vitro fertilization - IVF is affected by numerous factors. One important modifiable factor is the number of embryos transferred into the uterus. The data tell us that placing two embryos into the uterus will produce more pregnancies than placing one. Unfortunately, it also increases the risk of multiple pregnancy.

Multiple pregnancy, even twin pregnancy, is associated with greater risks than a singleton pregnancy. In fact, every complication that occurs in pregnancy occurs more often in twins. This includes, premature birth, gestational diabetes, hypertensive disorders of pregnancy (pre-eclampsia), birth defects and even death of the baby. The greater the number of babies in a multiple pregnancy, the greater the risk.

Unfortunately, many in vitro fertilization - IVF programs still transfer high numbers of embryos in an attempt to boost or maintain their pregnancy rates. This may make the program look better but it puts both mother and baby in greater jeapordy.

It has been questioned, over the years, whether you can get just as many women pregnant if you put one embryo in over two different attempts compared to putting both in at once.

Recently, researcher from Sweden put that question to the test. They looked at a specific group of women undergoing in vitro fertilization - IVF. These women are generally considered to be good prognosis patients.

All under 35 years of age

On their 1st or 2nd in vitro fertilization - IVF attempt

Had at least two good quality embryos for transfer into the uterus

They divided these women into two groups at random. One group received transfer of two embryos. The other group had transfer of a single embryo with cryopreservation (freezing) of the remaining embryos. If not pregnant, this secoond group were brought back for transfer of a single frozen embryo.

The results were looked at in two ways. The pregnancy rate for each attempt or the per cycle pregnancy rate and the cumulative pregnancy rate over two cycles.

In the double-embryo-transfer group, 142 (42.9%) of 331 women had pregnancy resulting in at least one live birth compared with a cumulative live birth rate of 29.6% after the first and 38.8% after the second transfer for the single-embryo group. It should also be pointed out that 38 women did not receive a second transfer because they did not have a viable embryo after thawing.

However, multiple births occurred in a whopping 33.1% of women in the double-embryo-transfer group and in only 0.80% of women in the single-embryo-transfer group (basically one twin pregnancy).

The difference in live birth rate between the groups was about 4% on this study. Doing some statistical analysis we can say that any reduction in the rate of live births with the transfer of single embryos is unlikely to be greater than 11.6 percentage points.

What can we conculde from all this? Well in a well selected group of good prognosis patients, transferring one embryo at a time is just about as successful as putting two embryos in at once but with a fraction of the risk for multiple pregnancies.

The costs to the patient will initially be higher because of the extra expense of embryo cryopreservation, storage, thawing and preparation of the uterus for the second transfer. However, the financial and social costs down the road will be considerably lower due to the avoidance of multiple pregnancy.

At our program, we are well known because we do very well but transfer very few embryos. We have done single embfyo transfers but for the most part patients have been resistant to them. This is in part due to the fact that patients talk on the internet and in support groups and say "My doctor recommended transferring four embryos" Instead of running as fast as they can away from that program, they create the illusion that you have to transfer many embryos to get pregnant.

Another problem results from failed cycles. Patients have a tendency to demand larger and larger numbers of embryos be transferred after failed attempts even though there is no data that this will improve their chances for becoming pregnant.

We cannot continue like this for much longer. Some countries already have passed laws limiting the number of embryos that can be transferred. I don't believe we are too far from that happening here.

Indiana legislature rules in favor of lesbian couples using donor insemination

In a landmark decision, the Indiana Court of Appeals has ruled that lesbian partners who agree to conceive a child through artificial insemination are both the legal parents of any children born to them.

In a unanimous ruling, the court said that "no (legitimate) reason exists to provide the children born to lesbian parents through the use of reproductive technology with less security and protection than that given to children born to heterosexual parents through artificial insemination."

This case arose when the two partners split up and one wanted visitation rights for the child. The lower court initially ruled that one partner had no parental rights because she was not a biological parent.

Now, I'm no lawyer but, it seems to me that this ruling is important not just for gay couples but for all my Indiana patients who use donor egg, donor sperm or donor embryos. If the lower court could negate the parental rights of a partner in a gay relationship, the same would apply for those in a heterosexual relationship who use donated gametes.

In my opinion, the Indiana court made the right decision and one which will benefit all of my patients who live there.