Mini IVF| Fertility Expert Randy Morris answers - Is it right for you?

Randy Morris -The BOARD CERTIFIED fertility expert with weekly TTC tips on InfertilityTV

One of the reasons that #IVF is so successful is that it is a selection progress. If you start out with a large number of eggs, you are more likely to find some that will produce healthy embryos.

This is the reason why #fertility experts use high doses of fertility medications when women do IVF. These medications are the best way to try to get a large number of eggs. But are there some women who might be better off using low doses of injections or even oral medications to stimulate their ovaries. Let’s take a look.

First, ALL well done studies and the U.S. IVF database have shown that overall, pregnancy rates are significantly LOWER with mini-IVF than with standard IVF. This makes sense, fewer eggs means a lower chance for finding good eggs. There is NO evidence that egg quality is better with mini-stimulations.

However, there are some women who do not respond well to fertility medications. Even with high doses of meds, they may still produce very few eggs. Since fertility injections are very expensive, this can make the treatment very costly.

Using a medication like #Clomid will typically get only a small number of eggs to develop but it is much less expensive and easier to take - it’s a pill - not a shot. The egg quality is no better buts its not any worse either. So… instead of trying to get a large number of eggs at one retrieval, you can try to get just one or two eggs - but repeat the process several times.

So the main advantage of mini IVF is for women who would need a high dose of fertility meds. They can save a lot of money on expensive injections. The disadvantage is that they may need to have several egg retrieval procedures.

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Frozen embryo transfer ( FET ) or Fresh? | Infertility TV

Should you be doing a frozen embryo transfer ( FET )? Dr Randy Morris | The BOARD CERTIFIED Fertility Expert |Weekly TTC tips on InfertilityTV: IVF Embryo Transfer-Fresh or Frozen?



There are two options for transferring embryos during IVF.



During a FRESH TRANSFER, the embryos are placed in the uterus within 5 days of the egg retrieval without being frozen.



The embryo transfer can be deferred until a later time, however, by freezing the embryos. (FROZEN TRANSFER or #FET )



There are several advantages to a deferred transfer.

Most importantly, studies now show that the chance that the embryos will implant into the uterine lining is improved by waiting until a later time.

Second, deferred transfer helps avoid a serious complication of IVF treatment called ovarian hyperstimulation syndrome.



Third, deferring transfer allows genetic testing of the embryos to be performed with improves the chance for pregnancy and reduces the risk for miscarriage.



#frozenembryotransfer



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The latest from Dr. Randy Morris's Fertility Blog

Fertility Tips - Fertility Facts - Fertility Myths - Dr. Randy Morris on...

You hear so many fertility tips. Which are fertility facts? and which aren't. Do you know which is true??

For women who are trying to get pregnant, there are many myths about what you are supposed to do when trying get pregnant.

Dr. Randy Morris, a #fertilityspecialist  is here to clear up some facts and fiction.

Question: Are we seeing more couples having trouble conceiving or are women trying to have babies later in life?

#fertilityfact from Dr Morris:

1) We are seeing more couples who are experiencing difficulty primarily because they are waiting until later in life. The older a woman gets, the harder is to get pregnant.

2) Fertility and fertility treatment are a more acceptable thing now so more people with fertility problems are likely to come out and see a doctor about it.

Question: Do birth control pills reduce fertility?

Fertility Fact from Dr. Morris:

This is fiction. The old thinking was that if you are inhibiting ovulation that somehow that was going to cause a problem and we now know that that is not true.

In fact, in certain circumstances birth control pills can be helpful toward promoting fertility

Question: Does stress cause infertility? #stressandfertility

Fertility Fact from Dr Morris

This is fiction. There is very little data to support that. Procreation vacations may give a couple a chance to have intercourse but their chances to get pregnant won't be any better than at home

Question: Does obesity play a role in infertility? #obesityandfertility

Fertility Fact from Dr Morris

The is fact! There are a number of issues. Overweight women will have a higher incidence of #ovulation problems.  They will miscarry more often and they do poorly when put on fertility treatments

Question: Does being underweight cause infertility?

Fertility Fact from Dr Morris

This is fact. Triathletes and marathon runners can also have problems with ovulation and infertility

Question: Does Robitussin (cough medicine) increase your fertility if you have thick cervical mucous?

Fertility Fact from Dr Morris

This is fiction. This one has been around for a long time. If you look in the medical literature, there has never been a single study that supports it.

Question: Does smoking contribute to infertility?

Fertility Fact from Dr Morris

This is fact. Smoking does reduce fertility. Smoking decrease ovarian function. Women go through menopause at an early age if they are smokers

Dr. Randy Morris MD on WGN News - Ovarian Reserve Testing

Dr. Randy Morris, Medical Director of IVF1, discusses testing women's ovarian reserve as an #infertility test or for predicting the age of menopause. This interview aired on WGN News in Chicago.



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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.

#invitro
#IVF
#invitrofertilization

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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.

#IVF
#invitro
#invitrofertilization

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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...


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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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