The Annual meeting of the American Society for Reproductive Medicine (ASRM) gives us a chance to observe and present research and clinical projects that help improve the practice of reproductive medicine. PFC participates in this important event by sending staff from our laboratory and clinical teams for training, education and updates. The most recent meeting in Boston, MA, was well attended by delegates from across the US and around the world, and PFC was well represented.
PFC Infertility Doctor Blog
The Infertility Blog
Last October in Boston, the American Society for Reproductive Medicine (ASRM) held its annual meeting jointly with the International Federation of Fertility Societies (IFFS). It is tradition that the meeting opens with the President’s Guest Lecture, usually presented by an influential physician or scientist on a topic with broad health implications and in the context of advancing research and clinical care in reproductive medicine. Last year the guest lecturer was Prof. Elizabeth Blackburn of UCSF, Nobel Laureate in Physiology or Medicine 2009 for the discovery of telomerase. Her thought provoking talk was on the effects of telomeres on the chronic diseases of human aging and the potential relationship between telomeres and human reproductive aging.
Mary is aiming at starting her family. She and her husband have been working hard for two years to conceive. They did get pregnant, once, with a pregnancy ending in miscarriage. Fertility tests have not indicated a problem. She asked for our help at Pacific Fertility Center in San Francisco.
For a woman like Mary things look normal, but they are not. On the surface, everything is in place for pregnancy, but conception does not happen. The most common reason for this is aneuploidy.
Aneuploidy is an abnormal number of chromosomes in an embryo. Normally 23 pairs of chromosomes, including the X and Y, are evenly duplicated between cells as the embryo forms. In aneuploidy, one or more chromosomes is missing or duplicated, with loss of balance in the DNA coding for the embryo.
Last month PFC hosted a group of medical students from Japan for a lecture about the medical and scientific aspects of fertility treatment. The students also took a tour of the clinic and lab. Dr. Herbert presented on the medical treatment options we offer here at PFC as well as the new technologies we are able to offer to our patients. To the right is a picture of Dr. Herbert presenting to the group of students.
I spoke with a patient today about optimizing conception. Her concerns were age and cervical factor. At age 39, there are relatively few eggs of relatively poor quality available. She had surgery on her cervix a few years ago for a Pap smear concern, and her cervix was somewhat closed. Here is what I told her:
The main problems we are addressing are cervical factor and diminished ovarian reserve. Inseminations work for cervical factor, but do not do much for egg problems.
Ovulation induction with injectable medications like Follistim or GonalF would offer about twice the pregnancy rate of a natural cycle. The concern is the increased risk that attends this - the chance of multiple gestation and all its problems, miscarriage, and clinical aneuploidy (Downs Syndrome et al). For this reason, I don't often recommend this route. It is standard fertility therapy, but risky.