ASRM-San Antonio Roundup

Mind/Body Techniques

Stress Reduction Workshops

Coping Through the Holidays

Time for a Donor

Does PGD improve my chances?

PGD FISH Photo

We have provided this summary of highlights to share with Fertility Flash readers. This tiny sampling by no means reflects the scope and depth of the 1800 scientific research papers that were presented. Human Nuclear Transfer From a popular press's point of view, the most talked-about paper was Dr. Jamie Grifo's research on human nuclear transfer. Each day of the conference, a new headline appeared with the world "clone" or "clone-like" even though Grifo and his Chinese colleagues, who reportedly tried the process unsuccessfully, insist that the process is not cloning. They fused the DNA from the oocyte of an infertile woman with a donor oocyte from which the DNA had been removed, and then fertilized the "reconstituted egg" with sperm. This experimental procedure has not yet produced a live birth, and the FDA prohibits this type of research in the U.S. It was recently banned in China as well. It is an incredibly complex procedure that is not likely to ever be commercialized due to the fact that so many embryos are rendered non-viable. OK to Go Patients who have just undergone Embryo Transfer after IVF are no less or more likely to conceive if they immediately go to the restroom. A study revealed that there was no difference in pregnancy rates between those women who had to go immediately and those who waited. Relax about SSRIs Women undergoing infertility treatment who take prescription medications in the category of Selective Serotonin Reuptake Inhibitors (Zoloft, Prozac, Paxil, etc.) have less to worry about. Children conceived by women on SSRI medication were no more or less likely to have problems. 911 Decline Infertility patients from New York treated in the midst of the September 11, 2001 tragedy suffered from a higher rate of pregnancy loss than those treated prior. The results of nearly 400 patients who underwent an IVF procedure before and after September 11 were examined. Individuals placed in the "before" or "after" groups showed no significant differences in age, number of eggs retrieved, or number of embryos transferred. Clinical pregnancy rates were also comparable between the two groups. However, there was a nearly 25% lower delivery rate for the patients with a pregnancy test after September 11. This study again points to the significance of psychological factors that impact outcomes of infertility therapy.

Telomeres Predict Poor Prognosis Scientists are noticing a correlation between short telomeres and egg quality. Telomeres are small pieces of DNA at the ends of chromosomes, that shorten naturally as we age. Telomere length could someday be used as a test of fertility potential.

Joe Conaghan, PhD	Eldon Schriock, MD

Mind/Body Techniques for Infertility

Stress reduction through mindful well being... while this may sound like a new age mantra, the medical community is growing in consensus about a mind/body connection that can positively impact a patient's health. No other physician has probed the mind/body infertility correlation deeper than Alice D. Domar, Ph.D., who has written extensively on health and stress, conducted research and designed a comprehensive workshop series. Included in these mind/body and mindfulness health and wellness programs are relaxation techniques involving controlled breathing and posture awareness; yoga, meditation, journaling, neuro-linguistic programming, and joining a support network. Dr. Domar's techniques are designed to help women treat their own stress responses so their bodies might have a higher chance of conceiving. Pacific Fertility Center's team has examined the scientific, medical and anecdotal information surrounding the topic of stress and infertility. And because various relaxation inducing/stress reducing techniques are likely to have an overall positive impact on a patients' general health, PFC is offering classes modeled around Dr. Domar's mind/body practice (see From Us To You) Indeed, infertility clinics all over the country are offering similar programs despite the lack of scientific consensus about how stress affects fertility. Skeptics point out that millions of people under extremely stressful circumstances, even kidnap and rape victims, regularly get pregnant. But some facts are clear: Ongoing chronic stress can affect menstrual function; change hormone levels; alter blood sugar; increase heart rate and change a person's immune response. Mind/body therapies are frequently initiated for groups with serious medical conditions, from lupus to multiple sclerosis to major heart disease. It is only natural that the more serious an illness, the more anxiety it can induce in a patient, thus potentially bringing on accelerated and aggravated symptoms. This vicious stress/body cycle, when broken through stress reduction techniques, can provide overall improvement in health. Dr. Domar's initiated one of the few controlled studies funded by the National Institute of Mental Health on this topic. Results of the research showed an improvement in pregnancy rates using either relaxation techniques or though the psychological support of joining a group. With so much growing attention into the mind/body stress reduction methodologies, there is bound to be a greater body of critical scientific knowledge gathered. Meanwhile, take a deep breath and consider your own stress response strategy.
---Carolyn Givens, M.D. and Isabelle Ryan, M.D.

Stress Reduction Workshops to Reframe Your Journey to Pregnancy
We are excited to begin Mind/Body@PFC Weekend Workshops in January 2004. These workshops will be open to PFC patients and non-patients alike. Couples or individuals who are attempting to conceive and experiencing emotional distress and/or overall life stress will gain the tools and practices needed to reduce stress levels and enliven your journey to conception. Without question, infertility can bring on extreme stress and feelings of isolation. Studies have shown that some patients increase their chances to conceive by practicing relaxation techniques and stress reduction lifestyle changes. Women who join support groups also respond more favorably to infertility treatments. (See Critical Review article on Dr. Domar's work). Peggy Orlin and myself, Allison Chamberlaine, will lead PFC’s Stress Reduction Workshops. We were trained and certified by Alice Domar, PhD, who has pioneered stress reduction tools and techniques for infertility. ---Allison Chamberlaine, RN
Workshop Instructors:
Peggy Orlin, MFT is a Marriage and Family Therapist who specializes in the emotional aspects of infertility, third party family building, and adoption. She has been a therapist for 20 years, an infertility counselor for 12 years and affiliated with PFC for the past 6 years. Her personal history of infertility led her to specialize in infertility counseling. Allison Chamberlaine, RN is a registered nurse with 15 years of experience in the field of infertility. Ms. Chamberlaine has taught meditation and relaxation techniques for over 20 years and has been with PFC since 1996 where she now coordinates care for individuals involved in third party family building. Her personal history of infertility led her to specialize in infertility nursing. Mind/Body@PFC Weekend Workshop 2004
January 24th and 25th
April 24th and 25th
September 11th and 12th
December 4th and 5th
Please Call 888.834.3095 for class information, fees and your registration form

Following Halloween, the holiday season suddenly looms. Excited children, crowded stores, decorations, and holiday parties are all set to descend on us. Yet because the winter holidays tend to celebrate families and children, these usually joyous occasions can bring up painful feelings when you are struggling to create and celebrate with a family of your own. In order to feel as good as possible during the holidays, you will need to develop some good holiday coping skills. Coping is "developing the ability to manage in a difficult situation." Here are a few suggestions. Use whichever of these suggestions seems helpful to you. Do what feels right for you. DO: Give up any and all feelings of guilt for how you are feeling. There is no right or wrong way to experience infertility. Your feelings may run the gamut from indifference to intense anger and despair and everywhere in between.
DO: Reach out to childfree friends. Their parties will be adult-focused.
DO: Choose the gatherings you attend carefully. If you are upset by being around children or babies gracefully decline invitations to events where they are likely to be present. Know your limits and stick with them.
DO: Think of non-child centered holiday rituals. Take a vacation. Eat at a fancy restaurant.
DO: Continue to get moderate amounts of exercise. Eat healthy and get plenty of rest. You will feel better if you treat your body with care.
DO: Shop for the holidays online or from catalogs. You will avoid mall madness.
DO: Attend religious services at the time when there will be the least number of children. Or attend on a university campus, as those services tend to be more adult focused.
DO: Volunteer at a nursing home or homeless shelter. It may help to help others having a difficult time at the holidays.
DO: Plan for how you will answer uninvited questions about when you're going to have children. Remember, you are not required to tell them your entire "story!"
DO: Meet and talk with others who are experiencing similar feelings. Finding that you are not alone helps.
DO: Communicate with your partner to let him/her know of your feelings. If you are single, call a friend with whom you feel safe to share your feelings.
---Peggy Orlin, MFT

I have learned that things in life do not always turn out the way you might have thought that they would. What seems to be the "standard" life may not be so easy to attain. I just turned 45 years old and have just found out that I am pregnant for the second time since working with Dr. Chenette. We have a four year old son who we conceived the "old-fashioned" way after Dr. Chenette removed a polyp from my uterus. We wanted a second child, and somehow I thought that if we did it once, we could do it again. I have of lost track of the cycles, but over several years, we have done IVF at least 3 times with several incomplete cycles and hysteroscopies in between. After failing the 2nd IVF, egg donation came up in our meeting with Dr. Chenette. My husband was ready to do it the next day because the odds were much better. I was more hesitant and felt that I needed to try a 3rd IVF cycle with "my eggs" first. In the meantime, we entered counseling and I joined a donor support group. The counselor was wonderful and so was the support group. The idea of egg donation grew comfortable for me as an option. After our 3rd cycle failed, we started looking for a donor. Although a strange process, something became clear. The look, the height, the intelligence etc., were not as important as just finding a nice, happy person who seemed to approach life the way that I do.

I looked for "nice eyes"- for I believe they tell you about a person. We found a donor and I really like her. Now, everyone probably works through this process in their own way, and that is the point. To find what you and your partner are comfortable with, and to take it one day at a time. I try not to worry - it's easier and more fun to be positive. I envisioned myself at this point in my life to be like a Mrs. Cleaver with a couple of kids and a fancy hairdo like a grown-up. But I met my husband later in life (and learned a lot up until then...). I still feel young. I am healthy and we all really want a second child. We are hoping that it is meant to be, and we are grateful to Dr. Chenette, the special nurses (Sue, Ann, Pat, Carol and the rest), and the nice staff at PFC for their services and their support. ---A.W. in Oakland

Q:
I am 40 years old and have been experiencing unexplained infertility for about 2 years. I have been reading that PGD may help to improve my chances of success with IVF. Is this true?

A:
PGD, or Pre-implantation Genetic Diagnosis is a technique, when used in combination with IVF, that can help to determine if the embryos have what it takes to successfully establish a pregnancy. As women get older, there are more errors in the chromosomal make-up of eggs. The most well-known of these defects is Down Syndrome or Trisomy 21, a condition in which the fetus or baby has an extra chromosome number 21. Having a missing or an extra chromosome may make the embryo unable to develop much past a few days of life or may result in a first trimester miscarriage. PGD uses a DNA-binding technique to determine if there are a correct number of chromosomes in the embryo. To do this, embryos on Day 3 of culture (5-10 cells) undergo a biopsy to remove a single cell. The rest of the embryo remains in culture in the IVF laboratory. The biopsy cell is analyzed for the correct number of chromosomes. Currently, PFC with its cytogenetic partner, St. Barnabas Medical Center, tests for 9 chromosome pairs which represent the most common abnormalities seen and some of the most serious in terms of a potential birth defect. As this technology continues to evolve, we expect to be able to assess all 23 pairs. IVF with PGD cannot correct defects in chromosomes. It can only diagnose whether an embryo is abnormal for these 9 chromosomes. The embryo could still be abnormal for one of the other 14 pairs. PGD may decrease the possibility of a miscarriage due to abnormal chromosomes. It may allow for the selection of the embryos most likely to implant and cause a normal pregnancy. If a woman has a good number of fertilized eggs to work with, it may eliminate having an excess number of embryos returned to the uterus at any one time and may eliminate having frozen embryos that really are not genetically normal. Because the embryos will have been screened for some of the major chromosomal abnormalities, theoretically, the remaining embryos should provide a patient who is older a better chance at a viable pregnancy. Some studies have shown that the implantation rates (chance that any one embryo will successfully implant) can be doubled with IVF/PGD. Also, miscarriage rates have been reduced by one-half and the delivered pregnancy rate is increased. Women or couples interested in this procedure should discuss it with their Reproductive Endocrinologist. At PFC, we also refer our PGD patients for a special genetic counseling session in preparation for this process. ---Carolyn Givens, M.D.

PGD FISH (Fluorescent in situ hybridization) Photo An embryo with normal chromosomes

We are looking here at the DNA from a cell taken from a human embryo. It has been stained green, and colored fluorescent probes have been applied, which are specific to individual chromosomes. This allows us to count the number of chromosomes and tell if the embryo is normal or not for those chromosomes tested. For the chromosomes that we are interested in counting, we should see 2 brightly colored spots, since we have 2 copies of each chromosome. In this picture, we see 2 red spots (= 2 copies of chromosome 13), 2 yellow (chromosome 22), 2 light blue (chromosome 18), 2 dark blue (chromosome 16) and 2 green (chromosome 21). This embryo has the correct number of these chromosomes. Note that one of the green spots and one of the yellows are very close together in the picture, but they are definitely there.