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Pacific Fertility Center

55 Francisco Street,
Suite 500
San Francisco,
CA 94133
TEL: 888-834-3095
FAX: 415-834-3080
www.InfertilityDoctor.com
Info@PacificFertility.com



Our Promise

As a unified team, guided by the highest ethical standards, we provide our patients with the best quality, individualized, compassionate fertility care.
Science Pulse    The Benefits and Pitfalls of PGS


You may have heard about Preimplantation Genetic Screening as a technique provided in the IVF laboratory, and may have wondered if this technology is one you should consider incorporating in your IVF cycle. When considering various technologies in your IVF cycle, it is always important to clearly define what information you wish to gather with this technology, and also understand the pitfalls of the technology.

We have two methods of screening embryos. The first is called Preimplantation Genetic Diagnosis, for couples that have a known and defined genetic disease (e.g. Cystic fibrosis, Huntington's disease, thalassemia), or are carriers of a single chromosome abnormality (chromosomal translocation). In this case we screen the embryo(s) for that particular genetic disorder, and transfer appropriate embryos. For this type of genetic screening, the aim is to conceive a healthy, unaffected child.

The other type of genetic screening is called Preimplantation Genetic Screening, where we screen the embryos for abnormalities in chromosome number. We all have 23 pairs of chromosomes. Embryos that have extra or missing chromosome(s) (aneuploid embryos) are much more likely to not implant, or to produce a miscarriage. The incidence of implantation failure, or of miscarriage, depends on which chromosome(s) are missing or duplicated. We therefore can screen an embryo with a "five or nine chromosome panel." At PFC we utilize the nine chromosome panel. We look at the nine chromosomes that have been identified as most commonly being associated with implantation failures or miscarriages to see if that particular embryo has the correct number of those nine chromosomes. If so, this embryo is deemed "normal", and can be transferred back to the uterus.

So who might consider PGS? Patients who have had a number of failed IVF cycles (documented failed implantations), those with a poor response to ovarian stimulation or those with poor embryo development (poor responders), those with recurrent miscarriages (>2 first-trimester miscarriages), those with a prior aneuploid pregnancy, those who are at least 35 years old are all candidates for PGS. The chances of improved pregnancy rates with PGS are dependent on the indication for PGS.

When we started doing PGS for various indications, we expected a dramatic improvement in implantation rates, and therefore pregnancy rates, as we were transferring pre-selected embryos. As it turns out, we have not necessarily seen those expected improvements in all patient groups. Patients who are younger than 35 yeas of age have a better chance at improved implantation and pregnancy rates using PGS. Improvements can still be obtained for older patients, if the 9 chromosome probe set is used (some centers use a 5 chromosome panel). Studies now indicate that patients who have at least 6 fertilized eggs to screen will also have a better prognosis than those with 5 or fewer. For those patients who have five or fewer fertilized eggs in their IVF cycle, we may actually recommend not proceeding with the PGS. In this case less manipulation of embryos may provide the patient with the best overall chance at pregnancy. Patients who have had less than 3 failed IVF cycles may have greater benefit from PGS than those with > 3 failed cycles. Patients with a prior aneuploid pregnancy or with recurrent pregnancy losses can also expect an improvement.

For patients who have had repetitive IVF cycle failures, or repetitive pregnancy losses, a PGS cycle may be diagnostic (explain if those failures/losses are from a high number of abnormal embryos), and in that sense may provide important information that explains those fertility failures. With those answers, the patient can then decide about pursuing similar treatment cycles, or choosing other options (using a donor egg, pursuing adoption, or choosing to live child-free). Studies indicate that results from one PGS cycle are indeed predictive of probable results in subsequent PGS cycles. In other words, if we have a cycle with a higher than expected percentage of abnormal embryos, we have to anticipate that we will probably have a similar result in subsequent PGS cycles.

There are many proposed reasons to explain why we are not achieving a higher implantation/ pregnancy rate in PGS cycles. There clearly is added stress placed on the embryo(s) when one cell is biopsied out, and when the embryo is kept in culture for an extra day or two while waiting for the results of the genetic testing. We currently can only test for 9 chromosomes, and it is possible that there may be undiagnosed abnormalities on one of the untested chromosome pairs. There is also a small possibility that an embryo we deem "normal" may actually not be normal (false negative result). It also may be that simply looking at chromosomes is not the final answer. Most likely the integrity and health of the cytoplasmic structures, and other important structures of the egg are also critical in the ability of the embryo to develop into a viable and healthy pregnancy.

Who Benefits Most?

  • Patients with < 3 failed cycles, and > 5 fertilized eggs
  • Patients 35 year and older (if using a 9 chromosome panel)
  • Patients with a history of recurrent pregnancy losses
  • Patients with a previous aneuploid pregnancy
  • Patients using PGS as a Diagnostic Tool for:
    - Repeated IVF failure
    - Non-obstructive Azospermia

So, while PGS is a wonderful tool that can be incorporated into the various techniques of your IVF cycle, you need to be aware of the strengths and limitations of PGS testing. Your physician can help guide you in terms of the appropriate use of PGS and whether you may benefit from incorporating PGS in your IVF cycle.
-- Isabelle Ryan, MD
Dr. Isabelle Ryan, recognized by prestigious medical associations for her pioneering research, offers her patients a combination of clinical expertise and warm personal care. She has developed an interest in treating those with the diagnosis of unexplained infertility and endometriosis. Dr. Ryan serves as Director of PFC's Third Party Parenting Program.


From Us to You    Sharing Hope


Pacific Fertility Center is now participating in an important program that helps protect the fertility of cancer patients undergoing chemotherapy and radiation. Fertile Hope, an advocacy organization that raises awareness about fertility issues for cancer patients, is partnering with carefully selected clinics throughout the US in a program called Sharing Hope. The program will be open to those who have been diagnosed with cancer, want to preserve their fertility and have limited financial means. Sharing Hope offers qualifying cancer patients significant discounts for fertility-preservation treatments, such as embryo freezing and egg freezing before undergoing chemotherapy, radiation and/or surgery.

Cancer treatments can affect fertility in both men and women. In some cases infertility will be temporary, but in others it will be permanent. Currently, options are limited for cancer patients wishing to preserve their fertility. Men may freeze their sperm prior to cancer treatments to be used for artificial insemination or IVF. This is quite successful and in most cases at least 50% of a man's sperm will survive freezing and thawing. The best option for women is to freeze embryos (via IVF). Yet this offers a viable solution only to women with partners or those willing to use donor sperm. What is the single woman diagnosed with cancer to do? She has not yet found Mr. Right, or even Mr. Perfect Sperm Donor, but knows she wants to have a child in the future. The bright spot may be egg freezing. Still considered experimental, egg freezing is a relatively new procedure and has much lower success rates than embryo freezing. Some say the numbers for egg freezing are around 1 live birth for every 100 eggs frozen, yet there are clinics around the world claiming to have 1 live birth for every 10 eggs frozen. The success of egg freezing will continue to improve as technology and scientific knowledge develop. PFC will offer egg freezing in the near future.

For some people, the idea of losing their fertility is as devastating as the diagnosis of cancer. Often, cancer patients have little time or opportunity to gather funds for the high cost of cancer treatment, let alone fertility preserving treatments. At PFC we hope to extend a helping hand to cancer patients unable to afford these costly treatments and to provide them with the hope of building a family.

You may find out more about Sharing Hope at Fertile Hope's website:


Ask the Experts    Predicting Ovarian Reserves


Q.
I'm strongly considering an IVF cycle. Is there any way to know how productive my ovaries are likely to be besides blood tests? I'm 38 years old.

A.
There is no reliable screening test that peeks into your ovaries to determine your "ovarian reserve", that is, how many eggs you might have available for fertilization. However, one good measuring method that we use is to count your antral follicles, which are tiny resting sacs containing immature eggs that are waiting to develop.

Active ovaries continuously form these follicles - they bubble up or percolate from microscopic immature eggs to the antral follicles that are visible on ultrasound. As ovaries age, fewer of these antral follicles are visible. The antral follicle count is a powerful method of predicting the numbers of eggs; it is not quite so good at predicting embryo quality.

The test is usually done early in the menstrual cycle. Ideally, we like to see 6-8 follicles per ovary, although women have been known to get pregnant even with low antral follicle counts.
-- Philip Chenette, MD


Photo Gallery    Antral Follicles



PFC Spot Light    My Journey to the Best Job


My nursing career was born after a miscarriage, followed by a divorce, both life-altering experiences.

At Chico State School of Nursing as a nursing assistant I worked every weekend and full-time three summers. I envisioned providing for myself the rest of my life and was motivated to persevere. I started at age 38 - twice the age of other classmates. I am forever grateful for their compassionate acceptance of an "old lady".

Obtaining prerequisites for nursing was more demanding than nursing school. However, in retrospect, my prerequisite time was one of the best in my life as I grew more as a human being.

I was taking on a lot of student loans, so I set a goal to work in Iran where I heard American nurses received excellent compensation.

I obtained the minimum one-year nursing experience required prior to working overseas. My plan to go to Iran was dashed when the Shah's government collapsed. A colleague noticed I was a bit down (actually depressed) and suggested Saudi Arabia. After interviewing a nurse who had just returned and finding the country on a map, I decided to apply. This didn't come without sacrifice; my then nine-year-old daughter would need to live with her father and his new wife while I was gone.

In l983, I arrived in Saudi Arabia, where women could not drive or show their faces in public unless accompanied by a male relative, and where shops closed for prayer five times a day. I was placed at the King Kahlid Eye Specialty Hospital in Riyadh, the largest eye hospital in the world. Here are a few of the details contained in my contract:

  • Salary with no income taxes, equivalent to a 38% increase.
  • 44 hr. workweek, 30 days paid annual leave with return airfare.
  • Reduced price meals at the hospital cafeteria.
  • A nice, furnished, air-conditioned two-bedroom apartment, which I shared with an Australian nurse.
  • Free transportation shopping via hospital bus. (Dress code was a long skirt and no visible arms.)
  • No fraternizing with the natives.

After orientation, I was assigned to the Male Retina Unit, a 48-bed facility handling cataract, cornea, retina and injury surgeries. Within a few months I was Head Nurse for the day shift, overseeing staff from all corners of the world, including the Philippines, England, Ireland, Australia, and Sweden.

After three very challenging and fulfilling years, I repaid my student loans and traveled with my daughter in Europe and Mexico. I also met a wonderful man and remarried.

Our marriage was unexpected because I was a devoted single woman. How we met and dated in such a closed society and against my contract cannot be stated in this small venue, yet outright danger was always a factor. If we had been apprehended together, I would have been shipped out immediately and Muhammed could have been incarcerated for a long time. He had to petition the government for approval of our wedding even though his family readily accepted me. We were very fortunate to have found each other and continue to enjoy a wonderful life together.

We moved to El Cerrito in 1991 and for the next few years I worked part-time or cared for my ailing parents. Five years later, I convinced my husband that I should return to work and found San Francisco Center for Reproductive Medicine. Knowing nothing of the field, I had to learn all about IVF.

At first I was overwhelmed and I found myself thinking I would never be able to master all the new information. My job was to admit, monitor, and discharge IVF patients undergoing egg retrievals. Gradually my job expanded into ordering medication, medical supplies, and doing quality assurance tasks.

By the time the practice changed its name and moved to Francisco St., I had been with the practice for five years. I can truly say I have the "best job in the world". My job is rewarding, even though my part in the whole IVF picture is small, considering what all the coordinators, financial staff, clinical nurses, and medical staff have completed for the patient to reach the retrieval stage. I love taking care of our ladies. When they arrive for their retrieval some are very anxious, while others are calm. I try my best to assure them the procedure, from their prospective, is easy. Of course, most will not believe it until afterwards.

I provide them with a warm gown and slippers, go over pre and post op instructions, start their IV, send them in for their 20 minute retrieval, observe them in recovery before discharging them to a responsible adult. My main objective is to make their experience easy, comfortable and stress-free. For most patients, being in retrieval means they have endured many procedures and have ridden a very emotional roller coaster. I place a box of tissues under each recovery bed. The tissues get a lot of use, and the patients are encouraged to cry as much as they need. Not only have patients' emotions been thoroughly tested by the IVF experience, but the cost has also taken a major bite from their pocket books. These factors have formed my philosophy to provide every imaginable creature comfort.

Every morning as I am opening the IV bags for that day's procedures, after going over the mental check lists for a smooth procedure, I then find myself thinking how lucky I am to have the best job in the world.
-- Carol Willsey-Alyusuf, RN



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-- Best regards from all of us at Pacific Fertility Center.


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