By the end of the year we will have started a new and very exciting research project in our lab. We have partnered with a company called Incept Biosystems (www.inceptbio.com) to do a clinical trial of a new embryo culture system called microfluidics.
 The traditional culture dish with medium droplets under oil as described by Brinster, R.L., 1963, Exp. Cell Res., Vol. 32
The traditional vessel for embryo culture is the petri dish, where small droplets of culture medium are overlain with a highly purified mineral oil. The culture medium, regulated in much the same way as pharmaceuticals, is one of the most highly tested and expensive components of the IVF laboratory operation. We typically make droplets of medium that are in the 50-200µl size range, and the oocytes or embryos are placed in the droplets for 24-48 hours at a time. This is a static culture system where nutrients are depleted by the developing embryos and waste products (e.g. ammonia from amino acid breakdown) accumulate over time. The droplets are large enough to make sure that the supply of nutrients is more than adequate and that waste is diluted to the point of not harming the embryo in any way. The embryos are changed into fresh medium at least every 48 hours.
This system for embryo culture has been in use since human IVF began in the late 1970's and early 1980's. It was actually developed in the early 1960's by a pioneer of mouse embryo culture, Dr Ralph Brinster, at the University of Pennsylvania. Some early human embryologists cultured embryos in small test tubes without the mineral oil, but nowadays, despite the age of this technique, it is very unusual to find a facility that does not use the droplets under oil method. After 45 years, perhaps it is time for a change?
A microfluidic system for embryo culture has been in development for over 5 years at the University of Michigan in Ann Arbor. Professor Gary Smith combined the talents of his graduate students in physiology with those of engineering students and came up with a device that has had outstanding results with growing mouse embryos. Professor Smith is no stranger to IVF, as he was the director of the University's IVF Laboratory for many years and he was instrumental in designing and testing the vitrification system that we now use to preserve oocytes and embryos. He solicited venture capital to start Incept Biosystems with the intent to bring microfluidics into human IVF labs. Incept Biosystems were onsite at PFC during the last week of October to train our embryologists on the use of the system. We did several trials with mouse embryos to achieve proficiency with the system and then we will actively recruit patients to enroll in a clinical trial using the system.
The clinical trials are being run at 3 centers in the US. In addition to PFC, patients will participate at the Fertility Center of San Antonio and at Southeastern Fertility Center in Charleston, South Carolina.
A schematic of a microfluidic embryo culture device with fresh medium in blue and spent medium in red. The embryo is contained at the base of the chamber, where the blue medium ends.
Microfluidics has had impressive results with mouse embryos where it significantly increased rates of development and implantation over those for embryos grown in static culture. Cell numbers for the microfluidic embryos were almost twice as high as for traditional culture (110 vs. 65), and pregnancy rates from transferred embryos were increased by 22%. Incept Biosystems have tested the new technology extensively and have been able to obtain surplus IVF embryos donated for research for human trials. There are some nice videos on their website that showcase the equipment and procedure, and detail the mouse embryo results. Professor Smith presented the results and won the prize paper at the 2008 American Society for Reproductive Medicine (ASRM) meeting (Smith et al., 2008, Fertility and Sterility, Vol 90, pages S1-S2), and these results will soon be published in a peer reviewed journal.
We will be asking for participants to join the study, beginning in November and continuing for 2-3 months. This is a short study requiring enrollment of only 20 patients, but a larger study is planned for next year subject to favorable outcomes here. If you are interested in the study and would like more information, please ask your physician at your next visit.
--Joe Conaghan, Ph.D, HCLD
Joe Conaghan, Ph.D, HCLD is PFC's Laboratory Director. Dr. Conaghan is internationally recognized for his work on improving embryo culture conditions. His interests include developing programs for the treatment of severe male factor infertility; diagnosis of genetic disease in embryos; and improved embryo culture.
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This year's flu season is certainly not your standard flu season. 2010 brings not only the current seasonal flu variety, but also the pandemic H1N1 virus, commonly known as Swine Flu. These are two separate viruses. H1N1 is not only of great concern for all members of the population, but also of particularly serious concern for pregnant women.
The single most important action, strongly recommended by the Centers for Disease Control (CDC), is for pregnant women to be vaccinated against both the seasonal flu and, most importantly, H1N1. Both the seasonal flu vaccine and the H1N1 vaccine can be administered at the same time, at separate injection sites. There are two methods of dispensing the flu vaccine; either by injection or by a nasal spray (Flu Mist).
For immunization of pregnant women, only the injectable vaccine should be administered. Ob/Gyn practices will be the first to receive the vaccine. Patients should plan to be vaccinated at their Ob office.
 Above: Tis the season to be conscious about germs
In addition to the flu vaccines, there is medication available to treat those with symptoms of the flu or those who have been exposed to someone with the flu. Symptoms of the flu can include: cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, and sometimes diarrhea and vomiting. Fever is common, but it is important to note that not everyone with flu will have a fever. If you have symptoms or if you have been exposed to someone who has the flu, call your doctor right away.
Pregnant women with suspected influenza, or experiencing more severe symptoms such as evidence of lower respiratory tract infection or clinical deterioration should receive prompt empiric antiviral therapy, regardless of previous health or age. Most healthy persons who develop an illness consistent with uncomplicated influenza, or persons who appear to be recovering from influenza, do not need antiviral medications for treatment or prophylaxis.
Pregnant women exposed to someone with influenza should consider antiviral chemoprophylaxis. Chemoprophylaxis should generally be reserved for persons at higher risk for influenza-related complications who have had contact with someone likely to have been infected with influenza. However, early treatment is an emphasized alternative to chemoprophylaxis after a suspected exposure. Household or close contacts (with risk factors for influenza complications) of confirmed or suspected cases can be counseled about the early signs and symptoms of influenza, and advised to immediately contact their healthcare provider for evaluation and possible early treatment if clinical signs or symptoms develop. Early recognition of illness and treatment when indicated is preferred to chemoprophylaxis for vaccinated persons after a suspected exposure.
Go to the emergency room immediately if you have difficulty breathing, or shortness of breath, pain or pressure in your chest or abdomen, sudden dizziness or severe or persistent vomiting. Prevention is certainly the best defense--and there are a number of things we can all do to minimize the spread of flu this season.
Wash your hands! Frequent hand washing or use of alcohol-based hand sanitizers is a major preventative measure. Carry a hand sanitizer in your purse, in the car, even a small bottle in your pocket. You can use them just about anywhere at any time.
Cough into your elbow! This helps to keep your germs to yourself.
Keep your hands away from your face! You will not be infected with the flu by touching a contaminated surface -- unless you then touch your eyes, nose, or mouth.
Stay away from sick people if you are healthy and from healthy people if you are sick! You do not want to knowingly expose yourself, but remember, if it does happen, call your doctor straight away.
You do not want to spread the flu if you have it. Stay home and stay away from other family members as much as possible and make sure to call your doctor as soon as you have symptoms.
The CDC will continue to update their website as there is new information:
For general information on 2009 H1N1 flu go to:
cdc.gov/h1n1flu/qa.htm
For more information on flu shots go to:
cdc.gov/h1n1flu/vaccination
-- Karen Volpe, Director of Nursing
R.N., Karen Volpe, Director of Nursing has been a Registered Nurse since 1979. She started working in the hospital operating Room and first worked in the IVF clinic in 1986. Karen set up one of the earliest clinic based procedure suites. She became the Director of Nursing at PFC in 1999.
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Pacific Fertility Center is pleased to announce that as of October 1st we are enrolling patients into a groundbreaking research study to determine the value of combining acupuncture with IVF. Traditional
Chinese medicine has been practiced in throughout Asia for thousands of years:in the last decade, the west has been following suit.
There have been sufficient peer reviewed studies to warrant a clinical trial in which there are predictable parameters of patient involvement. One of the first studies involving acupuncture and IVF was published by Paulus et al in the journal Fertility Sterility in 2002. The Paulus study reported the influence of acupuncture on the pregnancy rate in patients who undergo assisted reproductive therapy. Clinical pregnancies were documented at 42.5% of patients in the acupuncture/IVF group, whereas pregnancy rates were 26.3% in the control group, using IVF alone. In this study, the acupuncture was performed before and after embryo transfer only.
How does acupuncture affect fertility? A review article in Alternative Therapies (Anderson 2007) suggested four possible mechanisms by which acupuncture could improve the outcome of IVF: modulatingneuroendocrine factors; increasing blood flow to the uterus and ovaries; modulating cytokines; and reducing stress, anxiety, and depression.
The participants of our study will be randomly separated into two groups. One group will have acupuncture along with their IVF cycle and the other group will continue with their regular IVF cycle without acupuncture. Both groups will have the majority of their IVF medication provided for them at no charge. Those in the acupuncture group will also have their acupuncture treatments at no charge.
We are very excited about this study. It is the first of its kind involving extensive, onsite acupuncture treatment pre and post IVF. As a study participant, you have the opportunity to help us determine with greater certainty the influence of acupuncture on fertility. We hope to better understand its mechanism and use; thus assisting others in achieving their dream of having children.
If you are interested in finding out if you are eligible to participate in our study please call 415-834-3000 and ask to speak to the Patient Care Coordinator.
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Since November 2007, the Acupuncture Group at Pacific Fertility Center (PFC) has been treating patients on-site who have been undergoing IUI, IVF and other assisted reproductive therapies. Since its inception,
the Group has grown to six practitioners and has treated well-over 200 patients. Many PFC patients take advantage of the Group's STAR package, which includes an initial visit, 16 follow-up treatments, and treatments on the day of the patient's IVF transfer. With over a year under its belt, the Group wanted to catch up with Beverly, the first patient to start and complete the STAR package at PFC. Beverly was kind enough to share her story with patients who are thinking about adding acupuncture to their fertility treatment program.
Beverly is 44 years old. She did not get pregnant on her first IVF cycle and was waiting to do a frozen embryo transfer. She had significant stress at work, and her physician at PFC (Dr. Givens) recommended that she try acupuncture in the month leading up to her transfer. We asked Beverly a few questions about her experience, and these were her responses:
[Acupuncturist]: In your own words, how would you describe your experience with acupuncture at PFC?
[Beverly]: The days I went for acupuncture were the best days of the week for me. The treatments were peaceful and relaxing. I tell everyone they should try acupuncture, not only for fertility issues, but for general stress relief as well.
[Acupuncturist]: What made you decide to do acupuncture with your IVF cycle?
[Beverly]: My first IUI and IVF treatments were unsuccessful. With my three remaining embryos, we planned to do just one more round of IVF. With that in mind, I wanted to do everything possible to make it successful. I had always been interested in acupuncture but until starting at PFC, I hadn't known that it was commonly used to treat infertility. With the added convenience of being able to do the treatments right at PFC, it seemed like the perfect arrangement for me.
[Acupuncturist]: How did you benefit from acupuncture while you were going through your cycle?
[Beverly]: I started acupuncture prior to the last cycle, and I felt that it increased my circulation. On transfer day, the treatments relaxed me as they usually did. And after the transfer, they made me feel as though I was doing something special for our three little embryos.
Going into the second (and last) IVF cycle, I wanted to keep both body and mind in a positive state, and the acupuncture combined with taking a lot of time off from work after the transfer helped me do that.
[Acupuncturist]: What was the outcome of your cycle and how are you doing now?
[Beverly]: The second IVF cycle resulted in a pregnancy and our daughter was born in October 2008. I continued acupuncture treatments once a month throughout the pregnancy to balance stress, relieve numbness in my fingers, carpal tunnel syndrome and back pain.
[Acupuncturist]: What would you say to anyone who was thinking of using acupuncture as a complimentary therapy with fertility treatments?
[Beverly]: Every day I look at my daughter and am amazed that she is here. We often look at the microscopic image of the three embryos from our second round of IVF and wonder which one she is. When I put her to bed, I tell her the story of how she came to be. Some day she'll understand it, and for now, it's a reminder to myself that she is truly a miracle baby, and I'm happy I did everything I could, including the acupuncture, to bring her into the world.
Acupuncture treatments are available seven days per week on site. To book your first appointment or to schedule a free 15-minute telephone consultation, call 888-834-3095.
The above patient's story is based upon one's personal experiences. Results may vary for other patients.
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Title: Everything Conceivable
Subtitle: How Assisted Reproduction is Changing Men, Women and the World
Penguin Books, 2007. 343 pages, with 57 pages of footnotes and references.
By: Liza Mundy
This is a very interesting book about the current state of affairs in the world of assisted reproduction. It is comprehensive in its coverage of almost all the latest technologies and the author has been very thorough in researching the subject. On most topics, there are insightful observations on the societal implications of current technologies. In this regard, it is a thought-provoking book.
In the epilogue, the writer states, "It was my goal to help readers understand why certain changes in the family are taking place and what their likely consequences might be. Why there is so much demand for donor eggs, now. Why there are so many more triplet sets than there once were. What life is like for those triplet parents. How embryo research and embryo politics are influencing our thought on human life and its origins. What is the real, rather than the imagined impact of medicine and science on families and culture."
I think this would be an excellent resource if one were a health care policy maker or if one were writing a term paper or thesis on the subject but I don't really think it's a book to inform the infertility patient about fertility options or what to expect with treatment. It really does not seem to be intended for fertility patients as the target audience.
However, the book does provide a lot of useful information in a somewhat scholarly fashion. Most of the facts are correct, with some of the usual journalistic license.
--Carolyn Givens, M.D.
Carolyn Givens, M.D. was the first in San Francisco to successfully initiate a pregnancy using intracytoplasmic sperm injection (ICSI). She currently co-directs the Bay Area Pre-Implantation Genetic Diagnosis Program (PGD) and is director of PFC's PGD program.
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Upcoming Events & Seminars
Overcoming Infertility:
The Next Step to Parenthood
Wednesday, February 17
Wednesday, March 17
Mind/Body @ PFC
Learn healthy, positive ways to reframe your journey to pregnancy.
Date:
Saturday, February 20
Saturday, March 20
Do You Love Your Genes?
FertilityWire is hosting its first tweetup/meetup.
Date: Thursday, February 11
Location:
Pacific Fertility Center
55 Francisco Street, Fifth Floor
San Francisco, CA 94133
Contact:
Please call for reservations,
directions and parking information:
888-834-3095
Sign Up Now
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-- Best regards from all of us at Pacific Fertility Center.
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