Alper M.M.,Boston IVF |
Fauser B.C.,University Utrecht
Reproductive BioMedicine Online | Year: 2017
Conventional ovarian stimulation protocols for IVF are designed to achieve maximum oocyte yields. Conventional protocols, however, are associated with patient discomfort, increased risk of ovarian hyperstimulation syndrome and higher costs. In recent years, mild stimulation protocols have risen in popularity. These protocols typically use lower doses (≤150 IU/day), shorter duration of exogenous gonadotrophins, or both, compared with conventional protocols, with the goal of limiting the number of retrieved oocytes to less than eight. The pregnancy rate per cycle (fresh embryo transfer only) is lower with mild stimulation compared with conventional stimulation; however, the cumulative pregnancy rate seems to be comparable between the approaches. Reports are conflicting on the effects of mild versus conventional stimulation on embryo quality. This article expands on a live debate held at the American Society for Reproductive Medicine 2015 Annual Meeting to compare the advantages and disadvantages of the 'more is better' (conventional protocol) versus 'less is best' (mild protocol) approaches to ovarian stimulation. Both protocols are associated with benefits and challenges, and physicians must consider the needs of the individual patient when determining the best treatment options. Further prospective studies comparing a variety of outcomes with conventional and mild stimulation are needed. © 2017.
Humm K.C.,Boston IVF |
Humm K.C.,Beth Israel Deaconess Medical Center |
Sakkas D.,Boston IVF
Fertility and Sterility | Year: 2013
The well documented increase in age that women conceive their first child has detracted from a similar change observed in males. As both males and females decide to conceive later, the question of whether this may impact their fertility individually and as a couple becomes even more crucial. A paternal age of over 40 years at the time of conception is a frequently quoted male age threshold, however, currently there is no clearly accepted definition of advanced paternal age or even a consensus on the implications of advancing male age. In this paper, we review some of the potential risks to the offspring of advancing male age and examine. The data available regarding pregnancy outcomes based on paternal age in both the fertile and infertile populations. Within the infertile population specifically, we examine the association between male age and outcomes based on treatment modality, including intrauterine insemination (IUI), in vitro fertilization (IVF), and donor oocyte IVF. Finally, we discuss the various mechanisms by which male age may impact sperm and fertility potential, including sperm DNA damage. Copyright © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.
Smith L.P.,Beth Israel Deaconess Medical Center |
Oskowitz S.P.,Beth Israel Deaconess Medical Center |
Barrett B.,Boston IVF |
Bayer S.R.,Beth Israel Deaconess Medical Center
Reproductive BioMedicine Online | Year: 2010
This report describes an unusual case of ovarian torsion during an IVF cycle prior to vaginal oocyte retrieval and the subsequent embryo development. A 27-year-old, whose husband carries a balanced translocation, presented on stimulation day 11 (day after human chorionic gonadotrophin administration) with signs of right ovarian torsion. Transvaginal ultrasound identified decreased right ovarian venous flow but preservation of right ovarian arterial flow. She underwent emergency laparoscopic right ovarian detorsion followed by vaginal oocyte retrieval on postoperative day 1. Ten oocytes were retrieved from the right detorted ovary, 4/10 (40%) were fertilized and 3/4 (75%) became blastocysts. Fifteen oocytes were retrieved from the left ovary, 14/15 (93%) were fertilized and 9/14 (64%) became blastocysts. All 18 embryos biopsied for preimplantation genetic diagnosis carried unbalanced translocations and none were transferred. The markedly reduced fertilization rate of the oocytes from the previously torted ovary is similar to the rate described in a prior report and likely related to decreased but maintained ovarian arterial flow. This report is unique because not only was the patient's ovarian torsion surgically corrected prior to oocyte retrieval but also the embryos originating from the previously torted ovary had excellent development with 75% progressing to the blastocyst stage. © 2010, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
Goldman M.B.,Dartmouth Hitchcock Medical Center |
Thornton K.L.,Boston IVF |
Ryley D.,Boston IVF |
Alper M.M.,Boston IVF |
And 3 more authors.
Fertility and Sterility | Year: 2014
Objective To determine the optimal infertility therapy for women at the end of their reproductive potential. Design Randomized clinical trial. Setting Academic medical centers and private infertility center in a state with mandated insurance coverage. Patient(s) Couples with ≥6 months of unexplained infertility; female partner aged 38-42 years. Intervention(s) Randomized to treatment with two cycles of clomiphene citrate (CC) and intrauterine insemination (IUI), follicle stimulating hormone (FSH)/IUI, or immediate IVF, followed by IVF if not pregnant. Main Outcome Measure(s) Proportion with a clinically recognized pregnancy, number of treatment cycles, and time to conception after two treatment cycles and at the end of treatment. Result(s) We randomized 154 couples to receive CC/IUI (N = 51), FSH/IUI (N = 52), or immediate IVF (N = 51); 140 (90.9%) couples initiated treatment. The cumulative clinical pregnancy rates per couple after the first two cycles of CC/IUI, FSH/IUI, or immediate IVF were 21.6%, 17.3%, and 49.0%, respectively. After all treatments, 110 (71.4%) of 154 couples had conceived a clinically recognized pregnancy, and 46.1% had delivered at least one live-born baby; 84.2% of all live-born infants resulting from treatment were achieved via IVF. There were 36% fewer treatment cycles in the IVF arm compared with either COH/IUI arm, and the couples conceived a pregnancy leading to a live birth after fewer treatment cycles. Conclusion(s) A randomized controlled trial in older women with unexplained infertility to compare treatment initiated with two cycles of controlled ovarian hyperstimulation/IUI versus immediate IVF demonstrated superior pregnancy rates with fewer treatment cycles in the immediate IVF group. Clinical Trial Registration Number NCT00246506. Copyright © 2014 American Society for Reproductive Medicine, Published by Elsevier Inc.
Alper M.M.,Boston IVF
Fertility and Sterility | Year: 2013
Assisted reproductive technology (ART) programs are complex organizations requiring the integration of multiple disciplines. ISO 9001:2008 is a quality management system that is readily adaptable to an ART program. The value that ISO brings to the entire organization includes control of documents, clear delineation of responsibilities of staff members, documentation of the numerous processes and procedures, improvement in tracking and reducing errors, and overall better control of systems. A quality ART program sets quality objectives and monitors their progress. ISO provides a sense of transparency within the organization and clearer understanding of how service is provided to patients. Most importantly, ISO provides the framework to allow for continual improvement. © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.
Sakkas D.,Boston IVF
Fertility and Sterility | Year: 2013
The increasing focus on developing new tools to more accurately diagnose and select individual sperm before intracytoplasmic sperm injection will allow us to counsel and treat couples with greater confidence and efficiency. Current sperm selection techniques are based on the premise that if an ejaculated spermatozoon has cleared spermatogenesis with the correct morphology and/or membrane properties then it is most likely normal. Techniques that are designed to prepare a clean "normal" sperm population or that assist in selecting an individual "normal" spermatozoon are currently being investigated. The use of techniques, including density-gradient preparation, electrophoretic separation, microfluidics, high-magnification sperm morphology selection, and hyaluronic acid binding, is discussed. The research evidence that supports the interrelated developmental and genetic integrity of the selected sperm, particularly sperm DNA damage and clinical outcome evidence are presented. Copyright © 2013 American Society for Reproductive Medicine, Published by Elsevier Inc.
Sakkas D.,Boston IVF |
Ramalingam M.,University of Dundee |
Garrido N.,IVI Valencia |
Barratt C.L.R.,University of Dundee
Human Reproduction Update | Year: 2015
BACKGROUND: In natural conception only a few sperm cells reach the ampulla or the site of fertilization. This population is a selected group of cells since only motile cells can pass through cervical mucus and gain initial entry into the female reproductive tract. In animals, some studies indicate that the sperm selected by the reproductive tract and recovered from the uterus and the oviducts have higher fertilization rates but this is not a universal finding. Some species show less discrimination in sperm selection and abnormal sperm do arrive at the oviduct. In contrast, assisted reproductive technologies (ART) utilize a more random sperm population. In this review we contrast the journey of the spermatozoon in vivo and in vitro and discuss this in the context of developing new sperm preparation and selection techniques for ART. METHODS: A review of the literature examining characteristics of the spermatozoa selected in vivo is compared with recent developments in in vitro selection and preparation methods. Contrasts and similarities are presented. RESULTS AND CONCLUSIONS: New technologies are being developed to aid in the diagnosis, preparation and selection of spermatozoa in ART. To date progress has been frustrating and these methods have provided variable benefits in improving outcomes after ART. It is more likely that examining the mechanisms enforced by nature will provide valuable information in regard to sperm selection and preparation techniques in vitro. Identifying the properties of those spermatozoa which do reach the oviduct will also be important for the development of more effective tests of semen quality. In this review we examine the value of sperm selection to see how much guidance for ART can be gleaned from the natural selection processes in vivo. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology.
Stern J.E.,Dartmouth Hitchcock Medical Center |
Hickman T.N.,Houston IVF |
Kinzer D.,Boston IVF |
Penzias A.S.,Boston IVF |
And 2 more authors.
Fertility and Sterility | Year: 2012
Objective: To assess whether total reproductive potential (TRP), the chance of a live birth from each fresh cycle (fresh cycle plus frozen transfers), could be calculated from the national Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) database and whether information not available in SART CORS resulted in significant changes to the TRP calculation. Design: Retrospective study using SART CORS and clinic data. Setting: Three assisted reproductive technology clinics. Patient(s): Women undergoing ART. Intervention(s): None. Main Outcome Measure(s): Two- and three-year TRPs for 2005 and 2006 were calculated according to patient age at cycle start by linking fresh to frozen cycles up to first live birth. Clinic records were used to adjust for (remove) frozen cycles that used more than one fresh cycle as a source of embryos and for any embryos donated to other patients or research or shipped to another facility before a live birth. Result(s): TRP was higher than fresh per-cycle rates for most ages at all clinics, although accuracy was compromised when there were fewer than 20 cycles per category. Two- and 3-year TRPs differed in only 2 of 24 calculations. Adjusted TRPs differed less than three percentage points from unadjusted TRPs when volume was sufficient. Conclusion(s): Clinic TRP can be calculated from SART CORS. Data suggest that calculations of clinic TRP from the national dataset would be meaningful. © 2012 by American Society for Reproductive Medicine.
Balaban B.,VKF American Hospital of Istanbul |
Sakkas D.,Boston IVF |
Gardner D.K.,University of Melbourne
Seminars in Reproductive Medicine | Year: 2014
Successful and consistent outcomes in human in vitro fertilization (IVF) can be readily achieved by all IVF clinics through consideration and optimization of each procedure associated with the collection and processing of gametes, culminating in the resultant culture and transfer of healthy embryos. Furthermore, understanding the interactions between the individual components of the IVF cycle will assist when trouble-shooting possible problems in a laboratory which could have an adverse effect on cycle outcome. This article will review handling of oocytes and embryo culture, preparation of gametes for insemination and microinjection, selection of the most viable gametes and embryos, cryopreservation, and successful embryo transfer from the laboratory perspective. © 2014 by Thieme Medical Publishers, Inc.
News Article | November 17, 2016
This program is ideal for those who understand there are many out of pocket expenses that can be billed for during a surrogacy cycle, causing uncertainty about all of the costs that can arise. At Fertility SOURCE Companies (FSC), we know how the fear of the unknown creates barriers in family building regarding the pregnancy, the baby, the relationship intended parents have with their surrogate and especially the financial costs of surrogacy. Our Single Fee Surrogacy program is unique to the industry, created for parents who want to transfer one embryo to offer up to three tries for a successful pregnancy. At Fertility SOURCE Companies, we are mindful of the health and safety of our surrogates and babies born via surrogacy. Because FSC is a well-established agency with experienced and dedicated professionals, we are proud to offer this program exclusively. Fertility SOURCE Companies is committed to helping intended parents reach their goals by recognizing the need for a more secure arrangement with limited risk. “The Single Fee Surrogacy Program allows intended parents and their treating physician to make medically and ethically responsible decisions about their fertility treatment while removing any financial uncertainty.” – Brian M. Berger MD, Boston IVF “It is my opinion that the Single Fee Surrogacy Program being launched by Fertility SOURCE Companies will be an excellent addition for the patient. It will give the couple a feeling of confidence and financial security. This can only be beneficial since it will allow the couple to have closure on the costs of surrogacy.” – Lawrence B. Werlin MD, Coastal Fertility Medical Center “It provides the intended parents with clarity on the exact cost of the process.” – Bruce Shapiro, MD, PhD, FACOG, The Fertility Center of Las Vegas “We are thrilled to offer a Single Fee Surrogacy Program option to our patients. Particularly international patients who truly appreciate the simplicity.” – Michael Kettel, MD, FACOG, San Diego Fertility Center Please call us to learn more about this fascinating program!