Florida IVF Doctor reviews recent information about In Vitro Fertilization Risks

A recent article published in JAMA (July 2013), Autism and Mental Retardation Among Offspring After In Vitro Fertilization by Sven Saudin et al., reminds us that most well done assessments have shown that the observed problems are most likely the result of the genetics of the patients being treated and not due to the IVF treatment.  Humans have a risk of congenital problems that is in the range of 3-4%.  These congenital problems may be as minor as a mole or as severe as a major heart defect.  The 3-4% risk of congenital anomalies is seen in a fertile population while infertility patients may expect the risk of congenital anomalies to be almost twice that even if a spontaneous conception occurs after prolonged sub-fertility.

As a Florida IVF Doctor, I find this recent report by Saudin et al (JAMA July 2013) very interesting.  He evaluated Swedish infants born between 1982-2007 for the incidence of autism or mental retardation.  They compared the incidence of these conditions in children conceived with IVF as compared to children born after spontaneous conception.  In my opinion, this is the greatest limitation of this study and many others that attempt to see if the IVF procedures are a cause of congenital anomalies or developmental problems.  Studies are flawed because these problems may be inherent to the infertile population or the multiple pregnancy itself and not the IVF procedures.  An example of this type of problem was seen a few years ago when there was a scare about whether IVF procedures were “causing” and increase in the risk of genetic imprinting disorders like the Angelman syndrome.  A follow up study evaluated the incidence of these conditions in the infertile or subfertile population that eventually conceived without IVF found that the conditions had the same incidence in the subfertile population whether they were treated with IVF or not.

Machelle L. Cedars, M.D. is Professor and Director of the UCSF Women’s Health Clinical Research Center.  He wrote an editorial in the same issue of JAMA.  I include some of his comments about this recent report:

“Prior studies have been largely reassuring regarding the risk of autism following IVF. Most of these studies have come from the Scandinavian countries where country-wide databases and registries provide populations for study and linkage with important aspects of both the exposures and outcomes of interest.  However, these studies have been compromised by relatively small sample sizes, poorly characterized outcomes of interest, and limited specific details about IVF and the associated procedures.”

“The results of the study support the absence of an association between any IVF procedure and autistic disorder compared with spontaneous conception.”

Although the authors found a small risk of mental retardation following IVF compared with spontaneous pregnancies (RR, 1.18 [95% CI, 1.01- 1.36]; 46.3 vs 39.8 per 100 000 person-years), this increase became nonsignificant when only evaluating singleton births.”

“The association of multiple birth and preterm birth with these outcomes is particularly important because decreasing the number of multiple births is a primary goal of assisted reproductive technology.”

“The increased risk of autistic disorder and mental retardation, largely accounted for by multiple pregnancies and preterm delivery, should provide another opportunity for reproductive health physicians to educate patients and other physicians about the importance of limiting embryo transfer number.”

“It is somewhat reassuring that the preliminary analyses in the current study failed to show an association with either assessed outcome and day 5 embryo culture.”

“Because ICSI is often used for male-factor infertility and is considered more invasive, it is of particular interest. The study by Sandin et al found an association between ICSI and mental retardation (RR, 1.51 [95% CI, 1.10-2.09]; 93.5 vs 61.8 per 100 000 person-years). However, similar to other outcomes, this relationship became nonsignificant in singletons.”

“The indication for ICSI in many of the studies with identified risk has been severe male-factor infertility. Very low sperm counts and sperm defects are frequently associated with paternal factors including increased genetic risk.”

“A recent study supports the concept that intrinsic genetic abnormalities of sperm may be a source of identified risk with ICSI in cases of very low sperm counts.”

We need to continue to evaluate these issues.  One fact is exceedingly clear.  We need to continue to do our best to avoid multiple pregnancies.  Recent technological advances with more reliable genetic evaluation of the embryos may make a significant difference in reducing the risk of a multiple pregnancy, the most obvious risk factor for potential morbidity.

Julio E. Pabon, M.D., F.A.C.O.G., July 4, 2013IMG_0440

Medical and Laboratory Director

Fertility Center and Applied Genetics of Florida

Sarasota and Bonita Springs, Florida

www.geneticsandfertility.com

 

 

IVF NEWS: Low Sugar and Higher Protein Diet Boosts IVF Success

IVF success may be boosted by a protein rich and low sugar diet.  More and more medical scientists and physicians are recognizing that  the usual American diet that is rich on carbohydrates may be bad for your health.  More evidence is piling up regarding the inflammatory nature of sugar.  High sugar/carbohydrate consumption has been shown to elevate serum inflammatory markers like C-reactive protein.  Inflammation is being recognized at the basis of the pathophysiology of diseases like atherosclerosis.  More and more cardiologists are realizing that a low carbohydrate diet may be healthier.  Inflammation and high sugar levels may not be the optimal environment for the developing gametes and embryos.

Personally speaking, many of you know that I adhere to a low carb. lifestyle (not a diet).  Since I have changed my habits, my serum inflammatory markers have normalized as well as my cholesterol and triglyceride levels.  I have also lost a significant amount of weight.

I have been recommending  a lower carb and higher protein diet to my obese patients.  Some have lost more than 100 pounds by just following this simple advice:

Buy a good scale and weigh each morning.

Drink an 8-10 ounce glass of sugar-free metamucil each day.

Take a prenatal vitamin or multivitamin.

Stop eating sugar, bread, flour, flour products, pasta, potatoes, sweets, sweet fruits, yogurt, and cereals.

Instead eat protein rich low sugar/carbohydrate foods like meats, eggs, cauliflower, broccoli, cheeses, etc.

Have your doctor check your cholesterol levels before you begin and repeat them after a few weeks on the program.  You will be amazed.  The physiology of the weight loss effect has to do with the lower insulin levels and the higher glucagon levels that result from this diet.

Now, the research quoted below applies to even patients of normal weight.  Read on…

Low-Carb Diet Improves In Vitro Fertilization

By Kate Johnson/As published on Medscape.com

May 08, 2013

 

Reducing carbohydrates and boosting protein intake can significantly improve a woman’s chance of conception and birth after in vitro fertilization (IVF), according to a new study.

The effect is “at the egg level,” said lead investigator Jeffrey Russell, MD, from the Delaware Institute for Reproductive Medicine in Newark. He presented the findings here at American Congress of Obstetricians and Gynecologists 61st Annual Clinical Meeting.

Carbohydrate-loaded diets create a hostile oocyte environment even before conception or implantation, he explained.

“Eggs and embryos are not going to do well in a high-glucose environment.” By lowering carbs and increasing protein, “you’re bathing your egg in good, healthy, nutritious supplements,” he said.

Dr. Russell said this study was prompted by the poor quality of embryos he was seeing in young, healthy women who came through his IVF program. “We couldn’t figure out why. They weren’t overweight, they weren’t diabetic,” he said.

The 120 women in the study, who were 36 and 37 years of age, completed a 3-day dietary log. It revealed that for some, their daily diet was 60% to 70% carbohydrates. “They were eating oatmeal for breakfast, a bagel for lunch, pasta for dinner, and no protein,” Dr. Russell explained.

Patients were categorized into 1 of 2 groups: those whose average diet was more than 25% protein (n = 48), and those whose average diet was less than 25% protein (n = 72). There was no difference in average body mass index between the 2 groups (approximately 26 kg/m²).

There were significant differences in IVF response between the 2 groups. Blastocyst development was higher in the high-protein group than in the low-protein group (64% vs 33.8%; < .002), as were clinical pregnancy rates (66.6% vs 31.9%; < .0005) and live birth rates (58.3% vs 11.3%; < .0005).

When protein intake was more than 25% of the diet and carbohydrate intake was less than 40%, the clinical pregnancy rate shot up to 80%, he reported.

Dr. Russell now counsels all IVF patients to cut down on carbohydrate intake and increase protein intake.

“There is no caloric restriction, but they have to get above 25% protein. This is not a weight-loss program, it’s a nutritional program. This is not about losing weight to get pregnant, it’s about eating healthier to get pregnant,” he said.

Back to Basics

In a study presented at the American Society of Reproductive Medicine (ASRM) meeting last year, IVF patients who switched to a low-carbohydrate, high-protein diet and then underwent another cycle increased their blastocyst formation rate from 19% to 45% and their clinical pregnancy rate from 17% to 83% (Fertil Steril. 2012;98[Suppl]:S47).

Even non-IVF patients with polycystic ovarian syndrome have improved pregnancy rates after making this lifestyle change, Dr. Russell noted.

This “draws attention to a previously understudied area of reproduction…and opens the way for understanding a host of dietary factors that may be related to improved outcomes in the assisted reproductive technologies,” ASRM president-elect Richard Reindollar, MD, who is chair of obstetrics and gynecology at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, told Medscape Medical News.

“These studies demonstrate how little we know about the effect of micronutrients in our diets on various aspects of reproduction. They demonstrate a field wide open for future research and beg questions such as whether, for example, it is carbohydrates in general or the inflammatory effects of gluten in grain carbohydrates that are deleterious to IVF outcomes,” said Dr. Reindollar.

The study’s connection between high blood glucose to IVF success is “an interesting finding that deserves to be evaluated further,” said Sharon Phelan, MD, from the University of New Mexico in Albuquerque, who is a member of the ACOG Scientific Program Committee. She was asked by Medscape Medical News to comment on the findings.

“Although the blood glucose is not high enough to be in the diabetic range, it is enough to be toxic to the developing blastocyst,” she added.” Perhaps this is a call for us to get back to our ‘roots,’ or basic diets, again.”

Dr. Russell, Dr. Reindollar, and Dr. Phelan have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) 61st Annual Clinical Meeting: Abstract 96. Presented May 6, 2013.

All the Best,

 

Julio E. Pabon, M.D.IMG_0440

Medical and Laboratory Director

Fertility Center and Applied Genetics of Florida

Sarasota and Bonita Springs, Florida, U.S.A.

www.geneticsandfertility.com

 

Where Should I do a Sperm Test in Florida?

Where, how, and by whom should the sperm test or semen analysis be done?

As a Board Certified Reproductive Endocrinologist and Infertility Specialist with over 23 years experience in the evaluation and treatment of couples with infertility, I only accept semen analyses performed in laboratories where the personnel is very experienced in this test.  The most qualified technicians for this test are usually found in clinics that treat the most severe infertility problems with in vitro fertilization.  In a state like Florida, the most qualified technicians for performing a semen analysis work with IVF clinics.

 

If a patient comes to see me for consultation, I will always repeat the semen analysis unless it was done within the past six months by our lab or the lab of one of our colleague Reproductive Endocrinologists and Infertility specialists.  I can recall many patients over my career that have been treated incorrectly by other clinicians that based their treatment decisions on incorrect results.  These patients were treated with simple ovulation induction and inseminations when they should have been treated with IVF from the beginning.

 

The semen analysis requires attention to detail and an understanding of very subtle motility and morphology aspects of the sperm cells that requires ongoing quality control and expert oversight.

 

Please read more about the semen analysis test in the Andrology and sperm testing section of our web site at www.geneticsandfertility.com

 

In order to schedule an appointment for a sperm analysis, please contact our offices at 239-333-2229 or 941-324-1568 or by email through our web site at www.geneticsandfertility.com or by direct email at drpabonadmin@geneticsandfertility.com

 

Most Sincerely,

 

Julio E. Pabon, M.D., F.A.C.O.G

copyright J. Pabon collection
copyright J. Pabon collection

Medical and Laboratory Director

Fertility Center and Applied Genetics of Florida

Assistant Clinical Professor, Florida State University College of Medicine

Former President and Current Board Member, Florida Society of Reproductive Endocrinology and Infertility

Sarasota and Bonita Springs, Florida

941-342-1568 / 239-333-2229

www.geneticsandfertility.com

 

Where Should I do a Sperm Test in Bonita Springs, Florida?

Where, how, and by whom should the sperm test or semen analysis be done?

As a Board Certified Reproductive Endocrinologist and Infertility Specialist with over 23 years experience in the evaluation and treatment of couples with infertility, I only accept semen analyses performed in laboratories where the personnel is very experienced in this test.  The most qualified technicians for this test are usually found in clinics that treat the most severe infertility problems with in vitro fertilization.  In a state like Florida, the most qualified technicians for performing a semen analysis work with IVF clinics.

 

If a patient comes to see me for consultation, I will always repeat the semen analysis unless it was done within the past six months by our lab or the lab of one of our colleague Reproductive Endocrinologists and Infertility specialists.  I can recall many patients over my career that have been treated incorrectly by other clinicians that based their treatment decisions on incorrect results.  These patients were treated with simple ovulation induction and inseminations when they should have been treated with IVF from the beginning.

 

The semen analysis requires attention to detail and an understanding of very subtle motility and morphology aspects of the sperm cells that requires ongoing quality control and expert oversight.

 

Please read more about the semen analysis test in the Andrology and sperm testing section of our web site at www.geneticsandfertility.com

 

In order to schedule an appointment for a sperm analysis, please contact our offices at 239-333-2229 or 941-324-1568 or by email through our web site at www.geneticsandfertility.com or by direct email at drpabonadmin@geneticsandfertility.com

 

Most Sincerely,

 

Julio E. Pabon, M.D., F.A.C.O.G

copyright J. Pabon collection
copyright J. Pabon collection

Medical and Laboratory Director

Fertility Center and Applied Genetics of Florida

Assistant Clinical Professor, Florida State University College of Medicine

Former President and Current Board Member, Florida Society of Reproductive Endocrinology and Infertility

Sarasota and Bonita Springs, Florida

941-342-1568 / 239-333-2229

www.geneticsandfertility.com

 

Where Should I Do a Sperm Test in Bradenton, Florida?

Where, how, and by whom should the sperm test or semen analysis be done?

As a Board Certified Reproductive Endocrinologist and Infertility Specialist with over 23 years experience in the evaluation and treatment of couples with infertility, I only accept semen analyses performed in laboratories where the personnel is very experienced in this test.  The most qualified technicians for this test are usually found in clinics that treat the most severe infertility problems with in vitro fertilization.  In a state like Florida, the most qualified technicians for performing a semen analysis work with IVF clinics.

 

If a patient comes to see me for consultation, I will always repeat the semen analysis unless it was done within the past six months by our lab or the lab of one of our colleague Reproductive Endocrinologists and Infertility specialists.  I can recall many patients over my career that have been treated incorrectly by other clinicians that based their treatment decisions on incorrect results.  These patients were treated with simple ovulation induction and inseminations when they should have been treated with IVF from the beginning.

 

The semen analysis requires attention to detail and an understanding of very subtle motility and morphology aspects of the sperm cells that requires ongoing quality control and expert oversight.

 

Please read more about the semen analysis test in the Andrology and sperm testing section of our web site at www.geneticsandfertility.com

 

In order to schedule an appointment for a sperm analysis, please contact our offices at 239-333-2229 or 941-324-1568 or by email through our web site at www.geneticsandfertility.com or by direct email at drpabonadmin@geneticsandfertility.com

 

Most Sincerely,

 

Julio E. Pabon, M.D., F.A.C.O.G

copyright J. Pabon collection
copyright J. Pabon collection

Medical and Laboratory Director

Fertility Center and Applied Genetics of Florida

Assistant Clinical Professor, Florida State University College of Medicine

Former President and Current Board Member, Florida Society of Reproductive Endocrinology and Infertility

Sarasota and Bonita Springs, Florida

941-342-1568 / 239-333-2229

www.geneticsandfertility.com

 

Where Should I Do a Sperm Test in Sarasota, Florida?

Where, how, and by whom should the sperm test or semen analysis be done?

As a Board Certified Reproductive Endocrinologist and Infertility Specialist with over 23 years experience in the evaluation and treatment of couples with infertility, I only accept semen analyses performed in laboratories where the personnel is very experienced in this test.  The most qualified technicians for this test are usually found in clinics that treat the most severe infertility problems with in vitro fertilization.  In a state like Florida, the most qualified technicians for performing a semen analysis work with IVF clinics.

 

If a patient comes to see me for consultation, I will always repeat the semen analysis unless it was done within the past six months by our lab or the lab of one of our colleague Reproductive Endocrinologists and Infertility specialists.  I can recall many patients over my career that have been treated incorrectly by other clinicians that based their treatment decisions on incorrect results.  These patients were treated with simple ovulation induction and inseminations when they should have been treated with IVF from the beginning.

 

The semen analysis requires attention to detail and an understanding of very subtle motility and morphology aspects of the sperm cells that requires ongoing quality control and expert oversight.

 

Please read more about the semen analysis test in the Andrology and sperm testing section of our web site at www.geneticsandfertility.com

 

In order to schedule an appointment for a sperm analysis, please contact our offices at 239-333-2229 or 941-324-1568 or by email through our web site at www.geneticsandfertility.com or by direct email at drpabonadmin@geneticsandfertility.com

 

Most Sincerely,

 

Julio E. Pabon, M.D., F.A.C.O.G

copyright J. Pabon collection
copyright J. Pabon collection

Medical and Laboratory Director

Fertility Center and Applied Genetics of Florida

Assistant Clinical Professor, Florida State University College of Medicine

Former President and Current Board Member, Florida Society of Reproductive Endocrinology and Infertility

Sarasota and Bonita Springs, Florida

941-342-1568 / 239-333-2229

www.geneticsandfertility.com

 

Where Should I Do My Sperm Test In Naples, Florida?

Where, how, and by whom should the sperm test or semen analysis be done?

As a Board Certified Reproductive Endocrinologist and Infertility Specialist with over 23 years experience in the evaluation and treatment of couples with infertility, I only accept semen analyses performed in laboratories where the personnel is very experienced in this test.  The most qualified technicians for this test are usually found in clinics that treat the most severe infertility problems with in vitro fertilization.  In a state like Florida, the most qualified technicians for performing a semen analysis work with IVF clinics.

 

If a patient comes to see me for consultation, I will always repeat the semen analysis unless it was done within the past six months by our lab or the lab of one of our colleague Reproductive Endocrinologists and Infertility specialists.  I can recall many patients over my career that have been treated incorrectly by other clinicians that based their treatment decisions on incorrect results.  These patients were treated with simple ovulation induction and inseminations when they should have been treated with IVF from the beginning.

 

The semen analysis requires attention to detail and an understanding of very subtle motility and morphology aspects of the sperm cells that requires ongoing quality control and expert oversight.

 

Please read more about the semen analysis test in the Andrology and sperm testing section of our web site at www.geneticsandfertility.com

 

In order to schedule an appointment for a sperm analysis, please contact our offices at 239-333-2229 or 941-324-1568 or by email through our web site at www.geneticsandfertility.com or by direct email at drpabonadmin@geneticsandfertility.com

 

Most Sincerely,

 

Julio E. Pabon, M.D., F.A.C.O.G

copyright J. Pabon collection
copyright J. Pabon collection

Medical and Laboratory Director

Fertility Center and Applied Genetics of Florida

Assistant Clinical Professor, Florida State University College of Medicine

Former President and Current Board Member, Florida Society of  Reproductive Endocrinology and Infertility

Sarasota and Bonita Springs, Florida

941-342-1568 / 239-333-2219

www.geneticsandfertility.com

 

Where Should I Do My Sperm Test in Ft Myers? / Who Does The Sperm Test in Ft. Myers?

Where, how, and by whom should the sperm test or semen analysis be done?

As a Board Certified Reproductive Endocrinologist and Infertility Specialist with over 23 years experience in the evaluation and treatment of couples with infertility, I only accept semen analyses performed in laboratories where the personnel is very experienced in this test.  The most qualified technicians for this test are usually found in clinics that treat the most severe infertility problems with in vitro fertilization.  In a state like Florida, the most qualified technicians for performing a semen analysis work with IVF clinics.

 

If a patient comes to see me for consultation, I will always repeat the semen analysis unless it was done within the past six months by our lab or the lab of one of our colleague Reproductive Endocrinologists and Infertility specialists.  I can recall many patients over my career that have been treated incorrectly by other clinicians that based their treatment decisions on incorrect results.  These patients were treated with simple ovulation induction and inseminations when they should have been treated with IVF from the beginning.

 

The semen analysis requires attention to detail and an understanding of very subtle motility and morphology aspects of the sperm cells that requires ongoing quality control and expert oversight.

 

Please read more about the semen analysis test in the Andrology and sperm testing section of our web site at www.geneticsandfertility.com

 

In order to schedule an appointment for a sperm analysis, please contact our offices at 239-333-2229 or 941-324-1568 or by email through our web site at www.geneticsandfertility.com or by direct email at drpabonadmin@geneticsandfertility.com

 

Most Sincerely,

 

Julio E. Pabon, M.D., F.A.C.O.G

copyright J. Pabon collection
copyright J. Pabon collection

Medical and Laboratory Director

Fertility Center and Applied Genetics of Florida

Assistant Clinical Professor, Florida State University College of Medicine

Former President and Current Board Member, Florida Society of Reproductive Endocrinology and Infertility

Sarasota and Bonita Springs, Florida

www.geneticsandfertility.com

 

Fertility Patients With Early Pregnancy Nausea

Here is a new product that can help patients feel better in early pregnancy.  I only wish the name was easier to remember. They should of named it something like nausearx or help-u-eat-better pill.  Anyway.  Here is the info:

FDA approves Diclegis for pregnant women experiencing nausea and vomiting

The U.S. Food and Drug Administration today approved Diclegis (doxylamine succinate and pyridoxine hydrochloride) to treat pregnant women experiencing nausea and vomiting.
Diclegis is a delayed-release tablet intended for women who have not adequately responded to conservative management of nausea and vomiting during pregnancy, such as dietary and lifestyle modifications. These modifications include eating several small meals instead of three large meals, eating bland foods that are low in fat and easy to digest and avoiding smells that can trigger nausea.
“Many women experience nausea and vomiting during pregnancy, and sometimes these symptoms are not adequately managed through recommended changes in diet and lifestyle,” said Hylton V. Joffe, M.D., M.M.Sc., director of the Division of Reproductive and Urologic Products in the FDA’s Center for Drug Evaluation and Research. “Diclegis is now the only FDA-approved treatment for nausea and vomiting due to pregnancy, providing a therapeutic option for pregnant women seeking relief from these symptoms.”
Diclegis was studied in 261 women experiencing nausea and vomiting due to pregnancy. Study participants in the clinical trial were at least 18 years old and had been pregnant for at least 7 weeks and up to 14 weeks. Women were randomly assigned to receive two weeks of treatment with Diclegis or a placebo. The study results showed that women taking Diclegis experienced greater improvement in nausea and vomiting than those taking placebo. Additionally, observational (epidemiological) studies have shown that the combination of active ingredients in Diclegis does not pose an increased risk of harm to the fetus.
Diclegis is taken daily. Tablets must be taken whole on an empty stomach. The recommended starting dose is two tablets taken at bedtime. If symptoms are not adequately controlled, the dose can be increased to a maximum recommended dose of four tablets daily (one in the morning, one mid-afternoon and two at bedtime).
Nausea and vomiting due to pregnancy usually improve after the first trimester. Health care professionals should reassess their patients for continued need for Diclegis as pregnancy progresses.
Drowsiness or sleepiness, which can be severe, is the most common side effect reported by women taking Diclegis. Women should avoid using Diclegis when engaging in activities requiring mental alertness, such as driving or operating heavy machinery, until cleared to do so by their health care provider.
Diclegis is marketed by Duchesnay Inc., based in Blainville, Québec, Canada.

All the Best!

Julio E. Pabon, M.D.

Bonita Springs and Sarasota, Florida

copyright J. Pabon collection
copyright J. Pabon collectionSarasota and Bonita Springs, Florida, U.S.A.

www.geneticsandfertility.com

IVF Ft. Myers / Cape Coral patient with good questions about PGS

A very nice patient who is also a nurse was seen in our Bonita Springs office today.  She is preparing for IVF in the coming weeks and was seen for her practice embryo transfer and other tests.  We were visiting and discussing the plans.  She indicated that she was interested in doing PGS “in order to increase her chance of pregnancy.”

PGS stands for pre-implantation genetic screening.  It is an added procedure during the IVF treatments.  Our clinic performs the embryo biopsies at the blastocyst stage in order to get more accurate results that when a day 3 biopsy is done.  The PGS gives the physician and the patient information about the genetic makeup of the embryo.  PGS results tell us if the embryo in question is expected to have 23 pairs of chromosomes or if it has an abnormal number of chromosomes like is seen in down’s syndrome where the embryo has an extra chromosome 21.

In the past and in most cases of IVF currently, the embryos are chosen based on their appearance.  Unfortunately, embryos can look completely normal and be genetically abnormal.  Abnormal embryos (with abnormal number of chromosomes) are the most common cause of implantation failure, IVF failure, and miscarriages.

In addressing this particular patient, I explained to her that “more technology is not always better.”  I explained that in her particular case the chance that the PGS information would increase her chance of pregnancy depended on the number of eggs and subsequent embryos that she made. If she were to respond conservatively to the ovarian stimulation and make few eggs, then the PGS would probably not increase her chance of pregnancy over the routine IVF where 2 or three embryos are selected based on their appearance.

If a patient makes fewer eggs, the PGS will just serve to give information and prevent the implantation or transfer of an abnormal embryo that would result in no pregnancy, a miscarriage, or even an abnormal fetus.  Fortunately, mother nature is quite good at preventing abnormal embryos from growing.  Please refer to the maternal age and reproduction web page at www.drpabon.com or www.geneticsandfertility.com

One other confounding issue is that I believe PGS can help in most cases because it can change clinical treatment and outcomes.  This is because when PGS is done at the blastocyst stage, the information is so good that we most often do a single embryo transfer.  This virtually eliminates the risk of twins and higher order pregnancies regardless of age.  So, the chance of pregnancy per transfer is higher, but some patients don’t have a transfer because all the embryos are abnormal by PGS or so abnormal they don’t develop to the biopsy stage.

This very nice patient should understand that it is ok to use technology when the use of the technology matches her goals and that sometimes the added cost of the additional technology may not increase her overall chance of pregnancy unless there is a good number of embryos to sort through.  The big question is: how many embryos is enough?  This question has not been answered yet in regards to blastocyst biopsies.

What we should say is that PGS increases the chance of pregnancy per embryo transferred.

All the Best!!

Julio E. Pabon, M.D., F.A.C.O.G.

copyright J. Pabon collection
copyright J. Pabon collection

Medical and Laboratory Director

Fertility Center and Applied Genetics of Florida

Assistant Clinical  Professor

Florida State Univ. College of Medicine

www.geneticsandfertility.com