Two studies have suggested that a male infection with ureaplasma may increase the risk of miscarriage after ICSI treatment. Ureaplasma is a bacteria which may grow in the reproductive tract. It is notoriously difficult to grow in the lab and so is seldom tested. There are no symptoms. We performed a study looking at how common ureaplasma was in our population. We asked all men having a semen analysis if they were happy to be tested for this.18% of men were positive. The study was tricky to do as we needed to taxi the samples to the lab immediately.
At Fertility Associates we have decided to ask all couples starting IVF to take a single dose of azithromycin (an antibiotic) as a precautionary measure. Many IVF clinics world-wide give prophylactic antibiotics to the man and woman prior to IVF treatment, so the concept is not new. Although ureaplasma may impact more on the outcome of an ICSI cycle, we decided to treat all people doing IVF as well, as there are some circumstances when ICSI may be required because of sperm quality on the day of egg collection.
Read more about Ureaplasma and Azithromycin in our Fertility Facts sheets here
Wednesday, 14 March 2012
Saturday, 25 February 2012
Fertility and Cancer
Fertility and cancer are subjects that many would not associate with each other but increasingly as cancer treatments are improving, then survivors are living with the consequences of their cancer treatments and for some this means infertility. There are an increasing number of options which are being offered so this blog is an overview of all of the options and what may be coming in the future.
So, I am going to separate the options for men and women. Men first. Freezing of sperm has been successful since the 1950s and in NZ sperm freezing prior to chemotherapy, surgery or radiotherapy is free. Men need however to be told about it ! The sperm may not be of good quality and ICSI may be required into the future. Occasionally no sperm is seen in the ejaculate and then sometimes testicular retrieval of sperm is offered. Studies have shown that less than 10% of men will request that this sperm is used into the future, as some will have normal fertility and some will not choose to parent, but at least if there is sperm frozen, then those men have the option.
Prepubscent boys are in a more difficult space. Those boys have not yet developed mature sperm producing cells in their testes and there is much debate whether testicular tissue should be stored in the hope that technology will develop so this tissue may produce usable sperm. At present in New Zealand this is not offered.
For women the choices are harder. The first option is to get on with the cancer treatment and then consider choices such as donor egg treatment or surrogacy in the future. For some women who are receiving radiotherapy to their pelvis, their ovaries can be moved away from the field of radiotherapy. Other women have the time to undergo a round of IVF treatment prior to starting chemotherapy and the eggs or embryos frozen for their future use. For others, then storage of ovarian tissue may be an option. This is where a part or whole ovary is removed, sliced into fine pieces and then frozen. The frozen tissue may then be thawed and replaced into the woman's pelvis. So far 19 pregnancies have been reported from this technology, so still early days. There are also some concerns around the chances of some cancer cells being present in the ovarian tissue.
There has also been some interest in a group of drugs called gonadotrophin-releasing hormone analogues as they may have a protective effect on the ovaries if used during chemotherapy. There are conflicting reports as to how useful these drugs may be and further studies are awaited. For girls, the only option is ovarian tissue storage.
All people who are facing cancer treatments and who have not completed their families should be given the option of a consultation with a fertility specialist so they can make some informed decisions, as once the cancer treatments have commenced, then it may be too late to preserve fertility.
So, I am going to separate the options for men and women. Men first. Freezing of sperm has been successful since the 1950s and in NZ sperm freezing prior to chemotherapy, surgery or radiotherapy is free. Men need however to be told about it ! The sperm may not be of good quality and ICSI may be required into the future. Occasionally no sperm is seen in the ejaculate and then sometimes testicular retrieval of sperm is offered. Studies have shown that less than 10% of men will request that this sperm is used into the future, as some will have normal fertility and some will not choose to parent, but at least if there is sperm frozen, then those men have the option.
Prepubscent boys are in a more difficult space. Those boys have not yet developed mature sperm producing cells in their testes and there is much debate whether testicular tissue should be stored in the hope that technology will develop so this tissue may produce usable sperm. At present in New Zealand this is not offered.
For women the choices are harder. The first option is to get on with the cancer treatment and then consider choices such as donor egg treatment or surrogacy in the future. For some women who are receiving radiotherapy to their pelvis, their ovaries can be moved away from the field of radiotherapy. Other women have the time to undergo a round of IVF treatment prior to starting chemotherapy and the eggs or embryos frozen for their future use. For others, then storage of ovarian tissue may be an option. This is where a part or whole ovary is removed, sliced into fine pieces and then frozen. The frozen tissue may then be thawed and replaced into the woman's pelvis. So far 19 pregnancies have been reported from this technology, so still early days. There are also some concerns around the chances of some cancer cells being present in the ovarian tissue.
There has also been some interest in a group of drugs called gonadotrophin-releasing hormone analogues as they may have a protective effect on the ovaries if used during chemotherapy. There are conflicting reports as to how useful these drugs may be and further studies are awaited. For girls, the only option is ovarian tissue storage.
All people who are facing cancer treatments and who have not completed their families should be given the option of a consultation with a fertility specialist so they can make some informed decisions, as once the cancer treatments have commenced, then it may be too late to preserve fertility.
Wednesday, 1 February 2012
Donor Sperm
We have just launched a campaign to increase the recruitment of sperm donors. We have deliberately gone with an edgey feel so as to generate some hype and media interest. With slogans such as 'come one come all' and 'give it a shot' then there has been a pleasing amount of interest and after the first weekend 6 potential new donors contacted the clinic yay!
Our donor sperm programme has changed dramatically over the last 10 years. Now more than 90% of those on our waiting list are single or gay women with the number of heterosexual couples becoming very much the minority. This reflects the improvements that have occurred in the treatment of male infertility along with changing social trends seen in our society. Women in their 30s outnumber men and many have not been able to find a suitable life partner and are aware of their biological clock and are choosing to parent alone. We never have sufficient sperm donors to meet the demand and many women are forced to wait for more than a year before a suitable donor is able to be found.
Potential sperm donors need to be in good health, be aged less than 45 and have no known genetic disorders. They also are required to be identifiable and understand that most children born as a result of sperm donation will want to make contact with their donors at some stage in their lives.
Our donor sperm programme has changed dramatically over the last 10 years. Now more than 90% of those on our waiting list are single or gay women with the number of heterosexual couples becoming very much the minority. This reflects the improvements that have occurred in the treatment of male infertility along with changing social trends seen in our society. Women in their 30s outnumber men and many have not been able to find a suitable life partner and are aware of their biological clock and are choosing to parent alone. We never have sufficient sperm donors to meet the demand and many women are forced to wait for more than a year before a suitable donor is able to be found.
Potential sperm donors need to be in good health, be aged less than 45 and have no known genetic disorders. They also are required to be identifiable and understand that most children born as a result of sperm donation will want to make contact with their donors at some stage in their lives.
Thursday, 12 January 2012
Fertility Tourism
We have all become travellers with cheaper airfares and now with the internet the whole world has become accessible and this has effected change in the fertility world. Many people are exploring options offshore when locally their needs are not being met.
Mostly people are travelling because they cannot find an egg or sperm donor. A few travel in the quest for surrogacy or because they perceive that better technologies may be available elsewhere.
With regards to sperm donation, then prior to the introduction of the HART act in NZ in 2004 then it was possible to go on line to most American sperm banks, select your favourite sperm donor profile (maybe 6 foot 2 inches, tanned with green eyes and a lawyer) and get the sperm shipped down. Now it is illegal to import sperm where the donor has been paid. So this means going there. However there are some real downsides to going to an overseas clinic for sperm donation and not just about the cost. The real downside is around losing the upside of the HART act, which allows the child to contact their donor into the future. The other huge drawback is that your donor may already have tens or even hundreds of offspring. It is also hard to know how well the donors have been screened for infectious and genetic diseases. Also many overseas clinics have a much more aggressive approach to multiple pregnancies. At Fertility Associates the current wait time for a clinic recruited sperm donor is around 10 months and for a sperm donor in an IVF programme it is only 3 months, so would I encourage offshore sperm donation? It's a no from me.
Egg donation is a little different. It is all about age in the world of egg donation so the younger the egg donor the more likely that a baby will result from her eggs. There are many countries where it is legal to pay egg donors (not in NZ or Australia) which has encouraged a thriving industry around young women effectively selling their eggs. There are some risks to the egg donor as a result of the egg donation process namely ovarian hyperstimulation syndrome, bleeding or rarely infection at the time of egg collection possibly resulting in infertility. Once again overseas egg donation often means that the process is anonymous, multiple pregnancies are more common and it is harder to be sure about the standards of the clinic. So if you are considering overseas egg donation I would encourage people to choose a reputable clinic, from a developed country and ask lots of questions. We have forged a relationship with the San Diego Fertility Centre as we know the doctors, have visited their clinic and are very satisfied with their standards of practice. Over the past year about 30 couples have travelled to San Diego and had egg donation and more than 70 % are now pregnant half with twins. The cost is huge around NZ$45,000 and any frozen embryos created cannot be imported back into NZ so more travel is required.
There is an argument around the exploitive aspects of egg donation but I think that is something that individuals need to resolve within themselves. My personal view is that provided a woman is 20 or more (so can vote, drink and fight for her country) and has been given appropriate information about the process of egg donation, counselling and the process is performed according to best practice, then compensation for egg donation is very reasonable.
Travelling for surrogacy is way harder as once the baby is born it is difficult or impossible to bring the baby back into NZ and arrange the adoption process.My advice is seek extensive legal advice before even considering this.
So if travelling overseas for fertility treatment is some you are considering, ask your local fertility specialists for advice, they will be able to give you a heads up around the process, good clinics and the legal aspects.
Mostly people are travelling because they cannot find an egg or sperm donor. A few travel in the quest for surrogacy or because they perceive that better technologies may be available elsewhere.
With regards to sperm donation, then prior to the introduction of the HART act in NZ in 2004 then it was possible to go on line to most American sperm banks, select your favourite sperm donor profile (maybe 6 foot 2 inches, tanned with green eyes and a lawyer) and get the sperm shipped down. Now it is illegal to import sperm where the donor has been paid. So this means going there. However there are some real downsides to going to an overseas clinic for sperm donation and not just about the cost. The real downside is around losing the upside of the HART act, which allows the child to contact their donor into the future. The other huge drawback is that your donor may already have tens or even hundreds of offspring. It is also hard to know how well the donors have been screened for infectious and genetic diseases. Also many overseas clinics have a much more aggressive approach to multiple pregnancies. At Fertility Associates the current wait time for a clinic recruited sperm donor is around 10 months and for a sperm donor in an IVF programme it is only 3 months, so would I encourage offshore sperm donation? It's a no from me.
Egg donation is a little different. It is all about age in the world of egg donation so the younger the egg donor the more likely that a baby will result from her eggs. There are many countries where it is legal to pay egg donors (not in NZ or Australia) which has encouraged a thriving industry around young women effectively selling their eggs. There are some risks to the egg donor as a result of the egg donation process namely ovarian hyperstimulation syndrome, bleeding or rarely infection at the time of egg collection possibly resulting in infertility. Once again overseas egg donation often means that the process is anonymous, multiple pregnancies are more common and it is harder to be sure about the standards of the clinic. So if you are considering overseas egg donation I would encourage people to choose a reputable clinic, from a developed country and ask lots of questions. We have forged a relationship with the San Diego Fertility Centre as we know the doctors, have visited their clinic and are very satisfied with their standards of practice. Over the past year about 30 couples have travelled to San Diego and had egg donation and more than 70 % are now pregnant half with twins. The cost is huge around NZ$45,000 and any frozen embryos created cannot be imported back into NZ so more travel is required.
There is an argument around the exploitive aspects of egg donation but I think that is something that individuals need to resolve within themselves. My personal view is that provided a woman is 20 or more (so can vote, drink and fight for her country) and has been given appropriate information about the process of egg donation, counselling and the process is performed according to best practice, then compensation for egg donation is very reasonable.
Travelling for surrogacy is way harder as once the baby is born it is difficult or impossible to bring the baby back into NZ and arrange the adoption process.My advice is seek extensive legal advice before even considering this.
So if travelling overseas for fertility treatment is some you are considering, ask your local fertility specialists for advice, they will be able to give you a heads up around the process, good clinics and the legal aspects.
Sunday, 18 December 2011
Running out of Eggs?
This is the hardest thing that both patients and fertility doctors have to deal with. Women are born with their entire egg supply and never make new ones and about 10 years before the menopause their fertility declines precipitously. The average age at last birth in normally fertile women is 41. As egg supplies dwindle, then chromosomal abnormalities in eggs increase, leading to reduced implantations and increased miscarriages.
There are many women who know that their egg supply is low because of their age, FSH or AMH levels or previous response to treatment and who wish to know how they may improve their egg quality or egg numbers in an IVF cycle.
There is a large amount of research looking at whether the mitochondria in eggs may be refreshed which may mean that eggs do not age in the same way. Currently, there are no products that have been shown to be effective.
There are a variety of medications that have been used to try and increase response ie egg numbers in an IVF cycle, ranging from increasing doses of IVF drugs, DHEA, LH, testosterone and growth hormone. Increasing the dose of drugs only works to a degree as all receptor sites become occupied. There is no good evidence to recommend the use of DHEA or LH. There are 2 small trials suggesting that testosterone may slightly increase response to IVF drugs and pregnancy rates in women who respond poorly. There are 6 small trials suggesting a benefit with the addition of growth hormone. Fertility Associates is recruiting for the LIGHT study, which is a multi-centre Australasian study aiming to recruit 400 women to properly answer the question: Does the addition of growth hormone in women who respond poorly, improve take home baby rates? If you are interested in being part of this study please contact me on mbirdsall@fertilityassociates.co.nz.
Sometimes the only option is the use of donor eggs. There is an increasing demand for donor eggs and along with it an increasing amount of reproductive tourism which has sprung up. Next week's blog will be about travelling to get a baby, what everyone should know.
To find out more about the difference between trying to conceive in your 30s compared with your 40s, take a look at our website here.
There are many women who know that their egg supply is low because of their age, FSH or AMH levels or previous response to treatment and who wish to know how they may improve their egg quality or egg numbers in an IVF cycle.
There is a large amount of research looking at whether the mitochondria in eggs may be refreshed which may mean that eggs do not age in the same way. Currently, there are no products that have been shown to be effective.
There are a variety of medications that have been used to try and increase response ie egg numbers in an IVF cycle, ranging from increasing doses of IVF drugs, DHEA, LH, testosterone and growth hormone. Increasing the dose of drugs only works to a degree as all receptor sites become occupied. There is no good evidence to recommend the use of DHEA or LH. There are 2 small trials suggesting that testosterone may slightly increase response to IVF drugs and pregnancy rates in women who respond poorly. There are 6 small trials suggesting a benefit with the addition of growth hormone. Fertility Associates is recruiting for the LIGHT study, which is a multi-centre Australasian study aiming to recruit 400 women to properly answer the question: Does the addition of growth hormone in women who respond poorly, improve take home baby rates? If you are interested in being part of this study please contact me on mbirdsall@fertilityassociates.co.nz.
Sometimes the only option is the use of donor eggs. There is an increasing demand for donor eggs and along with it an increasing amount of reproductive tourism which has sprung up. Next week's blog will be about travelling to get a baby, what everyone should know.
To find out more about the difference between trying to conceive in your 30s compared with your 40s, take a look at our website here.
Sunday, 4 December 2011
Supplements and fertility
Many people ask me what supplements they should be taking to maximise their chances of having a healthy child.
For a man then there is little evidence that a supplement is helpful. Menevit is extensively marketed in New Zealand and Australia for sperm health and contains lycopene, Vitamin C and E along with folic acid, zinc and selenium. There is one published trial on menevit which looked at 60 men with very abnormal sperm, who were randomised to take either menevit or a placebo for 3 months prior to an IVF cycle. The partners of the men taking menevit had 38.5% ongoing pregnancies and those in the placebo arm had 16% ongoing pregnancies and this result was significant. However, there have been no trials looking at men with normal semen analyses and so it is hard to come to the conclusion that all men should take menevit when trying to conceive. We need more trials.
For women, there is very good evidence that folic acid taken for 3 months prior to conceiving and then until 12 weeks of pregnancy is associated with a much reduced chance of a neural tube defect. In NZ the recommended dose of folic acid is 0.8mg. Some women should take an increased dose of folic acid (5mg) such as those with a neural tube defect, or a family history or a previous affected babe and those on some epilepsy medications, as well as possibly women with recurrent miscarriage.
The NZ Ministry of Health has just issued guidelines suggesting that women conceiving should also be on an iodine supplement unless they have hyperthyroidism. We used to get adequate iodine from our milk bottles being washed in an iodine based cleaner and through the use of iodised salt, neither of these things happen now and adequate iodine intake can make as much as 10 IQ points difference to your baby so go iodine.
Adequate vitamin D levels are also associated with better pregnancy outcomes. Dark skinned women are particularly at risk and usually benefit from a vitamin D supplement whereas fairer skinned women can usually get enough Vitamin D by exposing skin for 20 minutes per day to some sunshine.
Omega Fatty acids have received a lot of attention and may improve fetal brain development and in one study in women doing IVF, embryo morphology so reasonable to be on an omega 3 supplement or better still eat oily fish twice per week.
There is some interesting work being done on resveratrol in women with endometriosis suggesting there may be some benefit.
Other supplements? I guess I remain unconvinced and will wait to see some reasonable trials before recommending other supplements.
More information:
When planning to get pregnant, there are no wonder foods to boost fertility, but there are some foods that you should eat more of, and others which should be avoided. Find out what we recommend to our patients here and some lifestyle changes we suggest here.
For a man then there is little evidence that a supplement is helpful. Menevit is extensively marketed in New Zealand and Australia for sperm health and contains lycopene, Vitamin C and E along with folic acid, zinc and selenium. There is one published trial on menevit which looked at 60 men with very abnormal sperm, who were randomised to take either menevit or a placebo for 3 months prior to an IVF cycle. The partners of the men taking menevit had 38.5% ongoing pregnancies and those in the placebo arm had 16% ongoing pregnancies and this result was significant. However, there have been no trials looking at men with normal semen analyses and so it is hard to come to the conclusion that all men should take menevit when trying to conceive. We need more trials.
For women, there is very good evidence that folic acid taken for 3 months prior to conceiving and then until 12 weeks of pregnancy is associated with a much reduced chance of a neural tube defect. In NZ the recommended dose of folic acid is 0.8mg. Some women should take an increased dose of folic acid (5mg) such as those with a neural tube defect, or a family history or a previous affected babe and those on some epilepsy medications, as well as possibly women with recurrent miscarriage.
The NZ Ministry of Health has just issued guidelines suggesting that women conceiving should also be on an iodine supplement unless they have hyperthyroidism. We used to get adequate iodine from our milk bottles being washed in an iodine based cleaner and through the use of iodised salt, neither of these things happen now and adequate iodine intake can make as much as 10 IQ points difference to your baby so go iodine.
Adequate vitamin D levels are also associated with better pregnancy outcomes. Dark skinned women are particularly at risk and usually benefit from a vitamin D supplement whereas fairer skinned women can usually get enough Vitamin D by exposing skin for 20 minutes per day to some sunshine.
Omega Fatty acids have received a lot of attention and may improve fetal brain development and in one study in women doing IVF, embryo morphology so reasonable to be on an omega 3 supplement or better still eat oily fish twice per week.
There is some interesting work being done on resveratrol in women with endometriosis suggesting there may be some benefit.
Other supplements? I guess I remain unconvinced and will wait to see some reasonable trials before recommending other supplements.
More information:
When planning to get pregnant, there are no wonder foods to boost fertility, but there are some foods that you should eat more of, and others which should be avoided. Find out what we recommend to our patients here and some lifestyle changes we suggest here.
Thursday, 24 November 2011
What can guys do to make great sperm?
Men make sperm continuously from puberty to death so general lifestyle factors and health can have a very direct influence on sperm production. So what can a guy do to improve sperm quality?
Firstly, start young as men's sperm quality worsens with age and there is a slightly increased risk of autism, schizophrenia and dwarfism in the children born from older dads. Secondly, keep the testes cool, they are located outside of the body for a reason, so being active, wearing baggier pants and not sitting in a hot bath or sauna every night is wise. Then, stay slim as fatter men have worse sperm and lower success rates on an IVF program compared to slimmer men. Having just said that, there should be some caveats around moderation as serious cyclists (greater than 200km per week) may have poorer sperm.
Avoiding cigarettes and dope also improves sperm health. Too much alcohol is also detrimental to both sexual performance and sperm production and the recommended limits are 20 units per week.
Antioxidants may also benefit sperm and they can be found in brightly coloured fruit and veg such as berries, dark chocolate, red wine and nuts such as brazil nuts. There was a recent study showing that men who had a prudent diet consisting of fish, fruit,vegetables, legumes and whole grains had better sperm motility compared to men having a typical Western diet.
Bisphenol A found in soft plastics are also thought to be disruptive to the DNA in sperm so avoiding drinking out of BPA bottles is wise.
Frequent ejaculation is also great for sperm, definitely saving it up does not help.
There are also some commonly prescribed medications which may be detrimental to sperm such as hairloss medication, sulphasalazines, paroxetine, methotrexate and some blood pressure medications. Check with your doctor.
Next week I am planning to blog about supplements, which are good, bad or downright ugly.
Thanks,
Mary
Firstly, start young as men's sperm quality worsens with age and there is a slightly increased risk of autism, schizophrenia and dwarfism in the children born from older dads. Secondly, keep the testes cool, they are located outside of the body for a reason, so being active, wearing baggier pants and not sitting in a hot bath or sauna every night is wise. Then, stay slim as fatter men have worse sperm and lower success rates on an IVF program compared to slimmer men. Having just said that, there should be some caveats around moderation as serious cyclists (greater than 200km per week) may have poorer sperm.
Avoiding cigarettes and dope also improves sperm health. Too much alcohol is also detrimental to both sexual performance and sperm production and the recommended limits are 20 units per week.
Antioxidants may also benefit sperm and they can be found in brightly coloured fruit and veg such as berries, dark chocolate, red wine and nuts such as brazil nuts. There was a recent study showing that men who had a prudent diet consisting of fish, fruit,vegetables, legumes and whole grains had better sperm motility compared to men having a typical Western diet.
Bisphenol A found in soft plastics are also thought to be disruptive to the DNA in sperm so avoiding drinking out of BPA bottles is wise.
Frequent ejaculation is also great for sperm, definitely saving it up does not help.
There are also some commonly prescribed medications which may be detrimental to sperm such as hairloss medication, sulphasalazines, paroxetine, methotrexate and some blood pressure medications. Check with your doctor.
Next week I am planning to blog about supplements, which are good, bad or downright ugly.
Thanks,
Mary
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