A recent study reported in the Journal Nature Medicine led by Massachusetts General’s Jonathan Tilly describes the use of stem cells taken from human ovaries to make new eggs. The stem cells from the ovaries were injected into human ovarian tissue that was then placed under the skin of mice, which provided the blood supply that enabled growth of the tissue. Within two weeks, early stage human eggs had formed.

This study, though promising for new fertility treatment in the future, is a long way from practical medical use. First it must be validated in other studies, and proven safe to use to replenish an older human ovary with a “new supply” of eggs. Practical use of stem cell therapy in the field of infertility and other areas of medicine are still a long ways off. For now the important message is that since women do run out of eggs over time, as women get older it gets much more difficult to get pregnant, so time is critical with female fertility.

Women have millions of eggs when they are developing in their mother’s uterus. By the time a woman is born, she is left with a million eggs; by puberty approximately 300,000, and this number is rapidly depleted over time. The biggest challenge we face in the field of infertility is helping infertility patients to get pregnant who have very few eggs left. We see many patients with very few eggs left in their early 40s, a large number in their late 30s, and even some in their early 30s and late 20s.

At RSC we have aggressive ovarian stimulation protocols available that will help mature multiple eggs in an IVF cycle, but in some women running out of eggs these treatments still do not work. Using a donor egg is a highly successful option for infertility patients who are running out of eggs, and RSC has had outstanding success with this treatment. Soon to be announced in our center is the formation of a national Donor Egg Bank, in which we have collaborated with some of the best infertility centers in the country. This Donor Egg bank will have frozen donor eggs available for women looking for an egg donor. Until very recently, eggs did not freeze well, so if a woman wanted to use an egg donor she needed to get fresh donor eggs which introduced more difficulties with timing and availability. At RSC we will very soon be offering a successful way to use eggs frozen from egg donors through a national Egg Bank.

Though stem cells may hold promise for replenishing a woman’s egg supply in the future, if it does prove to be successful it is still many years away from practical use. When it comes to a woman’s fertility, remember time is of the essence. At RSC, we will try to assist you to make good decisions for your fertility treatment to reach your goal to have a baby.
~ Dr. Louis Weckstein, IVF and Medical Director

 

It should be an easy thing to do, but we're not always so good at doing something that may feel self indulgent. I mean really, ten minutes to do nothing! You could get a load of laundry in, or do some filing from that stack on the corner of your desk, or check your emails.

Finding ten minutes just for you won't fix anything; it won't get the laundry or filing done. But finding ten minutes for yourself is a gift only you can give. Everything else will still be there waiting for you in ten minutes. But just maybe you'll feel that those ten minutes were ten minutes well spent in your otherwise busy day and that it felt good to both give and receive!
~ Karen Volpe, RN, Director of Operations

Many women have trouble getting pregnant due to irregular periods. One of the most common reasons for having irregular menstrual cycles is polycystic ovary syndrome (PCOS). The typical symptoms of PCOS are unpredictable periods and evidence of high male hormone levels (such as excess hair growth on the face or body). Two other common features of PCOS are excess body weight and insulin resistance.

 It is because of this insulin resistance that many women with PCOS are prescribed metformin. Metformin (Glucophage) is an insulin-sensitizing medication that is widely used in treating type 2 diabetes. Women with PCOS do not necessarily have type 2 diabetes, (although they have a higher lifetime risk of developing it), but their bodies may respond in a manner similar to someone who does have diabetes. Therefore, metformin has been extensively studied in women with PCOS.

 Women with PCOS are often given fertility medications to help them ovulate. These medications can come in the form of oral pills, such as clomid or letrozole, or in the form of shots, such as gonadotropin injections. Metformin can be used in addition to any of these medications. It is not uncommon for women with PCOS to be on a combination of metformin and ovulation induction medications in order to achieve a pregnancy. Metformin is a category B medication that has been shown to be safe in pregnancy and is usually continued into the first trimester.

 Women with PCOS may need to do in vitro fertilization (IVF) to become pregnant. One of the risks of IVF is ovarian hyperstimulation syndrome (OHSS). PCOS patients are at a higher risk for developing OHSS because they tend to be young with many follicles. Last month, a randomized controlled trial was published in the Fertility and Sterility journal which showed that metformin reduces the risk of OHSS in patients with PCOS undergoing IVF. 120 patients were studied in which 60 women were placed on metformin and 60 women were given placebo pills. The group of women on metformin had a significantly lower rate of OHSS. There was no difference in embryo quality or pregnancy rates between the two groups.

 If you have irregular periods or have been diagnosed with PCOS, consider asking your physician if metformin may be a good medication for you to try.
~ Dr. Deborah Wachs

You have diligently taken your injections, come to multiple ultrasound appointments, put up with numerous side effects from medications, undergone surgery to retrieve your eggs... and then you get the call. The one in which your nurse case manager tells you to have a full bladder for the transfer of your embryos. This may well be the thing that sends a patient's anxiety level into overdrive. You might be thinking "How on earth do I hold my urine long enough to get through this procedure?" Well the best answer to this question is, you may not have to. All patients are different and depending on how full your bladder is when you arrive for your transfer, you will more than likely be letting some of that urine out. There is a happy place in the middle where the patient is feeling like this might just be doable and we can still see the uterus well to help guide the catheter that will be placing your embryos. There are three things that the full bladder helps us with. The urine in bladder provides an acoustic window to conduct the sound so that we may see the endometrial cavity well, helps to straighten the uterus so that the cather passes easily, and lastly helps to push the intestines out of the way which also helps with the view.

This brings to mind another question. You might be wondering "How do I let out a little urine without going all the way?" When you arrive for your transfer the technician will do a quick ultrasound on your abdomen to see how full you are. Once it has been determined that you can let some out, she will give you a number to count to. Usually you will be told to "go" for 5-10 seconds. This is much easier to do if you don't sit down. Most people just pretend that they are in a public restroom and that there are no seat protectors. You will then have another ultrasound to check the view and many times you will be sent to the restroom again to let a little more urine out. It is much easier to empty a little from your bladder than it is to try to fill one that is empty. You can even practice this technique of "letting a little out" before the day of transfer. Remember that we want the best experience for you and will do our very best to help you achieve "the happy medium".

~Amy Simpson, Ultrasound Tech

 

As part of the routine health screening that RSC does for all patients planning pregnancy, we order a fasting cholesterol panel for any patient over 40. We can also run this panel for you if you have a family history of cholesterol or have any risk factors (obesity, Polycystic Ovarian Syndrome) or complicating factors for heart disease (high blood pressure, diabetes.)

The following articles will help give you an overview of cholesterol disease and the steps we often take prior to pregnancy and during pregnancy. They were written by other doctors and nurses but we agree with what they say.