Dr. Jeff Rakoff, Formerly, Director Fertility Center of Scripps Clinic
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Anxiety, depression may not hinder IVF success
NEW YORK (Reuters Health) – Among women undergoing fertility treatment, symptoms of anxiety and depression do not seem to reduce their chances of becoming pregnant, a new study suggests.
The findings, say researchers, should offer women some reassurance that such psychological symptoms do not have a strong effect on in vitro fertilization (IVF) success.
The multicenter study enrolled 783 Dutch women having their first fertility treatment. the women were asked to complete a questionnaire to assess anxiety and depression symptoms when they were put on the waiting list, 1 or 2 months before the procedure, and 1 day before the treatment.
A total of 421 women had complete information available for analysis. Overall, anxiety and depression symptoms were unrelated to the odds of becoming pregnant. These signs of psychological distress were also unrelated to the cancellation rates.
The findings do not minimize the importance of psychological well-being in women having IVF, the researchers report in the journal Human Reproduction. Studies show that many women suffer anxiety and depression after a failed IVF attempt, and research is still needed to see how to best identify and treat these women.
What’s more, "stress" should be considered a "wide concept," and this study did not look at all the forms stress can take — or the possible impact on IVF success, explained lead researcher Dr. Bea Lintsen of Radboud University Nijmegen Medical Center in the Netherlands.
Still, Lintsen told Reuters Health, "the message can be reassuring.
The chance of pregnancy seems not be influenced by anxiety or depression."
Some past studies have linked psychological distress to a lower likelihood of IVF success, while others have found no such connection. this study, according to the researchers, appears to be the largest one to date to look at this relationship.
They point out, however, that further large studies are needed to "reveal more information about the interrelationship between emotions and fertility."
For now, Lintsen said, it’s possible that counseling women that there is a low likelihood that depression or anxiety symptoms will harm their IVF success may actually improve their mental health.
SOURCE: Human Reproduction, January 29, 2009.
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Anxiety, depression may not hinder IVF success
Tags: multicenter study, odds
First IVF Babies Born Using New Chromosome Counting Technique
ScienceDaily (Feb. 7, 2011) — The first babies have now been born in the UK using a new technique pioneered at Oxford University to select the best embryos for IVF. The advance could bring hope to many British couples struggling to have a child and going through many cycles of IVF treatment.
George and Helen Ashton from Gloucestershire are thought to be the first couple to have babies in the UK after using a technique called microarray CGH with IVF embryos five days after fertilisation.
The technique allows the embryos to be checked for the right number of chromosomes before implantation in an IVF treatment, lessening the chance of miscarriage or Down’s syndrome.
The Ashtons had twins last November following treatment at the Oxford Fertility Unit, an independent IVF clinic which maintains strong research partnerships with the University. The boys, Alex and Louis, are now 11 weeks old.
The strategy of applying microarray CGH, or comparative genomic hybridisation, to five-day-old embryos, or ‘blastocysts’, was developed by Dr Dagan Wells and Dr Elpida Fragouli at the University of Oxford, with funding from the Oxford Biomedical Research Centre and in collaboration with partners in the health services and industry.
‘If a sperm and egg come together and produce an embryo with the wrong number of chromosomes, the embryo will usually fail to establish a pregnancy or miscarry,’ explains Dr Dagan Wells of the Nuffield Department of Obstetrics and Gynaecology.
As with routine IVF treatment, several eggs are produced and fertilised. Five days later at the blastocyst stage, a small number of cells are removed from the growing embryo and microarray CGH is used to check for any significant abnormalities present in the chromosomes. in effect it scans the DNA packed up in the cells’ chromosomes for any clear problems. Results are available 24 hours later.
Based on this information, it is possible to make sure that only embryos with the correct number of chromosomes are transferred in IVF, improving pregnancy rates as a result.
The Ashtons had first tried IVF in 2004 and had had five unsuccessful IVF cycles. they were told that it was probably down to bad luck and poor embryo selection, so the couple went to the Oxford Fertility Unit and had their embryos tested using microarray CGH.
"We were of the opinion that this was going to be our last go,’ Mr Ashton said. ‘Array CGH has been a godsend to us — but the big issue is that not many people know about it."
There have been other couples who have given birth to babies after receiving this treatment in Oxford, and a couple from Lancashire had a baby shortly after Christmas after opting for a closely related technique at a Manchester clinic.
Tim Child, director of the Oxford Fertility Unit and a senior fellow at the Nuffield Department of Obstetrics and Gynaecology at Oxford University, said: "We are proud that Oxford Fertility Unit was the first clinic in the UK to use blastocyst chromosome screening successfully. We have a number of couples who have already given birth to babies using this method and we look forward to helping many more."
An ongoing study by Dr Wells and colleagues, part of which was published in the journal Fertility and Sterility last year, has revealed that pregnancy rates after chromosome testing were increased by more than 50% in a group of 200 American patients undergoing IVF treatment. Other studies by the Oxford University group have shown microarray CGH has an accuracy of greater than 95% for detecting abnormal embryos.
Dr Wells says: "for IVF treatment there are two problems. Firstly, many of the embryos produced in a typical IVF cycle have the wrong number of chromosomes or significant chunks of DNA missing or duplicated. secondly, the usual assessments done in an IVF clinic, which involve looking at embryos under the microscope to see how they are growing, cannot distinguish embryos with lethal chromosome problems from those that are healthy.
"The method we have developed allows us to identify which embryos have the correct number of chromosomes. These embryos should have the best chance of producing a baby and the lowest chances of miscarrying or having Down’s syndrome."
Dr Wells does caution that a randomised clinical trial is necessary to be able to say exactly how much benefit microarray CGH provides in reducing the risk of miscarriage and Down syndrome and in improving IVF success rates, and further clinical studies are needed to reveal which patients will benefit the most. there is evidence, however, that couples who have experienced several miscarriages may benefit from this type of testing.
The technique is available now — a company Reprogenetics now provides the test to multiple IVF clinics in the UK — but adds an extra £2,000 on top of the cost of an IVF cycle. The hope is that new innovations being developed at the University of Oxford will lower prices further in the near future.
"in the long run, this could actually save the NHS money," says Dr Wells, "as well as reduce the emotional and physical stresses suffered by couples who often have to undergo multiple cycles of IVF treatment in order to have a child."
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The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by University of Oxford.
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Disclaimer: this article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.
First IVF Babies Born Using New Chromosome Counting Technique
Tags: gloucestershire, implantation, research partnerships
How many ivf cycles did you have to have success?
I am 37 and think that my cycle of ivf has been unsuccessful. I had bleeding on sunday and monday. the embroyo transfer was on November 30. I have one frozen embroyo left. I am just curious on other womans experiences.
Sorry to hear that it was unsuccessful for you this time.
Try to keep positive and also try to relax once you've had the next transfer. sometimes giving yourself a break for a month or two can help. You're 37 so you still have time on your side and if it doesnt work then you can always do another complete cycle.
We did two IVF cycles. the first one resulted in a chemical pregnancy and the second cycle (in November) was successful! I'll be 6 weeks on Wednesday so I'm really, really hoping this one sticks. We didn't have any frozen embryos left after either cycles. I have to say, I didn't think this cycle was successful and figured I would "just know" if I was pregnant. well, I was wrong! keep your chin up and stay positive! I know, easier said than done. I really hope this works for you… IVF is such an emotional rollercoaster.
I was 34 and my husband was 36 – our diagnosis was unexplained infertility. After 4 cycles of Clomid, 3 with Clomid, IUI and HCG trigger shot, 3 IUI cycles with injectibles that all ended in failure . . . we moved onto IVF and were blessed on our first cycle. Our twins will be 16 months old the day after Christmas.
Good luck and loads of baby dust to you!
My wife was 40 and I was 41. Other than minor cysts (that were removed), most of the issues were on my side (low sperm count and no motility). We opted for ICSI IVF.
We were lucky enough to get five embryos with three with real potential. We succeeded on the first try.
My wife had minimal issues with fertility, and, at 40, amazed the doctors with the number of good eggs she produced. the health of her reproductive system may have helped with the success.
Best of luck and keep positive.
I have gone through 2 rounds of ivf. the first failed, the second took. neither cycle left us with any frozen. I was 28 and my husband was 35 and our problem is my husbands' sperm count. We transferred 3 great quality embryos each time, but the second time we did assisted hatching and ended up with twin boys.
Just remember to try to stay positive because I really think that helps. I hope you're wrong about your transfer but if not, keep trying. one day it will be your turn! Good luck!
I have been trying to concieve for 3.5 years . We have been doing IVF for 2 years -2 natural clomid, I IUI, 5 stimulated cycles, 5 fresh embryo transfers and 2 frozen and no success yet!! I am now 38.
Just have to keep going ! I believe it will happen one day .Good luck x
My first IVF took had a baby boy, He was born to early. He lived for four days. nothing to do with Ivf. I am in my second cycle of ivf. I had bleeding the first time. It's called implation bleeding. You have to keep on trying.
How many ivf cycles did you have to have success?
Tags: chemical pregnancy, frozen embryos, ivf cycles, quot
Uterine Health More Important Than Egg Quality
Posted on: Wednesday, 2 February 2011, 19:15 CST
For women seeking pregnancy by assisted reproductive technologies, such as in-vitro fertilization (IVF), a new study shows that the health of the uterus is more relevant than egg quality for a newborn to achieve normal birth weight and full gestation. this study, published in Fertility and Sterility, an international journal for obstetricians, offers new information for women with infertility diagnoses considering options for conceiving.
The study was conducted by Dr. William Gibbons, director of the Family Fertility Program at Texas Children’s Hospital and professor of obstetrics and gynecology at Baylor College of Medicine, along with colleagues at the Society for Assisted Reproductive Technologies (SART) Marcelle Cedars, MD and Roberta Ness, MD. They reviewed three years of data that compared average birth weight and gestational time for single births born as a result of standard IVF, IVF with donor eggs and IVF with a surrogate. while the ability to achieve a pregnancy is tied to egg/embryo quality, the obstetrical outcomes of birth weight and length of pregnancy are more significantly tied to the uterine environment that is affected by the reason the woman is infertile.
There were more than 300,000 IVF cycles during the time of the study producing more than 70,000 singleton pregnancies.
"this is the first time that a study demonstrated that the health of a women’s uterus is a key determinant for a fetus to obtain normal birth weight and normal length of gestation," said Dr. Gibbons. "while obvious issues of uterine fibroids or conditions that alter the shape of the uterus are suspected to affect pregnancy rates, conditions that result in poorer ovarian function to the point of needing donor eggs are not known. Further research is needed to fully understand this complex issue."
As assisted reproductive technologies (ART) in the U.S. mature, increasing attention is directed not just to pregnancy rates but also to the obstetrical outcomes of those resulting pregnancies – meaning the newborn’s birth weight, health and gestational age. Currently, about one percent of U.S. births are the result of ART therapies such as IVF, donor eggs, intracytoplasmic sperm injection, embryo cryopreservation, embryo donation, preimplanation genetic diagnosis, and male infertility surgery and medical therapy.
The study explored several scenarios and found that the birth weight associated with standard IVF – in which the patient carried the embryo created with her own egg – was greater than that associated with donor egg cycles, and less than that in gestational carrier cycles. this finding held true even when other factors were considered showing that the woman’s own uterus may be a determining factor.
Gibbons said the study also determined that a diagnosis of male infertility did not affect birth weight or gestational age, yet every female infertility diagnosis was associated with lower birth weight and a reduced gestational age.
Patients diagnosed with a uterine health issue, such as fibroids or other factors, had babies with the lowest birth weights and gestational ages. this led the researchers to examine the uterine environment as it relates to the type of therapy being considered.
Gibbons explains that in standard IVF, an embryo is transferred to a woman who has just undergone controlled ovarian hyperstimulation, while in donor egg IVF and gestational carrier IVF, the embryo is transferred to a "natural" or unstimulated uterus. Then, the researchers looked at IVF utilizing frozen embryo transfer in which an embryo created with a patient’s own egg is transferred to her own unstimulated uterus. They found that babies born of frozen embryo transfer cycles had markedly greater birth weights than those born as a result of standard IVF.
"That finding may help women seeking pregnancy and their physicians to consider frozen embryo transfer as a possible option if the uterine health is not a consideration," said Gibbons. "this study shows us how so many factors are related to a successful outcome and we continue to learn where further research may be needed."
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Uterine Health More Important Than Egg Quality
Tags: baylor college, embryo quality, william gibbons
