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COGI update IVF risks

IVF/ICSI, still high risk procedures.

Dr Skupski reminded everyone at the COGI conference 2011 that fertility treatment is still a high risk procedure. Six deaths have been directly linked to IVF in the Netherlands and 17 deaths occurred as a result of complications during pregnancy after IVF. The Netherlands keeps a very good medical record of patients and therefore this country was chosen as an example. However, it is expected that the risk is similarly high across Europe. In his opinion, this is clearly under-reported, and similar figures are expected to exist in other countries.

What are the risks to be aware of?

COGI conference update on DHEA

DHEA supplementation

The DHEA hormone? has now been mentioned at several international congresses. It appears to be particularly useful in women with low ovarian reserve undergoing IVF/ICSI. Dr Gleicher reported a few case studies with very promising results. In just a few months, the AMH levels had improved. This probably also plays a positive role for natural conception?.

Testing for ovarian reserve

FSH? and AMH - How best to test for ovarian reserve

It is now well established that AMH and FSH measured in blood can give a clear indication of ovarian reserve. This in turn will give an indication on how easy, challenging or impossible it will be to stimulate the ovaries during an IVF/ICSI cycle.

During the COGI 2011 conference Dr Gleicher advised that, in his experience, he recommends AMH and FSH to both be measured in women over 42, however for younger women measuring AMH is sufficient. He mentioned that, in his clinic, they do not offer IVF for patients who have an AMH below 0.5ng/mL as the results are not high enough to justify the invasiveness of the procedure.

CGH array

A fairly new technique is now in use in the largest IVF/ICSI clinics worldwide.

CGH array is a method allowing scientists to have a clear overview of the chromosomal content of the embryo?. This is particularly relevant when the couple has a few “good looking” embryos, but which are not leading to a successful pregnancy. It is likely that a number of embryos are chromosomally abnormal, and so would automatically lead to a miscarriage.

IVF protocol

Which IVF protocol is best - Agonist or antagonist?

Dr Gleicher, from the Center for Human Reproduction in New York, presented findings at the COGI 2011 infertility research conference suggesting that in his experience, there is no difference between the live birth rates for the two protocols in “normal responders” (women who produce a good number of eggs during the stimulation). In his opinion, given that the antagonist approach doesn’t lead to a lower success rate, and that it is a safer protocol, it should be the first point of call.

In-vitro maturation

Disussion at COGI, Paris 2011

IVM – In vitro maturation - is a procedure recommended for women who do not respond well to IVF treatment (not enough eggs are produced, no eggs are mature or when there is a high risk of OHSS - ovarian hyper-stimulation syndrome.

The overall success rate of IVM is lower than for IVF. However it may be the only solution for some patients. Scientists around the world are carefully studying the possible causes of this lower success rate; but as always in this field, it is never a simple story.

COGI discussion on luteal phase support

How can the Luteal phase be supported?

Luteal phase support during IVF/ICSI cycles was the topic of several debates at the COGI conference in Paris. Due to the nature of the conference, the focus was solely on the developments of assisted medical treatment and procedures for infertile couples.
During an IVF/ICSI cycle, the woman takes medication which cause her to secrete? lower levels of the LH? hormone?. This is known to have an effect on progesterone? and oestradiol levels and reduce the chance of pregnancy. This is why most women undergoing IVF/ICSI receive progesterone supplements to support the luteal phase.

COGI update - Nutrition and fertility

The role of nutrition on fertility

During the COGI conference in Paris, a whole session was dedicated to nutrition, and Dr Chavarrow gave a very positive message, encouraging fertility specialists to talk to their patients more about beneficial effects of nutrition. In particular for women with ovulation? disorders, the data is particularly encouraging.

Cryopreservation

Egg? and embryo? freezing

Cryopreservation allows medical professionals to store eggs, sperm? and embryos. This is commonly performed as part of the IVF cycle, since often many embryos are produced, and they need to be stored. The freezing of the eggs, sperm or embryos is now quite successful, in particular for sperm and embryos.

Scientists at the COGI conference discussed how this technique could also have positive effects on the IVF cycles for patients with PCOS. It would allow the stimulation cycle and the re-implantation? cycle to be separated. On one cycle the woman would have the ovarian stimulation, but the embryos are immediately frozen and re-introduced the following cycle when her hormones are more in control.

Daily sex could improve sperm quality and boost your chances of becoming a father

A study conducted by Dr. Greening of Sydney IVF, a centre for infertility in Sydney, Australia, suggests that daily sex could enhance the genetic quality of sperm? and therefore the chances of conception? for infertile couples.

A pilot study on 42 men with substantial sperm DNA damage was initially conducted, and found that ejaculating every day for a week reduced the DNA fragmentation index — a measure of sperm damage – by 12 per cent. The study was then repeated on 118 men with above average sperm DNA damage. In 81 per cent of these men, DNA damage fell by 12 per cent while sperm DNA damage increased in the remaining 19 per cent.