More than 40 percent of patients who experience total fertilization failure after an IVF cycle have a baby at a later attempt, researchers report.
Total fertilization failure after IVF or ICSI can be very frustrating for patients and clinicians alike.
Little information has been available about patients' chances of success in the future or how changes in treatment could improve the likelihood of fertilization in later cycles.
To investigate, Donna Kinzer (Boston IVF, Waltham, Massachusetts, USA) and colleagues conducted a retrospective analysis of data for 555 couples who experienced total fertilization failure during conventional IVF or ICSI.
They found that 44 percent of IVF patients who chose to continue treatment eventually gave birth. This equated to a delivery after 25 percent of embryo transfers and 22 percent of cycles.
After ICSI, 36 percent of couples had a child, after 23 percent of their embryo transfers, in 18 percent of their cycles.
Results also showed that fewer mature oocytes were used in the transfers that ended in complete fertilization failure, compared with earlier or later transfers, Kinzer et al report.
They say these results suggest that "total fertilization failure is not related to sperm parameters but rather is a result of suboptimal response to ovarian stimulation.
They add: "If subtle improvements in oocyte yield can be effected, this may increase the chance of fertilization in subsequent cycles for these patients."
Source: Fertility and Sterility 2008; 90: 284-8
Thursday, October 2, 2008
Wednesday, October 1, 2008
Young, Childless & Snipped
Although he wasn't the neighborhood Lothario, and he didn't have a significant other, Jason Eskridge opted to have a vasectomy when he was 27.
"I did not want to raise children or be a parent due to some sort of mistaken encounter," explains the video engineer from San Jose, California, who is now 34 and lives with his girlfriend of three years.
It's not that Eskridge doesn't like kids; he has eight nieces and nephews whom he adores. He just likes his freedom more, especially the ability to travel throughout the U.S. and Europe, honing his photography chops.
"I've quit steady, solid jobs to work for next to nothing to live somewhere else in the country," Eskridge says. "Not having kids and not having to worry about finding a good city with a good school system certainly does free me to do that."
Eskridge isn't alone in downplaying the act of reproduction. In a 2007 Pew Research Center telephone survey of 2,000 U.S. men and women, only 41 percent said children are "very important to a successful marriage." In 1990, that figure was 65 percent.
Better sterile than sorry
According to the National Institutes of Health, by 2006 one in six U.S. men over age 35 has had a vasectomy, with about half a million getting snipped each year. And while men in their late 30s or 40s are often the ones who opt for the surgery, Dr. Dale McClure, director of Male Infertility at Virginia Mason Medical Center in Seattle, says he sees "a fair number of people under 35" who have undergone the procedure.
"I'm actually seeing more people than I have in the past that are younger that had a vasectomy at age 21 or 22," says McClure.
That doesn't mean doctors are doling out vasectomies like condoms at a free health clinic.
"I jokingly tell patients it's like buying a gun in Chicago," says Dr. Lawrence Ross, professor of urology at the University of Illinois at Chicago. "You can go look at the gun but you can't buy it right away."
That's because, Ross says, "there's no 100 percent guarantee in any case that we can reverse it." Within 10 years of having a vasectomy, there's a 90 to 95 percent success rate for reversal surgery. Beyond that, the success rate drops to 75 to 80 percent.
Given those stats, it's best to consider a vasectomy "a permanent form of sterilization," Ross says. "I will always tell young men that in my 38 years of practice, I've seen many men change their minds."
Second -- and third -- thoughts
McClure says he spends most of his time "putting vasectomies back together," performing more than 2,000 reversals since 1975.
"Over the last several years, it appears that more males under the age of 25 who've never had children and who had a vasectomy are coming in [for a reversal] because they've found a new partner and they want to have children," says McClure.
And sometimes there's more than one change of heart.
"Probably several times per year," the doctor says, "I have people come in who've done the reversal and had a couple kids and want the vasectomy again."
That can end up being an expensive form of birth control: Fees for a vasectomy range from several hundred dollars to $1,000, although it's often covered in part by insurance. Not so for reversals -- McClure charges $6,000, and the cost can run as high as $15,000.
Saving money was one incentive for Eskridge, whose insurance covered $800 of the cost of the procedure. The decision to have a vasectomy was drama-free. "It was something that I'd thought about for years," he says. "It wasn't like the idea came to me three months beforehand."
'So what does your girlfriend think?'
Eskridge's vasectomy wasn't a surprise to girlfriend Sonya Carr, 27, a sales accounts manager. The two were friends for several years before dating, so she knew all about his decision.
"I plan to spend the rest of my life with him, so before I moved in, I did have to consider that I was basically giving up the option of having children," Carr says. "I was already on the fence about having kids, and since realizing I either had to find a new guy or live without them, I've only become more convinced it was the right choice for me, too."
Gloria Mashayekhi, 29, from Houston, can relate. She and husband Dan Mitten, a security supervisor, weren't interested in raising children. But Mashayekhi's birth control pills were sending her blood pressure through the roof.
"I had to go off the birth control in January and he got the vasectomy in February," says Mashayekhi, an executive assistant. "I think the month of no sex was enough of an initiative to quickly find an alternative."
Mitten spent his 30th birthday getting a vasectomy.
Staying snipped
Chuck Rathmann, 42, had a vasectomy during his first marriage at age 33 and then warmed up to the idea of starting a family when he remarried at 38. But rather than undergo reversal surgery, he and his current wife adopted a daughter.
"Frankly, I don't think there is anything really special about my genetic material," says the marketing analyst from Delafield, Wisconsin.
Seven years after his decision, Eskridge admits to only one regret:
"My [best friend] from high school, she's going to get inseminated," he says. "She's a lesbian and she wants to have kids and she hasn't found a partner. I certainly would have liked to have donated [sperm] for her."
"I did not want to raise children or be a parent due to some sort of mistaken encounter," explains the video engineer from San Jose, California, who is now 34 and lives with his girlfriend of three years.
It's not that Eskridge doesn't like kids; he has eight nieces and nephews whom he adores. He just likes his freedom more, especially the ability to travel throughout the U.S. and Europe, honing his photography chops.
"I've quit steady, solid jobs to work for next to nothing to live somewhere else in the country," Eskridge says. "Not having kids and not having to worry about finding a good city with a good school system certainly does free me to do that."
Eskridge isn't alone in downplaying the act of reproduction. In a 2007 Pew Research Center telephone survey of 2,000 U.S. men and women, only 41 percent said children are "very important to a successful marriage." In 1990, that figure was 65 percent.
Better sterile than sorry
According to the National Institutes of Health, by 2006 one in six U.S. men over age 35 has had a vasectomy, with about half a million getting snipped each year. And while men in their late 30s or 40s are often the ones who opt for the surgery, Dr. Dale McClure, director of Male Infertility at Virginia Mason Medical Center in Seattle, says he sees "a fair number of people under 35" who have undergone the procedure.
"I'm actually seeing more people than I have in the past that are younger that had a vasectomy at age 21 or 22," says McClure.
That doesn't mean doctors are doling out vasectomies like condoms at a free health clinic.
"I jokingly tell patients it's like buying a gun in Chicago," says Dr. Lawrence Ross, professor of urology at the University of Illinois at Chicago. "You can go look at the gun but you can't buy it right away."
That's because, Ross says, "there's no 100 percent guarantee in any case that we can reverse it." Within 10 years of having a vasectomy, there's a 90 to 95 percent success rate for reversal surgery. Beyond that, the success rate drops to 75 to 80 percent.
Given those stats, it's best to consider a vasectomy "a permanent form of sterilization," Ross says. "I will always tell young men that in my 38 years of practice, I've seen many men change their minds."
Second -- and third -- thoughts
McClure says he spends most of his time "putting vasectomies back together," performing more than 2,000 reversals since 1975.
"Over the last several years, it appears that more males under the age of 25 who've never had children and who had a vasectomy are coming in [for a reversal] because they've found a new partner and they want to have children," says McClure.
And sometimes there's more than one change of heart.
"Probably several times per year," the doctor says, "I have people come in who've done the reversal and had a couple kids and want the vasectomy again."
That can end up being an expensive form of birth control: Fees for a vasectomy range from several hundred dollars to $1,000, although it's often covered in part by insurance. Not so for reversals -- McClure charges $6,000, and the cost can run as high as $15,000.
Saving money was one incentive for Eskridge, whose insurance covered $800 of the cost of the procedure. The decision to have a vasectomy was drama-free. "It was something that I'd thought about for years," he says. "It wasn't like the idea came to me three months beforehand."
'So what does your girlfriend think?'
Eskridge's vasectomy wasn't a surprise to girlfriend Sonya Carr, 27, a sales accounts manager. The two were friends for several years before dating, so she knew all about his decision.
"I plan to spend the rest of my life with him, so before I moved in, I did have to consider that I was basically giving up the option of having children," Carr says. "I was already on the fence about having kids, and since realizing I either had to find a new guy or live without them, I've only become more convinced it was the right choice for me, too."
Gloria Mashayekhi, 29, from Houston, can relate. She and husband Dan Mitten, a security supervisor, weren't interested in raising children. But Mashayekhi's birth control pills were sending her blood pressure through the roof.
"I had to go off the birth control in January and he got the vasectomy in February," says Mashayekhi, an executive assistant. "I think the month of no sex was enough of an initiative to quickly find an alternative."
Mitten spent his 30th birthday getting a vasectomy.
Staying snipped
Chuck Rathmann, 42, had a vasectomy during his first marriage at age 33 and then warmed up to the idea of starting a family when he remarried at 38. But rather than undergo reversal surgery, he and his current wife adopted a daughter.
"Frankly, I don't think there is anything really special about my genetic material," says the marketing analyst from Delafield, Wisconsin.
Seven years after his decision, Eskridge admits to only one regret:
"My [best friend] from high school, she's going to get inseminated," he says. "She's a lesbian and she wants to have kids and she hasn't found a partner. I certainly would have liked to have donated [sperm] for her."
Tuesday, September 30, 2008
Now, Fertility Spas
Blame it on that ever-expanding Jolie-Pitt brood: I've been reading lots of reports about the increasing popularity of fertility spa treatments. This is not limited to big cities, where career women may be postponing having children. In Ohio, BecomingMom, a "Pregnancy Spa and Imaging Center" offers a 50-minute Preconception Massage for $69, and Peaceful Beginnings in North Carolina offers the same at $40 for 30 minutes.
Many spas list causes of infertility as stress and accumulation of toxins, none of which are causes listed on the evidence based medicine websites. In fact, really the only cause listed that a woman struggling with infertility may be able to change on her own is consumption of too much caffeine. Traditional infertility treatments can be dangerous and expensive so spas have picked up on the need for something more gentle and less invasive, which may be a good thing. But are they peddling false hope? While alternative treatments may be worth a try, it's worth considering why so few of these spas offer infertility treatment for wannabe fathers.
Monday, September 29, 2008
A Biological Clock for Dads Too
Turns out women aren't the only ones with an expiration date on their fertility. An emerging body of research is showing that men, too, have a "biological clock."
Not only do men become less fecund as they age, but their fertility begins to decline relatively early - around age 24, six years or so before women's. Historically, infertility has been seen as a female issue, as has the increased risk of Down syndrome and other birth defects, but studies now also link higher rates of autism, schizophrenia and Down syndrome in children born to older fathers. A recent paper by researchers at Sweden's Karolinska Institute found that the risk of bipolar disorder in children increased with paternal age, particularly in children born to men age 55 or older.
It used to be that "if you had hair on your chest, it was your wife's problem," says Barry Behr, an associate professor of obstetrics and gynecology at the Stanford Medical School and director of Stanford's in vitro fertilization laboratory. Even now, he said, though about half of infertility cases are caused by male factors, such as low sperm count or motility, there are many more tests to evaluate a woman's fertility than a man's.
To some degree, that bias is rooted in biology. Women are born with as many eggs as they'll ever have - about a million. That number steadily diminishes, and "the best eggs are ovulated first," Behr says. The ones that remain - after age 35 or so, on average - are vulnerable to toxins, radiation and other insults that may degrade their quality and viability.
By contrast, men make new sperm about every 90 days, Behr says, so the logic has been that there should not be that much difference between a young man's sperm and an old man's. Indeed, men as old as 94 have been known to father children.
Still, the research suggests it gets harder with age. A French study published in the current issue of Reproductive BioMedicine Online found that in couples undergoing infertility treatment, the father's age had as much effect as the mother's on rates of pregnancy and miscarriage - the older either parent was, the less likely they were to get pregnant, and the more likely to miscarry. Other studies have found similar trends: on average, it will take longer than a year to conceive for 8% of couples in which the man is younger than 25; that percentage nearly doubles, to 15%, in couples with men age 35 or older. Data have also suggested that couples whose partners are the same age, or in which the man is younger than the woman, are more likely to conceive within a year, compared with couples in which men are at least five years older than their partners.
There are many possible explanations for the decline in male fertility, from a decrease in the number of sperm and their motility to lower testosterone levels to the effects of other age-related diseases like diabetes, which is associated with erectile dysfunction and lower levels of testosterone. But researchers think that genetic factors may be behind the link between paternal age and a child's risk of bipolar disorder and psychiatric disorders like autism and schizophrenia, whose origins are increasingly being attributed to DNA. Although sperm may be no more than 90 days old, the cells that make sperm may be subject to increasing DNA mutations as men age, affecting the quality of the sperm they produce.
In the Swedish study, published Sept. 1 in the Archives of General Psychiatry, researchers found that the risk of developing bipolar disorder began to increase in children born to fathers around age 40. The highest risk, however, occurred in men age 55 and older; their offspring were 37% more likely to develop the disorder than children born to men in their 20s. Children of older men were also twice as likely to develop early-onset disease - before age 20 - which studies suggest has a strong genetic component.
What does all this mean for would-be older dads? While women are used to seeing grim statistics about their decreasing chances of achieving pregnancy and the increasing risks of Down syndrome as they age, men have typically believed that they have all the time in the world. Perhaps now, men in their mid-30s will start sharing the same "now or never" pressure to conceive that women have long endured.
When older men father children, Behr says, the traditional response has been to "pat them on the back and buy them a beer." He has seen patients that he felt were too old to become fathers, but "plenty of people make decisions about parenthood that I wouldn't," he says. "Our responsibility is to educate patients with the facts, and they decide."
Not only do men become less fecund as they age, but their fertility begins to decline relatively early - around age 24, six years or so before women's. Historically, infertility has been seen as a female issue, as has the increased risk of Down syndrome and other birth defects, but studies now also link higher rates of autism, schizophrenia and Down syndrome in children born to older fathers. A recent paper by researchers at Sweden's Karolinska Institute found that the risk of bipolar disorder in children increased with paternal age, particularly in children born to men age 55 or older.
It used to be that "if you had hair on your chest, it was your wife's problem," says Barry Behr, an associate professor of obstetrics and gynecology at the Stanford Medical School and director of Stanford's in vitro fertilization laboratory. Even now, he said, though about half of infertility cases are caused by male factors, such as low sperm count or motility, there are many more tests to evaluate a woman's fertility than a man's.
To some degree, that bias is rooted in biology. Women are born with as many eggs as they'll ever have - about a million. That number steadily diminishes, and "the best eggs are ovulated first," Behr says. The ones that remain - after age 35 or so, on average - are vulnerable to toxins, radiation and other insults that may degrade their quality and viability.
By contrast, men make new sperm about every 90 days, Behr says, so the logic has been that there should not be that much difference between a young man's sperm and an old man's. Indeed, men as old as 94 have been known to father children.
Still, the research suggests it gets harder with age. A French study published in the current issue of Reproductive BioMedicine Online found that in couples undergoing infertility treatment, the father's age had as much effect as the mother's on rates of pregnancy and miscarriage - the older either parent was, the less likely they were to get pregnant, and the more likely to miscarry. Other studies have found similar trends: on average, it will take longer than a year to conceive for 8% of couples in which the man is younger than 25; that percentage nearly doubles, to 15%, in couples with men age 35 or older. Data have also suggested that couples whose partners are the same age, or in which the man is younger than the woman, are more likely to conceive within a year, compared with couples in which men are at least five years older than their partners.
There are many possible explanations for the decline in male fertility, from a decrease in the number of sperm and their motility to lower testosterone levels to the effects of other age-related diseases like diabetes, which is associated with erectile dysfunction and lower levels of testosterone. But researchers think that genetic factors may be behind the link between paternal age and a child's risk of bipolar disorder and psychiatric disorders like autism and schizophrenia, whose origins are increasingly being attributed to DNA. Although sperm may be no more than 90 days old, the cells that make sperm may be subject to increasing DNA mutations as men age, affecting the quality of the sperm they produce.
In the Swedish study, published Sept. 1 in the Archives of General Psychiatry, researchers found that the risk of developing bipolar disorder began to increase in children born to fathers around age 40. The highest risk, however, occurred in men age 55 and older; their offspring were 37% more likely to develop the disorder than children born to men in their 20s. Children of older men were also twice as likely to develop early-onset disease - before age 20 - which studies suggest has a strong genetic component.
What does all this mean for would-be older dads? While women are used to seeing grim statistics about their decreasing chances of achieving pregnancy and the increasing risks of Down syndrome as they age, men have typically believed that they have all the time in the world. Perhaps now, men in their mid-30s will start sharing the same "now or never" pressure to conceive that women have long endured.
When older men father children, Behr says, the traditional response has been to "pat them on the back and buy them a beer." He has seen patients that he felt were too old to become fathers, but "plenty of people make decisions about parenthood that I wouldn't," he says. "Our responsibility is to educate patients with the facts, and they decide."
Sunday, September 28, 2008
Fluctuations
I had a bunch of Canadian dollars I needed to exchange, so I went to the currency exchange window at the local bank teller line.
Just one lady in front of me. . .an Asian lady who was trying to exchange yen for dollars and she was a little irritated . . .
She asked the teller, "Why it change?? Yesterday, I get two hunat dolla fo yen. Today I get hunat eighty?? Why it change?"
The teller shrugged his shoulders and said, "Fluctuations".
The Asian lady says, "Fluc you white people, too!"
Just one lady in front of me. . .an Asian lady who was trying to exchange yen for dollars and she was a little irritated . . .
She asked the teller, "Why it change?? Yesterday, I get two hunat dolla fo yen. Today I get hunat eighty?? Why it change?"
The teller shrugged his shoulders and said, "Fluctuations".
The Asian lady says, "Fluc you white people, too!"
Saturday, September 27, 2008
Lawyer Tale
Having already downed a few power drinks, she turned around,
faced him, looked him straight in the eye and said,'Listen up, Buddy.
I screw anybody, anytime, anywhere, your place, my place, in the car,
front door, back door, on the ground, standing up, sitting down,
naked or with clothes on, dirty, clean . . it doesn't matter to me.
I've been doing it ever since I got out of college and I just love it.'
Eyes now wide with interest, he responded,
'No kidding. I'm a lawyer, too. What firm are you with?'
Friday, September 26, 2008
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