What is PGD (Pre Implantation Genetic Diagnosis) or Preimplantation Genetic Testing?

PGD (Preimplantation Genetic Diagnosis), is a process that allows genetic testing of an embryo prior to implantation and before pregnancy occurs. The procedure coincides with In-Vitro Fertilization (IVF) and uses only embryos analyzed as being free of a specific genetic disorder to be transferred for pregnancy.

PGD is broadly used to refer to any testing performed on an embryo prior to it being transferred to the uterus. However, there is a difference in the terms PGD and PGS.

PGD, Preimplantation Genetic Diagnosis, is a test looking for a specific genetic condition (like cystic fibrosis, sickle cell disease, muscular dystrophy) prior to transfer

PGS, Preimplantation Genetic Screening, is testing for overall chromosomal normalcy in embryos. PGS is not looking for a specific disease diagnosis - it is screening the embryo for normal chromosome numbers.

By testing the chromosomes of the embryos available for transfer, fertility clinics can discard embryos with abnormal chromosomal arrangements and pick the embryo(s) for transfer from those with normal chromosomes.

If you answer Yes to any of these questions, PGD could be helpful for you:

•            Are you a woman over the age of 35?

•            Have you suffered from several miscarriages?

•            Have you had a previous pregnancy with a chromosome abnormality?

•            Has a past IVF cycle been unsuccessful for you?

•            Does low sperm count play a role in your difficulty to conceive?

•            Are you aware of any family history of genetic diseases? For example: cystic fibrosis, muscular dystrophy or Huntington disease

•            Do you want to choose the gender of your child?

Visit our website to read our clients most FAQs about PGS & PGS: http://www.vcrmed.com/other-services/genetic-screening/pgd-and-pgs/

What is Infertility?

Approximately 85% of women will become pregnant within one year of trying. Only an additional 7% of couples will conceive in the second year. Based on these results, infertility is defined as the inability to conceive within 12 months.

The most common causes of Infertility are:

● Advancing Maternal Age: As women age, the number of eggs they produce and the egg quality decreases at a rapid rate.

● Ovulation disorders: Normal and regular ovulation (the release of a mature egg) is essential for women to conceive naturally. There are many disorders that may impact the ability for a woman to ovulate normally. The most common disorders impacting ovulation include PCOS (link to past written PCOS article). Ovulation can be detected by keeping a menstrual calendar or using an ovulation predictor kit.

● Uterine Fibroids: There are three types of fibroids and 40% of women have them. However, only submucosal fibroids reduce a woman's pregnancy rate. Submucosal fibroids can cause heavy periods, or bleeding between periods LINK TO PAST FIBROID ARTICLE

● Endometriosis: It causes infertility by producing inflammation and scarring in the uterine cavity. This can result in pelvic pain and affect eggs, sperm or developing embryos.

● Unknown: About 15% of couples can never pinpoint the cause of their infertility.

Luckily there are fertility treatments to help overcome Infertility:

1) Clomid, Tamoxifen, Letrozole (pill form) or Gonadotropins (Injectable): These medications help induce egg development and ovulation

2) Insemination: Intrauterine Insemination (IUI) is the process where sperm is washed and prepared for placement into the uterine cavity, bypassing the cervix and bringing the sperm closer to the tubes and ovulated egg

3) In Vitro Fertilization (IVF): IVF is the process where the woman's eggs are collected and then fertilized by sperm outside the body in a laboratory

When a couple decides to seek the help of a fertility specialist they will have a fertility evaluation. 

During this process the following will be conducted:

● Medical and Fertility History

● Transvaginal Ultrasound: An ultrasound is an important tool in evaluating the structure of the uterus, tubes, and ovaries. It can also detect any abnormalities like fibroids or ovarian cysts. Additionally, transvaginal ultrasound offers the opportunity for your doctor to assess the estimated number of available eggs (i.e your ovarian reserve).

● Laboratory testing: Blood work is conducted to measure blood levels of hormones like Estradiol, FSH and AMH (anti-Mullerian hormone), (related to ovarian function and overall egg numbers), TSH (assesses thyroid function) and Prolactin (hormone that can affect menstrual function if elevated), and Vitamin D.

● Hysterosalpingogram (HSG): This test is important in evaluating fallopian tubal patency, uterine filling defects such as fibroids and polyps, and scarring of the uterine cavity (Asherman syndrome). Many uterine and tubal abnormalities detected by the HSG can be surgically corrected. We have been performing HSG at our facility since 2009, and Dr Sharara has performed over 1000 HSGs.

● Semen analysis: The semen analysis is the main test to evaluate the male partner fertility concerns. There are many factors analyzed including:

1) semen volume

2) sperm concentration

3) sperm motility (movement)

4) morphology (shape)

5) WBC count

6) viscosity

If you are having trouble conceiving or have already been diagnosed with infertility and are in the process of selecting a fertility clinic, we invite you to visit read this article for an overview of options and factors to consider. Visit: http://vcrmed.blogspot.com/2015/04/how-to-choose-fertility-center.html

Improve your Fertility with a proper Diet

According to the National Survey of Family Growth, Infertility affects over 7.3 million individuals or 1 in 8 couples in the United States. While there are numerous conditions that may cause or contribute to a diagnosis of infertility, a poor diet is a growing and significant factor that couples can address.

Factors like age and genetics cannot be controlled, but controlling the foods you consume is something you can do yourself, without medical procedures, to help improve your fertility. Dr Sharara created The Infertility Diet (TID) to educate couples about this very important topic

 

As a woman contemplates conception, it is recommended that she starts consuming foods high in certain vitamins:

·      Vitamin B supports the release of an egg and promotes implantation Zinc can help with cell division and progesterone production

·      Vitamin C is found in high quantities in the follicle after the egg is release and could play a role in progesterone production

·      Essential Fatty Acids (EFA’s) promote blood flow to the uterus and support the opening of the follicle to release the egg

 It is also recommended to eat the following types of food:

1.    Leafy greens

2.    Whole Grains

3.    Eggs

4.    Meat

5.    Fish (or fish oil supplements)

6.    Drink LOTS of water. Water can transport hormones and develop follicles. It also thins out cervical mucus, allowing sperm to reach the egg

7.    Stop all processed food and avoid foods high in sugar

Dr. Sharara, the Founder & Medical Director at the Virginia Center for Reproductive Medicine understands the road to parenthood can be emotional and costly. To support and guide couples on their journey of trying to conceive, he created an app called “The Infertility Diet.” 

The App shows users how a proper diet can improve their chances of naturally conceiving a healthy baby.

We invite you to learn more about the app http://theinfertilitydiet.com/

An Overview on Egg Freezing

Egg Freezing has become quite popular over the past few years. Women find it appealing to be able to preserve their fertility for medical, lifestyle or career reasons. A variety of companies including Apple and Facebook even assist their employees with the financial costs of Egg Freezing. According to WebMD, there have now been more than 2,000 live births from frozen eggs, about 1,000 within the past 5 years.

The Egg Freezing process is done for a variety of reasons:

•            Cancer or other radiation treated diseases

•            Delay motherhood to pursue educational, career or personal life goals (fertility preservation)

In order to retrieve eggs for freezing, a woman undergoes the same hormone-injection process as in-vitro fertilization. The only difference is that, following egg retrieval, the eggs are frozen.

It takes approximately 4-6 weeks to complete the egg freezing cycle and the steps are the same as the initial stages of the IVF process including:

•2-4 weeks of birth control pills to temporarily turn off natural hormones

•10-14 days of hormone injections to stimulate the ovaries and mature multiple eggs.

Once the eggs have adequately matured, they are removed with a needle placed through the vagina under ultrasound guidance. This procedure is done under intravenous sedation and is not painful. The eggs are then frozen within few hours.

The Virginia Center for Reproductive Medicine recommends and practices a newer freezing technique called Vitrification. This process is ultra-rapid cooling (not true freezing) and reduces potential egg freezing risks. Frozen embryos remain viable for an infinite amount of time after the initial freeze.

When a woman is ready to try to conceive, the eggs are thawed, fertilized using OCSI with partner’s sperm, and transferred to the uterus 5 days later as embryos. This process is called Frozen Embryo Transfer (FET). The eggs will be the exact age and quality of the time period she froze them, regardless how many years have gone by. The pregnancy success rates related to a Frozen Embryo Transfer depend on the women’s age at the time she froze her eggs.

The Virginia Center for Reproductive Medicine invite you to learn more about the Egg Freezing process by visiting: http://www.vcrmed.com/other-services/egg-freezing-program/