Irresponsible!!!

In one word this sums it up!!!  I am delighted at the news that the octuplets were brought into this world safely even though they have a long road ahead of them, I sincerely wish them the best.  However, as for the parent and the doctor responsible for their conception, I have other not so delightful thoughts.  I have read a number of reports and it seems to date that the story is still not entirely clarified. From what I have gathered so far, the mother of the octuplets was 33 years old, she already had 6 children at home and she had no male partner.  I have heard different versions……everything from she treated herself, to she had a frozen embryo transplant of 4 embryos and they all split, to she had a fresh IVF cycle and 8 embryos were implanted.  Either way, any of these versions are frankly IRRESPONSIBLE.  At the age of 33, ASRM or the American Society of Reproductive Medicine, recommends that no more than 2-3  embryos be implanted.  So even if four were implanted and they all split, which is highly unlikely, then that is still too many.  A multiple gestation pregnancy has a lot of risks.  I counsel my patients at length on the risk of multiples when undergoing any form of fertility therapy.  The wonderful thing about IVF is that the number of embryos that land in the uterus can be controlled, as opposed to injectable medicine with intrauterine insemination.  In the United States, we are very fortunate to have the freedom to transfer multiple embryos.  There are several scenarios where I could possibly see a reason to transfer more than 3.  IF the person is over the age of 38, or if the person had failed multiple IVF cycles, or in some cases of recurrent miscarriage where PGD was not performed.  Otherwise it is totally IRRESPONSIBLE !!!  Unfortunately, now that the system has been so blatantly abused, regulations may come about which prevent the freedom of performing multiple embryo transfers, which we are able to perform in the United States.  This will directly impact the people who fall into any of the above mentioned categories who may benefit from multiple embryo transfer.

In my clinic, almost every patient that I have seen over the past week has inquired about this.  I would like to inform anyone who is concerned that we are very responsible here at Red Rock Fertility Center and we practice according to the ASRM guidelines as to the recommended number of embryos that should be transferred.  In addition, we have also structured our financial packages in a way that you are not penalized financially if you choose to transfer less embryos and are not successful.  This allows the patients and myself to make the decision together on what we both are comfortable with.  I went into medicine to help people, not to harm them.  I think whoever was responsible for the creation of the octuplet pregnancy needs to reread the Hippocratic Oath!!!  That’s my opinion on this, hopefully in the upcoming weeks we will learn more details on this subject matter.

There is a great deal of research going on in the IVF world on sperm quality.  For the past 20 years, most of the research has been done on oocytes (eggs,) but now there are new tests to better determine sperm quality.  About a year and a half ago, researchers at Yale University came out with a new test, called the PICSI Sperm Selection Device.  You can read more about it by clicking this link.

The main area of interest with this is when a couple is using ICSI to fertilitize the eggs.  This involves directly injecting the sperm DNA into the egg.  Traditionally, a trained embryologist picks the best looking sperm for this procedure.  The goal of the PICSI dish is to give the embryologist a test to see which sperm is the best.  The scientific theory behind this, is that the best sperm bind better to the Hyaluronan on the dish.  Their tests appear to confirm this.  Hyaluronan is a naturally occurring biopolymer in humans.  The data coming from the company appears to confirm the science behind the device.  Hopefully, it will be proven over time in the general fertility community.

This could be a very useful test for couples, as many couples opt to have intrauterine insemination (IUI) done, rather than IVF.  In many cases, this is appropriate, but in some cases, a couple could be letting valuable months go by.  One other use of this test is to determine if the male partner has good quality sperm.  If very few of the male’s sperm bind to the plate, it is very predictive that they will be unsuccessful with either natural intercourse, or IUI.  If this is the case, they would be better off to do IVF with ICSI, using one of the few sperm that actally bind.  One way to look at it, is that they may only have 2% of their sperm binding and it is unlikely that such as few number of “competent” sperm could achieve the feat of traveling through the cervix, up the fallopian tube and fertilizing an egg.  We will be offering this test at Red Rock Fertility in the near future.

I will try to address some of the economics and emotional issues that go along with failed fertility treatments in my next post.

When a couple experiences infertility, approximately 40% of the time, it is a sperm problem.  Many couples are surprised by that number, as many couples assume that just because there is ejaculate, there is functional sperm in it.  Unfortunately, that is not always the case.  There must be an adequate quantity of sperm and sperm that are moving produce much higher pregnancy rates than non-moving sperm.  We can get around the non-moving sperm problem with ICSI, which works quite well.

Men who have had vasectomies can get even more complicated.  Sperm live an environment that is protected from the human immune system.  Once a man has had a vasectomy, that protective environment is breached and sperm are “seen” by the human immune system and the immune system forms antibodies against the sperm.  Even if the man has his vasectomy reversed, or has the sperm aspirated from the testicle by a urologist, the sperm are often of low quality.  A new test is out that can be performed at home and give the couple and idea of whether or not the man has enough sperm to achieve pregnancy by natural methods.   Here is a link to the article.

One of the drawbacks of this test is that it does not measure quality.  This has to be done by a full semen analysis, which can be done at our clinic.  A full semen analysis measures not only quantity, but also quality.  Quality is measured by both appearance and function.  It is not enough to just have a good sperm count.  Function can be more important than number.  We have had a number of patients with almost normal sperm counts, but there wasn’t a moving sperm in the sample.  These types of results can influence whether a couple is a good candidate for intra-uterine insemination (IUI) vs. in vitro fertilization (IVF.)

At Red Rock Fertility, we are evaluating another sperm quality test that tests the ability of sperm to bind to a protein that is normally present on human eggs.  I think this is going to prove to be an excellent test to let patients know if IUI will work for them on not.  I will discuss this test in a future post.

Thank you for taking the time to visit our website and blog.  I hope to be able to keep the local fertility community updated on news and events related to Red Rock Fertility Center.  I am also going to bring up news items of interest to potential patients that may help them to make more informed decisions about their fertility journey.

The incidence of infertility is growing every year.  Thankfully, the resources available to patients is growing very fast.  If you haven’t discovered them yet, there are a number of infertility discussion groups available on the web.  I participate as a moderator on FertilityTies, though there are numerous other discussion boards, such as ivfconnections.com, fertilethoughts.com, and fertilitycommunity.com.  Many of my patients have found them to be quite useful, as they are able to learn about different treatments and what has worked, and hasn’t worked for people similar to themselves.