About 11 years ago I heard Jonathan Tilly speak at the American Society of Reproductive Medicine (ASRM) meeting. His research suggested in mice new eggs could be made. This raised the question "what if our understanding that women are born with all the eggs they'll ever have, is wrong?" What if we could make new eggs for women? Huh. A basic premise of human reproduction is that you can't. All evidence so far has supported the idea that women are born with about a million eggs and rapidly lose them, running out at menopause.
I'll make this brief because it is 10pm on Friday night and Netflix is calling, but: please do not wait to try and get pregnant again after a miscarriage. We've known for years that you are more fertile and less likely to have an adverse pregnancy outcome if you get pregnant soon (within 6 months ideally) of a miscarriage. It's "old school" to tell women to wait a few months to get pregnant after a miscarriage, but this message is still being conveyed by some health care providers.
What about the guy? As fertility doctors we focus a lot of our energy on investigating the woman and counselling couples about the success rate, risks and outcomes as they relate to the woman. Partly this is because testing of the male is more straightforward and partly because the success rate is usually more dependant on female factors, but outcomes are different: the male matters more than we previously thought.
I didn't want my blog to become stale but lately I haven't been writing much. I blame myself and Facebook and Instagram and Netflix and a few other life distractions. I am sure in the pre-social media years I got a lot more done. Then again, maybe I didn't and I am just glamourizing the olden days. Anyway, I am on vacation this week so thought I'd put fingers to my keyboard.
At least once a month I have a woman in my office crying because her IVF cycle didn’t work and she believes in her heart that she is to blame. Typically she will say she “did too much after the transfer.” Women are so hard on themselves.
Happy New Year’s Eve 2016! Now that I have eaten my body weight in chocolate and chips, it’s time to make resolutions. First, stop eating my body weight in chocolate and chips. My other resolutions are pretty similar to previous years:
There are a few main infertlity journals I read: Human Reproduction, Fertility and Sterility (F&S) and the Journal of Clinical Endocrinology & Metabolism. It is in these journals the latest fertility research is published, useful topics are reviewed and in F&S they have a section called "Inkings." This is the section I enjoy the most, honestly. Inklings are short musings, generally by well respected fertility doctors and scientists. They write about their "gut feelings" or their pet theories about disease or treatments.
I remember a lovely couple whom I helped conceive with IVF once emailed me to ask about their children's intelligence. The child was 3 or 4 at the time and, according to the parents, exceptionally good at everything. They believed their daughter was intellectually gifted, among other gifts. They asked me if she was so special because, as an embryo, she has been selected from a field of many as the "best looking" and "strongest."
We all have genes in the DNA of our cells. Genes determine our hair colour, eye colour, height, and about 20,000 other things about us including which diseases we will develop. Over the past decade scientists have figured out the "spelling," or sequence of nucleotides, of every gene in humans. This project was called the Human Genome Project. Since this project of sequencing of all human genes was completed, the focus shifted to figuring out which gene mistakes, or mutations (or misspellings), cause which diseases.
Lets' talk about intracytoplasmic sperm injection (ICSI), pronounced ick-see. During IVF treatment a woman takes medication to grow multiple eggs at once. We then extract the eggs and fertilize them. You can fertilize an egg in one of two ways:
- Insemination - several thousand sperm are placed in a dish around the egg
- Intracytoplastic sperm injection (ICSI) - one sperm is injected into the egg