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.
Dr Beth Taylor MD, FRCSC
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.
The word on the internet is that Janet Jackson is pregnant at 50. This is wonderful news - I am always happy to hear about new life, new light, being brought into the world. There is something that makes me deeply happy when people grow their families. It is why I do the work I do. It is why I have children. It is why I tear up at every birth announcement and thank you note I receive from patients.
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
I just got back from a family vacation in Nova Scotia. There I gained about 10 lbs, never exercised, and listened to countless funny stories about relatives I've never met. I do the same thing every summer and while it objectively sounds boring, it's actually quite fun. Food is love and the more sugary and buttery the food they serve, the more a maritimer loves you. So visiting old friends and family on vacation meant eating plenty of butter-soaked lobster, ice cream, and potato chips. Again, a lot of fun. Now I have a rich-food hangover and jet lag.
Maybe it's my mother's influcence but I do think things happen in threes. Yes, since my birth, my mother has been warning me that after two relatives die, it's only a matter of time before a third one bites the dust too. After two stubbed toes, two bad hair cuts, two car accidents, two divorces, two failed anything, a third one is inevitable. I am not sure why bad but not good things run in threes, but it's best not to question superstition too much anyway.
Every job has good days and bad days. Today was 90% good and 10% bad.
A couple brought their 6-month-old daughter from IVF by to meet us, a woman who has been trying to conceive for a few years brought us a gift to say "thanks for trying so hard" for her, a couple who has twins on the way sent a "thank you" note, and a box of chocolates came from another successful couple.
Is there a diet you should follow to promote fertility? The Environment and Reproductive Health (EARTH) study is trying to answer this question. Since 2006, women at a Boston IVF program are being studied with questionnaires on diet, lifestyle, and other environmental factors that might impact fertility. Some results from this work are starting to be released.
Today the Vancouver Sun ran a story about a lawsuit against a fertility clinic and a sperm bank. The lawsuit alleges that the sperm bank improperly screened a sperm donor. Two families in BC and more in Ontario used donor sperm purchased from the USA sperm bank, Xytex.
Friday night I was watching Dax Shepard, the actor, on the Jimmy Kimmel show. He and his wife, Kristen Bell, have two young children. He was describing how quickly and unexpectedly they conceived their second child after their first. He said that just a few days after learning Kristen was pregnant with their second child, he had a vasectomy, not wanting more than two children. I gasped. What if something had happened in the pregnancy and the baby hadn't survived? What if they had changed their minds later and wanted a third child? What if...?
When you've been trying to conceive for months or years, twins seem like a good thing. After all, many people imagine their family as having two children. When you've waited for so long to have a child, having two children at once seems ideal. I agree, except twins have risks. The American College of Obstetricians and Gynecologists states the risks of a multiple pregnancy as follows:
May 12-20th is Canada's Infertility Awareness Week. Why? Well, if we keep infertilty a secret, no one will advocate for infertile people (out of sight, out of mind) and no one will consider public funding for fertility care. If people don't make people think about infertility, there will be less empathy for those who struggle to conceive.
"All my friends who had IVF have had boys. Does IVF make more boys than girls?" I was asked this very question recently. So, does IVF, ICSI, or similar treatments result in more boys or girls than expected?
How many eggs am I going to get? This is a good question and nearly every IVF patient will ask me this at some point during their treatment. While I've been doing IVF for a decade, I still stammer when trying to answer this question. Why don't I know how many eggs a woman is going to get in IVF when I am looking at the egg sacs (aka follicles) on ultrasound?
Let’s talk about donor eggs. When a woman’s eggs are too low in number or quality to produce a healthy child, using donated eggs is an option. You can obtain donated eggs from a woman you know or from an anonymous woman through an egg bank. The use of egg banks has exploded over the past few years as the techniques of freezing and thawing eggs have improved dramatically. As a result, eggs can be donated, frozen, and then used weeks, months, or even years later. These frozen donated eggs can be shipped anywhere.
IVF works most of the time in couples where the female age is under 40. When it doesn't work, we ask: is it the embryo or is it the woman? With more widespread use of chromosome screening of embryos -- called Comprehensive Chromosomal Screening (CCS) or Preimplantation Genetic Screening (PGS) -- the embryo is less likely to be the culprit.
I try to adapt to new thinking, technologies, and ideas but this time I'm struggling. The topic is "uterus transplantation." Some women have a very unhealthy uterus or don't even have one because they were born without or had surgery to remove it. Those women need a uterus. They would typically use a surrogate: a nice healthy, proven effective, uterus. While surrogacy is medically and legal complex, it is quite successful and poses little to no additional risk to anyone, most importantly the baby.
Infertility doctors rarely take care of women after the first few weeks of pregnancy. This is because it's hard to master the science of infertility and also master pregnancy care. So, like that jerk who got your friend-of-a-friend pregnant in high school, we get women pregnant and then leave them after the first month or so of pregnancy. Haha. Ok, that sounds calous but it's a tiny bit true.