ACFS2000 Blog

Arizona Center for Fertility Studies was part of a multi-center study, published in Nature Proceedings; that, for one of the first times, documents that human embryos can “self-correct”. The study showed that human embryos demonstrate a significant rate of genetic correction of aneuploidy (chromosome abnormality), or “genetic normalization” when cultured from the cleavage stage on day 3 to the blastocyst stage on day 5 using routine in vitro fertilization (IVF) laboratory conditions. The study showed that if day 3 embryos that were biopsied came back abnormal but went on to develop to the blastocyst stage (day 5) and subsequently re-biopsied, 64% demonstrated “genetic normalization”. Recognizing that genetic normalization may occur in developing human embryos has important implications for stem cell biology, preimplantation and developmental genetics, embryology, and reproductive medicine. As a result of this data, Arizona Center for Fertility Studies decided to do all PGD/PGS biopsies on day 5.

Published in Nature Proceedings: hdl:10101/npre.2011.6045.1 : Posted 21 June 2011

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The Third national Health and Nutrition Examination Survey (NHANES III) study recently showed that removing ovaries in women younger than 45 is associated with a subsequent doubled prevalence of osteoporosis and similarly elevated rate of arthritis, compared with women with intact ovaries. This of course, has to weighted against the risk of breast and ovarian cancer in BRCA mutation positive carriers. Women who had completed having children and have been told they need a hysterectomy for anyone of a number of gynecological problems should discuss these new findings with their doctor. Ob.Gyn. News Jan 2012.

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Legislation will remove financial barriers for infertility treatments

RESOLVE: The National Infertility Association applauds Rep. John Lewis (GA) for introducing a bill in the U.S. House of Representatives that would provide eligible taxpayers a tax credit for the out-of-pocket expenses associated with infertility medical treatment. Co-sponsored by Rosa L. DeLauro (CT), William Keating (MA), and Richard E. Neal (MA), the appropriately named the “Family Act of 2011,” HR 3522 would apply to expenses related to in vitro fertilization and treatments to preserve fertility for cancer patients.

The “Family Act of 2011”, HR 3522, is a companion bill to S 965 which was introduced in the U.S. Senate in May 2011. Advocates can now push for action on the two bills including bipartisan co-sponsorship, Committee Hearings, and movement on the Bills in both chambers.

What YOU can do:

Now that it is introduced, HR 3522 needs co-sponsors in the U.S. House of Representatives. We need EVERYONE who is facing infertility (and their friends and family) to contact their Representative. If you sent a letter to your two U.S. Senators, you now need to send a letter to your Representative.

1. Contact your Representative right now. It takes 3 minutes through RESOLVE’s Action Alert System. PLEASE review the online letter and personalize it with your story. Personal content is far more impactful than a form letter.

2. Ask your friends and family to send letters too! Forward this link so they can take action today. http://www.resolve.org/taxcredit

3. Share the information about the tax credit on your Blog or Facebook page!

4. Do you live in a district of one of the co-sponsors listed above? Send them a “thank you”. They need to know they are supporting you by supporting this bill! You can find their contact information here.

For more questions, please visit our web site at acfs2000.com or call the office at 480-860-4792.

There are lots of clinics, websites and patients raving about the financial savings when traveling abroad for fertility treatments. HOWEVER, when considering this option, you need to be aware that there may be some hidden costs that you need to consider before you pack your suitcase.  For instance:

MEDICATIONS: A fresh IVF cycle for under $5000. Sounds great, right? But does that include the medications? Some clinics will figure them into your total fee, but others don’t since they assume you’ll purchase the medications at home. If you have to buy them in the U.S. – you are probably adding about $3000-5000 to your bottom line (unless you are lucky enough to have insurance coverage.) Some clinics will give add in the costs of medications in their local country (which are typically much less expensive than in the U.S.) – but it is often difficult to ship them and some patients worry about the quality or temperature variations during the shipping process. Still, you can consider purchasing some of your medications in your home country (to start the cycle) and purchasing the rest once you arrive in the location where you will do the cycle.  This will help to cut down the overall cost. More importantly, when figuring out your bottom line do make sure to ASK whether or not medications are included in the IVF cycle fee.

AIRFARE: When budgeting an IVF cycle at home, typically your travel costs will only include gas mileage. If you have to go one or two or more times to the clinic per cycle, for repeat ultrasounds or lab work, it’s not usually a big financial drain.  But when looking to go abroad, some clinics request that you come two times at a minimum – once for the initial evaluation and again for the egg recovery and embryo transfer.  Sometimes you can ship sperm but some clinics request that the sperm “donation” be made at the clinic.  Also, as difficult as it is to think about, you have to consider the possibility of what happens if your cycle doesn’t work on the first try. Will you be able to go to your overseas clinic for another attempt – and if so, how much is that going to set you back in airfare costs? Of course, you may be lucky enough to have loads of frequent flier miles (so many of us have by putting most of our fertility charges on credit cards!), but you usually have to book those trips way in advance and that may be inconvenient to your IVF cycling plans. Still, there are plenty of low-fare websites and travel agencies that you can check for last minute (or close to last minute) deals.

TRAVELING COSTS: Okay, we talked about airfare, but that’s just getting in the air and landing at the airport. What happens once you’re on the ground in this foreign country? So, don’t forget to add in car rental or taxis to and from your clinic (or anywhere else you might want to go), food (check the exchange rate and the cost of an average meal), plus hotels or accommodations. There are some countries where great food is cheap, but others where a cup of Joe can run you $12.  If you do your research, you can typically find a more reasonably priced place to stay – and perhaps one that has a kitchenette so that you can cut down on food costs by eating a meal or two at home. Your clinic may even have a discounted rate at some local hotels – so don’t be too shy to ask. You should also remember to budget in a day or two of sightseeing – yes, you are here with the specific goal of making a baby, but you might as well do some sightseeing in your time off.

GETTING AWAY: Even though you may be using a passport and going to an exotic location, it’s not really a vacation. So if you work, how are you going to handle it? Are you going to use some of your vacation time or will you be giving up a paycheck? Is your employor okay with you taking the time off or will you have the extra added stress of checking in from overseas?  These are very personal decisions but not ones that are necessarily dealt with when the initial decision to travel for IVF or ART is made.  Also, you are most likely going to be monitored at a local clinic near your home or work (if you are using your own uterus and/or own eggs), so don’t forget to figure in some time away from work for that.

LOCAL MONITORING: Speaking of local monitoring, it is more than likely that you will need to find someone (either an RE or your OB/GYN) to assist in some local monitoring and tests during your cycle.  The costs for these vaginal ultrasounds, hormone level blood work checks and any other testing needed prior to your travelling is another thing to consider in your overall costs.  Sometimes your insurance will cover this – so don’t forget to call and ask.

MORE THAN ONE ATTEMPT and SUCCESS RATES: Sadly, this is something you must think about (even for the most positive amongst us!) – what if you don’t get pregnant on the first try?  It is sometimes very hard or even impossible to get accurate information on the clinics success rates.  “Telling” you their success rates and actually seeing them documented in a reliable source may be two different things. If you’re using a gestational surrogate and you have left over embryos then this is a non-issue, you won’t have to go back for the second try, your gestational surrogate will most likely already be in place for the second attempt. But if you have used your own eggs or an egg donor’s (and putting them back into your own uterus), then you’ll be faced with deciding what to do next. Should you go back? Should you ship the embryos home? Each choice comes with its own set of costs, and even with a clinic with a great success rate, there is no guarantee it will work on the first try.

FREEZING: So, let’s say your first try works (Yeah! You’re pregnant!), but you’ve left behind some frozen embryos that you may very well like to use in the future.  We can guarantee you that your distant (as well as your home) clinic is going to have a freezing and storage charge (also for sperm). So don’t forget to ask what it is and factor in paying for it for a couple of years. Okay, so by now you may be thinking, maybe this seems like we’re saying traveling for treatment isn’t such a good idea. I guess that you need to decide.  ACFS does not encourage this option but if you “must” make sure to check it out thoroughly.  There have been a lot of “scam” clinics offering deals “that seem to good to turn down” and although there are overseas clinics that are highly reputable; if choose this option, please do your homework. When considering this option, you need to know all of the plusses and the minuses and not get blind-sided when you’re too far in to turn back. A happy patient is an informed patient (and of course a pregnant patient!)

by Global IVF

Visit us at www.acfs2000.com to learn more about infertility treatments.

ACFS was part of a multiple center study, recently presented at ASRM October 2010 (American Society of Reproductive Medicine), looking at the efficacy of PGD: 23-chrosomome microarray, a technique to scan the genome for gains and losses of chromosomal material. This method has significantly high resolution and clinical yield. This new analytical technology, microarray analysis, allows for the evaluation of all 23 pairs of human chromosomes on a single cell. While advances both in methods and drugs used for ovarian stimulation as well as improvements in embryo culture techniques have undoubtedly had a positive influence, IVF success rates have lagged and even stagnated over the last 10 years . This is largely due to an inability to reliably identify and selectively transfer only “competent” embryos (those that are capable of producing a healthy baby) to the uterus. Even in young women, an embryo that “looks good” under a microscope is not necessarily competent. At best, it has a 25% chance of implanting. Furthermore, this statistic shrinks with advancing age beyond 35 years. Even the use of preimplantation genetic diagnosis using fluorescence in-situ hybridization (FISH) (PGD/PGS- old technology) to identify chromosomes does not significantly improve this capability and is limited to testing 5-10 chromosomes. As a result, many IVF specialists still transfer multiple embryos at a time to increase the odds that at least one competent embryo will reach the uterus and produce a pregnancy. The problem is that while this improves the chance of a pregnancy occurring, it also markedly increases the risk of multiple gestations pregnancies. It is, however, an undeniable fact that reproductive failure (i.e. failed implantation, miscarriages and major birth anomalies) are far more likely to be due to embryo incompetence (70-75%) than to a lack of uterine receptivity (25-30%). It is mostly (but not exclusively) the embryo’s chromosomal configuration that will determine its “competence”. The number of chromosomes in a cell is referred to as its ploidy. A cell with a normal number of chromosomes is referred to, as euploid, while one with an irregular chromosome number is aneuploid. It appears that it is the ploidy of the mature egg (rather than the sperm) that determines the post-fertilization chromosome configuration of the embryo. The embryo’s ploidy, in turn, determines its competence. Recently, a newer technology has emerged that has appears much more promising in its ability to deliver complete genetic (all the embryo’s chromosomes) information about an embryo in question. This technique is referred to as PGD/PGS: 23-chromosome microarray. In contrast to FISH, PGD/PGS: 23-chromosome microarray is able to provide information about all 24 chromosomes (22 pairs plus X and Y) from a single cell, which has been removed from a 3-day or day 5/6 (blastocyst) old embryo. ACFS believes it is likely that 23-chromosome microarray will replace FISH for this reason and hopefully will actually be able to improve the efficiency of IVF by improving pregnancy rates while limiting the occurrence of miscarriages, by only transferring chromosomally competent morphologically normal embryos back into the uterus. ACFS STRONGLY BELIEVES THAT PGD/PGS: 23-chromosome microarray COULD CHANGE THE FUTURE OF IVF. WE FEEL SO STRONGLY ABOUT THIS TECHNOLOGY AND HOW IT COULD SIGNIFICANTLY IMPROVE OUR IVF SUCCESS RATES THAT ACFS HAS DECIDED NOT TO CHARGE FOR THIS PROCEDURE ( other than what the PGD lab charges ACFS- $2400) IN ORDER THAT ALL PATIENTS DOING IVF CAN BENEFIT FROM THIS VERY EXCITING NEW TECHNOLOGY

First the attack on Planned Parenthood funding and now this: State Rep. Bobby Franklin of Georgia introduced a bill in his state last week that, if enacted, would require proof that a miscarriage occurred naturally. If a woman can’t prove that her miscarriage–or spontaneous abortion–occurred without intervention, she could face felony charges.First the attack on Planned Parenthood funding and now this: State Rep. Bobby Franklin of Georgia introduced a bill in his state last week that, if enacted, would require proof that a miscarriage occurred naturally. If a woman can’t prove that her miscarriage–or spontaneous abortion–occurred without intervention, she could face felony charges.From the Daily Kos, “Franklin wants to create a Uterus Police to investigate miscarriages, and requires that any time a miscarriage occurs, whether in a hospital or without medical assistance, it must be reported and a fetal death certificate issued. If the cause of death is unknown, it must be investigated. If the woman can’t tell how it happened, then those Uterus Police can ask family members and friends how it happened. Hospitals are required to keep records of anyone who has a spontaneous abortion and report it.”  The mind reels. I don’t even know where to begin. “If the cause of death is unknown”?? Does this guy know a thing about miscarriage?

Many miscarriages happen without warning or explanation. Women are devastated. Most occur in the first trimester. Most are not “investigated.” Often we just don’t know why the miscarriage happened. It’s thought that the reasons for many miscarriages has to do with some kind of chromosomal abnormality that makes the pregnancy nonviable. So, if a doctor says, I’m not sure precisely why this pregnancy didn’t continue, what will happen? How will they “investigate?” By asking friends? Asking them what? I can’t even imagine these conversations, the whole thing is so misguided.

And miscarriage is common– as many as one in five pregnancies end in on. That’s lots of conversations and investigations of women who have just lost their babies.  The bill is mostly aimed to make sure that any attempt to remove an embryo or fetus from a mother must be with the goal of a live birth. Ectopic pregnancy– which can be fatal to mother and fetus– is no exception. Maternal bleeding, cancer… no exceptions. I doubt it will pass, but this news comes at the end of a really rotten week for reproductive rights.

Whether you agree with the law or not, ACFS believes you can not allow any government agency to interfere with a women’s reproductive rights

Women who take over-the-counter painkillers during pregnancy have an increased risk of having sons born with undescended testicles, according to a study that also incorporates rat models to show why this might be.

Using data from a birth cohort of singleton sons born to 1,463 women in Finland and 834 in Denmark, the researchers found the risk of cryptorchidism (undescended testes) to increase sevenfold in boys born to women who used more then one of three over-the-counter painkillers- aspirin, paracetamol or ibuprofen.  Exact dosages were not recorded.

The findings, published online Nov. 8th in the journal Human Reproduction (doi:10.1093/humrep/deq323), also showed that any of these painkillers that were used for any duration during the second trimester more than doubled the risk of cryptorchidism, although tylenol did not reach statistical significance.  The highest risk was in women who used more than one compound simultaneously for more than 2 weeks in the second trimester.  This findings were confirmed in rat studies and adds to findings published earlier from a cohort of 47,000 boys born in Denmark, 980 of whom were identified in childhood of having undescended testicles.

The significance of these findings is that men who are born with cryptorchidism, show an increased risk of having poor sperm quality and testicular germ cell cancer.

ACFS strongly advise pregnant women to talk with their obstetrician before taking any medications, especially OTC painkillers.

Colorado volunteers worked tirelessly to reject the State’s “Personhood” Amendment. On November 2, Colorado voters went to the polls and rejected Amendment 62, the so called “personhood” amendment which would have given legal rights to fertilized eggs under the Colorado Constitution. According to the American Society for Reproductive Medicine (ASRM), Amendment 62 would have applied the term ‘person’ as used in those provisions of the Colorado Constitution relating to inalienable rights, equality of justice and due process of law, to “any human being from the beginning of the biological development of that human being.”

“I applaud the citizens of Colorado for rejecting this ballot measure by a three to one margin,” said Barbara Collura, RESOLVE’s executive director. “This measure would hurt those 1 in 8 couples battling the disease of infertility and seeking treatment.”

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The federal government can continue funding of embryonic stem cell research, a U.S. Court of Appeals in Washington has ruled, while the Obama Administration appeals a ruling in Sherley v. Sebelius in which a lower court judge ordered a temporary halt to the funding of this type of research. The lawsuit was filed by two scientists who study adult stem cells who argued that the administration’s stem cell research policy violates a congressional ban on research that harms human embryos.

A federal appeals court earlier this month temporarily lifted the injunction to give the administration the opportunity to argue that even a temporary halt to the research could set back promising science. The Coalition for the Advancement of Medical Research, of which ASRM is a founding member, filed an amicus brief in this case, maintaining that NIH guidelines are clear that federal funds can be used to investigate cells and tissues created from human embryonic stem cells, but not to create them.  Moreover, the guidelines set forth rigorous ethical standards under which federally funded human embryonic stem cell research can be conducted.

While the latest ruling is welcome news, the future of government-funded embryonic stem cell research is far from fully resolved.  The Court of Appeals still must hear the appeal of the preliminary injunction and the case is due to go back to the lower court for a decision on the merits.

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TOP IVF SUCCESS RATES IN SCOTTSDALE, PHOENIX AND ARIZONA was achieved by Arizona Center for Fertility Studies for 2008 ART data (most recent data available)

An independent web site reviewed the most recent published ART-IVF data nationally. It showed that Arizona Center for Fertility Studies had the highest success rates in the Phoenix and Scottsdale area and for the state of Arizona in the age group under 35; and the Center was rated 6th in the nation among over 400+ clinics. All other age groups also achieved very good success rates.