Vitrification for Embryos and Eggs

Vitrification, a cutting edge technology for cryopreservation (freezing) of embryos and eggs, is now available at CNY Fertility Center.

Patients who undergo IVF may have several eggs collected. The eggs are then fertilized with a sperm and checked for fertilization. Fertilized eggs are called embryos. A patient may have multiple high quality embryos eligible for embryo transfer back to the uterus. A certain number of embryos are chosen for embryo transfer, and the surplus of high quality embryos are able to be cryopreserved for future use.

Previously, embryos were cryopreserved using a slow freeze method. Embryos were run through different solutions of media to dehydrate the cells of water and replace it with cryoprotectant. Then the cryoprotected embryos were individually labeled and stored in cryopreservation straws, which were put in special freezers. These freezers slowly (-0.3 degrees Celsius per minute), cooled the embryos to -35 degrees Celsius using liquid nitrogen. They were then stored in liquid nitrogen (-196 degrees Celsius). At that extremely cold temperature, cellular activity is essentially brought to a halt, allowing the embryos to remain viable indefinitely.

When patients decide to use their cryopreserved embryos to try for a pregnancy, the embryos are removed from the liquid nitrogen, warmed and run through solutions of media to remove the cryoprotectant and rehydrate the cells with water. During cryopreservation, the formation of intracellular ice crystals can damage the cells of the embryo, decreasing future viability. Therefore, new methods were developed to improve cryopreservation techniques.

Vitrification is a new process for cryopreserving embryos. Through vitrification, the water molecules in an embryo are removed and replaced with a higher concentration of cryoprotectant than in the slow freeze method. The embryos are then plunged directly into liquid nitrogen. This drastic (-12,000 degrees Celsius per minute) freezing creates a glass transition temperature, commonly called a “glass” state, and the embryos are vitrified. This quick freezing reduces the chance for intercellular ice crystals to be formed, thus decreasing the degeneration of cells upon thawing for embryo transfer.

Many studies show survival rates of vitrified embryos to be far higher than survival rates of slow freeze embryos. Thus far at CNY Fertility Center, vitrification results are very encouraging, and we are excited to offer this cutting edge technology to all patients who chose to cryopreserve their embryos.

To date there has been limited success with eggs surviving after the cryopreservation and thaw process. Eggs have a much larger volume of water than embryos. The large water component of an egg increases the formation of intracellular ice crystals during the freezing process, which causes degeneration. Vitrifying eggs reduces the occurrence of intracellular ice crystals, which improves freeze, thaw and pregnancy outcomes. This new technology allows women to preserve their fertility by freezing eggs at a younger age, and using them in the future.

For more information about vitrification, ask to speak to an embryologist at your center.

Creating Vision Boards with Dr. Rob

Dr. Rob has invited everyone to join him at the Syracuse, Rochester, and Albany CNY Fertility Center offices to create your own vision boards!  Creating a vision board is a wonderful, cathartic experience.  It is quite simple to do, you just gather various materials that you enjoy, and create a collage of what you want in life at that moment.  It is whatever you want to create, you may feel like focusing on a specific goal such as weight loss, a relationship, or a child, or you may decide to go more broadly and choose something like overall wellness and health.

The point of the vision board is to place on paper what your thoughts and dreams are.  Then, place the board somewhere in your home or office that you can see each day.  This will be a constant reminder of what you are working towards.  We have had wonderful success with vision boards in the past, because we have seen them come true.  You just need to be positive and have faith in what you want out of life.

You do not need to bring anything to our vision board session, but if you have any particular magazines or collage materials you would like to use, please feel free to bring them!  We look forward to seeing you there, and discovering what your vision is!

Dates and Locations:

Syracuse CNY Fertility Reception Area
Tuesday, June 9, 2009, 5:30-7:30pm
Please RSVP to Meg at Mmarnell@cnyfertility.com

Rochester CNY Fertility Reception Area
Wednesday, June 17, 2009, 5:00-7:00pm
Please RSVP to rochregister@cnyhealingarts.com

Albany CNY Fertility Reception Area
Thursday, June 18, 2009, 5:30-7:30pm
Please RSVP to Stacey at SDicerbo@cnyfertility.com

Maya Abdominal Massage Case Studies

Dr. Rob Kiltz’s CNY Healing Arts Center location in Syracuse, NY is currently looking for applicants to participate in Maya Abominal Massage Case Studies. These Massage Sessions are offered at no charge to the participant. Our Maya Abdominal Massage Practitioners, John Capozzi and Erika Lutwin will be running the Case Studies.

Click here to learn what Maya Abdominal Massage is all about and how you can participate in the case studies. Or just call CNY Healing Arts Center at 315.671.5755.

Words of support and encouragement, May 26th, 2009

As the month of May comes to a close at CNY Fertility Center, I would like to leave you with a short, but meaningful quote and a few reading suggestions by Dr. Rob.

“Further up and further in!” – The Chronicles of Narnia by C.S. Lewis

While this is quite a short line, there is a lot of thought and meaning behind it.  “Further up and further in!” was the response of one of the story’s main characters when asked simply, what do we do now?  At this point in the series a young group of explorers have been exercising and pushing their faith, in order to become closer to the spiritual being they identify with.  At this moment they are standing on the top of the world, and it appears they have reached their goal.  However they are humbled and reminded to go “Further up and further in!”.

This sentiment can be applied to any situation of searching and awareness.  Take meditation for example, although there will be sessions where we may find peace and the calming of thoughts we strive for, we can always continue our practice and work towards a greater calm and quiet.  In our search for happiness we can always find more, and better yet, spread happiness to even more corners of the earth.

We should always be grateful for where we are and the progress we have made, however we should also recognize that there is more room to grow and a deeper understanding to strive for.

Meditation and relaxation whether it is through prayer, yoga, acupuncture, or massage, has been shown to greatly increase chances for conception.  I suggest you move further in your relaxation practice, and you will ultimately reap the wonderful benefits.

Take a look at Dr. Rob’s reading list, found at www.mindbodysmile.com for some great books that can help you find that inner peace and continue to work on it.  Also, if you are in the area we have many wonderful books on sale at our CNY Healing Arts locations in Syracuse, Albany and Rochester and as always our CNY Healing Arts staff are more than happy to help you discover new ways to find peace.

Continue your journey to inner peace, and remember we are here to help you along the way.

Lisa Stack
LStack@cnyfertility.com
315-744-8073

Varicoceles

Forty percent of men who are diagnosed with male factor infertility may have a varicocele. A man’s testicles have veins that support proper circulation of blood back up to the heart. There are valves in the veins that stop blood from flowing backwards. When the valves fail, blood pools in the veins of the testicles, creating a varicocele. These veins may bulge, causing discomfort or a heavy feeling in the scrotum. The veins are similar in appearance to spider veins seen in the legs.

The testicles are located outside of the man’s body because they need to be at a lower temperature for proper sperm production. Varicoceles cause an increase in the temperature of the testicle, which often results in lower sperm concentration and motility, and an increase in abnormal sperm shape. All of these parameters, which are observed in a routine semen analysis, contribute to a man’s infertility.

A varicocele is diagnosed by ultrasound or a Valsalva maneuver, in which the patient stands in a warm room and bears down as if having a bowel movement. As more blood is forced to the testicles, the physician is able to palpate the testicles to locate the bulging vein.

Varicoceles are treated with surgery. A urologist makes a small incision in the abdomen and locates the varicocele. The vein is then closed off, stopping its blood flow. An alternative approach is to inject alcohol or coils into the vein to stop blood flow. Both procedures are out-patient, and have a three to four day recovery period.

Results from varicocele repair vary, however studies report that 33% of men’s semen parameters improved following surgery. Approximately 30-60% of these men were able to naturally conceive within one year of their surgery. Improvements in semen parameters are visible after four months; however, if improvements are not seen within six months, additional fertility treatments may be necessary to attain a pregnancy.

Lifestyle changes also help to improve success rates before and after varicocele surgery. Eliminating smoking, recreational drugs, anabolic steroids, and alcohol improves semen parameters. Exercising and taking vitamins that have antioxidants improve sperm production as well. Lubricants should be avoided when trying to conceive.

For more information about varicoceles, ask your physician at CNY Fertility Center.

April’s journey to fertility: Week one

April is a CNY Fertility Center patient and has been on her journey to fertility for approximately two years. April will share candid stories and a unique perspective on the fertility challenges many women and couples face.

My Story:
Patience has never been one of my virtues, but rather a skill I have been learning and re-learning over the years. In my journey to becoming a mother, I have had to readjust my initial plans. Fellow mothers-to-be, I decided that in April of 2007 we would begin trying to conceive so I would have my baby sometime in the spring of 2008. Then I would be able to take the rest of the school year off. (By the way, I am a high school English teacher.) In my head, the plan was perfect. Then the universe, or in my case, God, decided that I still had a few lessons to learn. In June of 2007, I was diagnosed with Multiple Sclerosis.

There were two questions I had for the doctor when he told me I had MS. 1.) Was I going to die early? and 2.) was I going to be able to have children? Here I was, being diagnosed with what can be a disabling and debilitating disease, and the second question out of my mouth was if I could still have children. (The neurologist happily informed me I was not going to die early and that I could safely conceive children.) Oh, friends, once we yearn for a baby there is little else that we are able to consider. In telling you about my initial reactions to my MS diagnosis, I simply want to let you know, that I get it – the feeling that maybe I am not meant to be a mother (what a sad thought), that choked up emotion that surfaces when I hear yet another one of my colleagues is pregnant, the tears that well when I begin another cycle. I have been trying to conceive for a bit over two years and my journey has been a challenging, frightening, and enlightening experience.

Before I finish this week’s blog, I have an intention for you. Is there anything you can do to embrace motherhood –not simply your motherhood, but motherhood in general? For example, I helped my best friend throw a baby shower yesterday. When I was telling my mom, she said that must have been hard for me; but for the first time in approximately two years, attending someone else’s baby shower was not an anxiety inducing event. I did not have to lock myself in the bathroom for any moments of escape nor did I have to give myself a pep talk before the event. Instead, I asked the mother-to-be to rub up against me as many times as she could before she left in hopes that her fertile hormones would rub off on my nearly fertile hormones. I sat with a table full of mothers who were discussing their childbirth stories and did not flinch when another woman asked me if I had any kids. Nor did I begin to tell her all about my fertility woes. A year ago, my response to this question would have been a 20 minute life story synopsis. Instead, I just moved on and focused on their stories because, ladies, one day it is going to be me in that birthing room. How did I get to the point where I am able to embrace others’ fertility? That is a topic for next week. I hope you will continue to follow my story!

Envision the outcome and embrace all motherhood. We will be mothers!

Baby Dust Blessings,
April all Year

CNY Fertility Support Group Recap

In an effort to share some of the valuable information that is discussed and learned during our monthly support meetings at CNY Fertility we will be posting a recap each month on the website here.

We had a wonderful Support Group session this past week at the CNY Fertility Center Syracuse office. Dr. Rob Kiltz gave a very inspirational talk touching on various subjects such has happiness, protecting ourselves from negative media, and embracing change. We all have the capacity for happiness. We have to place ourselves in situations that facilitate happiness. We have to protect ourselves from negative media and situations because although we may not notice it, they are absorbed, and they do influence our happiness. To begin this life of happiness Dr. Rob suggests that instead of turning on the evening news, we read a book off of his suggested reading list, or spend time doing something positive that we enjoy.

With this sense of happiness we will be more open and willing to change. Change is natural and is something we cannot control or prevent. Often times we resist change because we are afraid of what is to come. By seeking happiness and accepting that change is natural, we can better prepare ourselves to positively deal with various situations as they arise.

Some of the books Dr. Rob suggests we read to help us embrace a happy and full life are as follows and to read his full suggested reading list click here:

Eat, Pray, Love by Elizabeth Gilbert
The Alchemist by Paulo Coelho
Thoughts are Things by Prentice Mulford
A New Earth: Awakening to Your Life’s Purpose by Eckhart Tolle
The Secret by Rhonda Byrne

The support groups at all three locations will be focusing on the book, Eat, Pray, Love by Elizabeth Gilbert during the next meeting, June 16, 2009. We will also continue to share personal experiences, questions, and concerns regarding the fertility journey.

During our last discussion we once again touched on the common, but difficult question of whether or not to tell family, friends, and coworkers about your journey trying to conceive. We had some great insight from clients who have been with us for a bit of time, as well as from our new additions to the group! Although it can seem like an impossible discussion to have, it seems that the general consensus has been to tell those you are close with. You do not have to get into specifics, and a simple ‘We have been trying to have a baby, and it has been difficult’ can be all you need. The reason some couples have found it beneficial to make others aware is to protect their happiness and make difficult situations a little easier to bear. A good example of this is if a sibling finds out they are pregnant, and your family is aware, they can be sensitive to your situation and recognize that this could be a difficult time for you. This allows you to be happy for your sibling, without pretending that it does not cause some pain for you at the same time.

That being said, we do have some couples that have not told family and friends of their situation. They feel it is personal and is best to not worry them, or feel it is too private to share. Unfortunately we cannot tell you which option will be best for you. This has to be your decision, and please know that whatever you choose is OK and will be right for you as long as you trust your instincts. Also, remember that if you initially decide not to tell, you are not bound to that decision, just as if you do tell, you do not have to share each detail from every appointment.

It is most important to remember to trust yourself, and remember the message boards that can be accessed via www.cnyhealingarts.com can be very helpful. There you can bounce ideas off of each other and get some advise from women in similar situations.

Please feel free to contact me if there is any support I am able to offer you in the mean time.

Take care,
Lisa Stack
LStack@cnyfertility.com
315-744-8073

Ovarian Drilling

Ovarian drilling with laparoscopy is a technique which may help women who have Polycystic Ovarian Syndrome (PCOS) or Polycystic Ovaries (PCO) to ovulate normally, thus increasing their chances of pregnancy. Ovarian drilling is typically considered after several attempts at ovulation induction using clomid, or an insulin-sensitizing medication, such as metformin. Polycystic ovaries are generally smooth and pearl colored, and have many small immature follicles along the outside lining of the ovary. Women with either condition may have higher levels of testosterone in their bodies, which inhibits ovulation.

Ovarian drilling cauterizes the stromal theca cells in the ovary. The reduction of this testosterone-producing tissue leads to reduced testosterone levels in the body. Studies have reported that approximately 80% of women who underwent this surgery began ovulating regularly. Post surgery, women who did not regain ovulation, and were previously resistant to clomid citrate, were then more receptive to medical protocols. Pregnancy rates after ovarian drilling are reported as around 50%.

Ovarian drilling with laparoscopy is an out-patient surgery. Anesthesia is administered to the patient, and three small incisions are placed in the abdomen. The abdomen is inflated with gas to allow the physician to view the ovaries using a laparoscope. The drilling is done by cauterizing different parts of the ovary, and removing the unwanted tissue. The physician is able to explore the reproductive system during the laparoscopy, to determine if any additional issues may be present. When the procedure is done, a super glue-like adhesive is administered to the incisions, and the patient is able to go home to heal, after recovering from anesthesia.

Hydrosalpinx

A hydrosalpinx is a condition in which one or both fallopian tubes are blocked and filled with a clear fluid. To detect whether a patient has hydrosalpinx, a specialist may perform an ultrasound, HSG (Hystersalpingogram), or a laparoscopic surgery. At CNY Fertility Center, most hydrosalpinx are discovered through an HSG, during which a special dye is injected into the uterus and fallopian tubes, and then viewed through a fluoroscope (similar to an x-ray machine). If the fluid spills out of the fallopian tubes, they are not blocked. If the fluid remains, then the patient has a hydrosalpinx. Hydrosalpinx can be the result of endometriosis, previous pelvic infections, or can be due to a developmental abnormality. Some patients have recurrent abdominal pain, whereas others experience no symptoms at all. If both fallopian tubes have hydrosalpinx, then the sperm cannot reach the egg in the fallopian tube, and conception is thus prevented.

The best option for women with two hydrosalpinx is IVF (invitro fertilization), because fallopian tubes are not necessary for the process. Some studies indicate that the fluid in a hydrosalpinx decreases conception by about 50%, and increases miscarriage, when undergoing IVF. Therefore, your specialist may recommend that your tubes (with hydrosalpinx) be removed through laparoscopic surgery done in the office to enhance your success. Women who have one hydrosalpinx and one open tube can also benefit from removing the hydrosalpinx, and will increase their chances of conceiving on their own.

All About Injectables

Injectable medications are used for IVF or IUI cycles. One of the main processes in an IVF or IUI treatment cycle is the controlled stimulation of the ovaries, to produce eggs. The medications used in ovulation induction are called gonadotropins. Brand names include Follistim, Gonal-F, Menopur, Bravelle, and Repronex. Gonadotropins are primarily used to treat two types of women: 1) those who do not ovulate, ovulate irregularly, or have failed to conceive using Clomiphene citrate (Clomid) and 2) women who ovulate on their own, but may need help in producing multiple eggs, and whose bodies would benefit from the enhanced hormonal environment.

How do they work?
Gonadotropins are natural hormones that trigger the ovaries to make eggs. They are generally safe to use, but do require experience and careful monitoring.In a natural menstrual cycle without any medications, a woman produces one or two follicles, which are fluid filled sacs that contain an egg. The growth of the eggs and their release from the follicles are influenced by the secretion of two hormones from the pituitary gland: Follicle Stimulating Hormone (FSH); and Luteinizing Hormone (LH), both known as gonadotropins.When a woman becomes menopausal, her pituitary gland secretes large amounts of these hormones in an attempt to stimulate the ovaries, which no longer function. Gonadotropins (other than Follistim and Gonal F) are manufactured by extracting FSH and LH from the urine of post-menopausal women. Menopur contains both FSH and LH, while Bravelle contains only FSH.For a woman going through infertility treatments, these extracts must be injected and cannot be taken orally, because they would be digested by the stomach.Recently, gonadotropins (Gonal-F, Follistim) have been manufactured in the laboratory using recombinant technology, which allows a pure form of FSH to be produced. This is not a human tissue or urinary by-product, it is a recombinant FSH. Since it is more pure, it may be self-injected, using a small needle just under the skin.