While menopause limits a woman’s ability to conceive later in life, many men of advanced age continue to have the option to father a child due to continued sperm production. Despite frequent male fertility challenges, paternal age at time of conception has been steadily increasing over several decades, and very often, the popular culture media reports on male celebrities having children in their 70s or later. However, this may not be the case for most men, but solutions to fertility problems exist.
Persistent inequities for Black Americans have been captured by the phrase “Black Lives Matter” which began inauspiciously—a hashtag on Twitter following the 2013 acquittal of George Zimmerman in the shooting death of Trayvon Martin. The phrase is provocative by design, and its use conveys both urgency and frustration with the status quo. What is notably absent, with the exception of three isolated commentaries, is the use of the phrase in medical literature. Given similar inequities in medicine with glaring evidence, there is a need for outrage and frustration with the status quo in the medical field.
Filed Under: Social justice, infertility, access to care
What do we need from the people we love?
We frequently talk about what we don’t need from our family and friends when it comes to their commentary or prodding questions about infertility. We talk a lot less about what we do need from them when we feel stress or pressure while we're trying to conceive. Sometimes people refrain from sharing their experiences about infertility with their family and friends, not because they don’t want them to know, but because they don’t know how to broach the subject.
TALKING ABOUT INFERTILITY
Very often, when couples first start noticing difficulty in trying to conceive, they observe what other people notice as well. "Don't you want to have kids?" or "As soon as you stop worrying about it, you'll get pregnant" are common statements that our patients hear. Questions and statements like these, while perhaps well intentioned, can sometimes be very hurtful. Sometimes, when coping with infertility, it may seem that all of your friends are getting pregnant. If only other people knew what you were feeling and experiencing, or at least knew to respect what you'd rather not share?
The most important people to talk with about your infertility
You don't live in a vacuum. In addition to all the other challenges of infertility, you’re tasked with managing all of your normal relationships. There are internal questions to help you decide what you want to communicate and stay one step ahead of these conversations as they arise. The most important people to talk discuss your infertility with, are yourself and your partner.
Often, we focus on evaluating women when couples fail to conceive. Although we know that male factor accounts for 20 – 30% of couples seeking treatment, the treatment remains focused on ovarian stimulation to improve chances for success. With in vitro fertilization, we focus on oocyte retrieval and fertilize these eggs with sperm ejaculated, extracted from the testicle or from the epididymis. Therefore, the eggs can be fertilized directly with intracytoplasmic injection (ICSI) of individual sperm. The sperm source is important but separate in the consideration. If the partner has little or no sperm, we can try to extract immature of immotile sperm from the testes and still provide the opportunity for parenting. If fertilization fails, we may point to the sperm quality or function but still question the quality of the egg as the main cause for these challenges. Still, there are some men who the cause began earlier and there aren’t any sperm cells (germ cells) within the testes.
This article points to a more specific cause for challenges in men with azoospermia (no sperm with ejaculation) and reinforces that, even if successful, we aren’t dealing with the complete issue. The Tex11 gene identified first in mice and then a group of men and their families confirms that we need to investigate the causes of azoospermia more clearly. Moreover, the cause relates to a specific gene on the X chromosome and is transferred maternally. These men may have brothers or uncles who remain childless for the same reason. Women who have this disorder will transmit this to their daughters so they will pass this on as well. The children born to couples with this disorder may face similar challenges conceiving in the future and all the females within this line will transmit the gene to their children.
Therefore, should we be testing women for the causes as well so that their sons aren’t affected? Only time will tell.
Filed Under: Blog
Improving pregnancy rates have been the focus of fertility centers since 1978 after the birth of Louise Brown, the first child conceived after IVF cycle treatment. Since then, laboratory advances have improved remarkably and the implantation rates for IVF has increased significantly. Still, the delivery rate may be lower in certain patients. Pre-implantation genetic screening of embryos heralded a new development that allowed even greater success with implantation, and pushed the consideration for single embryo transfers (SET) to limit the risk of multiple pregnancies. Still, patients and physicians remain frustrated by continued unsuccessful attempts despite multiple transfers of euploid embryos identified by a-CGH or embryos derived from young, presumably normal, egg donors. It is very challenging to explain why patients don’t conceive in circumstances where the endometrial cavity appears normal and the endometrium development seems prepared by commonly realized ultrasound parameters,. Although we realize that not all euploid embryos or embryos from egg donors will implant, after several transfers without success, we try to provide an explanation to patients about else could impede the implantation of these embryos.
There is now a new method to get more information about the uterine environment at the time of embryo transfer. The Endometrial Receptivity Array (ERA) examines the endometrium at the molecular level by evaluating 238 genes expressed within the endometrium during the implantation window. These genes are expressed within normal endometrium that is prepared to support implantation of an embryo. Several recent studies support using the test as many show that > 75% of the patients with repeated failed implantations of good quality embryos have a lining that was not receptive for implantation. Importantly, the results of the biopsy helps to guide the correct timing for transfer by adding or reducing the number of days of progesterone support to create a lining that is receptive for implantation. These data confirm a significant improvement in pregnancy rates in those patients after adjusting the timing of progesterone supplementation based on the results of the assay.
The endometrial biopsy for the ERA test is performed in just a few minutes in the office. The material is sent for evaluation and takes approximately 7 – 10 days to analyze. This allows changing only the number of days of progesterone support before transfer and all other medications used with the frozen transfer cycle remain the same. This new test and protocol adjustment provides a new opportunity for improving ongoing clinical pregnancy rates in many women who have suffered from repeated failures with high-quality embryos.
Filed Under: Blog