ST JUDE CLINICAL UPDATE

2017 is sprinting ahead. All too soon it is April. So far, we are very pleased with significant progress in many areas of our activities especially our excellent clinical pregnancy rates. We are pleased to highlight the following:

1) Excellent clinical Pregnancy rates. The figures will soon be presented in a separate post.

2) Alongside the solid experience and skills of our staff, our newly acquired EMBRYOSCOPE is producing brilliant treatment outcome. We are now able to offer blastocyst embryo culture to most of our patients.

3) We use Embryo Glue for embryo transfer in all patients, unlike some clinics where it is offered as an optional extra at a cost to the patient

4) Our approach to treatment continues to be based on individually tailored protocols. No two couples are the same. Even when the diagnosis is the same in different couples, there are often differences in age, duration of subfertility and individual preferences, so we never adopt a one-cap-fits-all policy.

5) Our lead Consultant is one of the most experienced in assisted conception in the UK and more than ever he is putting his experience to bear for the benefit of patients.

6) We accept and acknowledge the uniqueness of each couple and decide the best treatment protocol from the following:

a) Natural Cycle IVF which has the advantage of being natural, without side effects for drugs. It is also much cheaper.   Although success rate is not as higher as some of the other IVF protocols, it may be the best option for some categories of patients

b) Minimal (Low dose) Stimulation IVF where we use a combination of tablets and low dose injections for ovarian stimulation. The advantage of this method is that there is little risk of side effects or complications from drugs. Pregnancy rate is reasonable and the cost is less than the typical IVF treatment cycle.

c) Elective Embryo freezing and subsequent frozen frozen-thawed Embryo Transfer in a natural or programmed cycle. The rationale for this approach is that in a typical IVF cycle, the high dose of drugs used generate high levels of oestrogen which produces detrimental effects on the endometrium making it unsuitable for implantation. Hence when embryos are frozen from the fresh cycle and implanted in a subsequent cycle the pregnancy rate is much better.

d) Standard IVF cycle whereby higher doses of drugs are used to stimulate the ovaries. This typically produces a high number of eggs. This method is still acceptable and works well in the correct group of patients.

e) Use of Embryoscope for all the above protocols. The embryoscope is a clever high-tech gadget. It is essentially an incubator with an in-built micro-camera which monitors and records embryo development 24/7, therefore the embryos are left to divide and develop undisturbed until the day of embryo transfer. This is akin to what happens in nature within the female reproductive tract and enhances embryo quality. Also because the micro-camera system records embryos development continuously we can review the record to help us select the embryos with the best quality and best implantation potential.

You can see from the above treatment strategies that St Jude’s is committed to helping you achieve your heart’s desire – to Make Your Fertility a Reality.

1. Attend for review with your Specialist/Consultant and ask specific questions:

• His or her opinion on possible causes responsible for treatment failure

• What further tests should be performed to throw more light on possible underlying causes

• Was the endometrial thickness adequate durng treatment cycles?

• Was embryo development satisfactory

• If Blastocyst culture indicated?

• Would seeking a second opinion help?

2. Investigations to Consider:

• Blood test for Thyroid Function - TSH, Thyroxine, Thyroglobulin Antibodies, Thyroid Peroxidase antibodies

• Full Blood Count - Haemoglobin level and other indices

• Blood test for Vitamin D & Calcium levels

• Infection screen

• 3D Pelvic Ultrasound scan

3. Other Specialist Investigations To Consider:

• Blood test for Immunological factor - Checking for Natural killer (NK) Cell activity

• Laparoscopy to exclude Hydrosalpinx which will require Salpingectomy

• Hysteroscopy to exclude endometrial polyp and also to take a biopsy to check for underlying inflammatory pathology

• Uterine artery doppler studies

• DNA fragmentation test on semen sample

This list is not exhaustive . It is unlikely that you will require all the tests above. Your specialist will decide which ones are appropriate based on your history and findings.

Snippets of fertility wisdom from the Practice Committee of the Society for Reproductive Medicine in collaboration with the Society for Endocrinology & Infertility

Clinicians are often asked to provide advice about sexual and lifestyle practices to enhance the chances of achieving a pregnancy in couples trying for a pregnancy who have no evidence of infertility.

Currently there are no uniform counselling guidelines or evidence-based recommendations available. This is the first part of a series of “blogs” to highlight some salient points based on a consensus of expert opinion.

The expert opinion is from the Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Reproductive Endocrinology & Infertility.  The reference for the opinion in this blog is cited below:

“Optimizing natural fertility: a committee opinion” Fertility & Sterility Vol. 100, No. 3, September 2013.

a)    Some basic fertility facts (Fertility & Aging)

• Fertility is defined as the capacity to produce a child. Approximately 80% of couples will conceive in the first 6 months of attempting pregnancy
• Relative fertility is decreased by about half among women in their late 30s compared with women in their 20s
• Fertility declines with age in both men and women, but the effect of age are muchmore pronounced in women
• For women, the chance of conception decreases significantly after age 35yrs, male fertility does not appear to be affected before approximately age 50

• This is best defined as the 6-day interval ending on the day of ovulation.  The viability of eggs and sperm should be maximal during this time. The interval of maximal fertility can be estimated by analysis of interval between periods, ovulation predictor kits, or cervical mucus assessment
• Pregnancy is most likely to result from sexual intercourse within the 3-day interval ending on the day of ovulation
• In one study based on a combination of criteria for assessment of ovulation, the likelihood of pregnancy is greatest when intercourse occurred the day prior to ovulation and starts to decline on the day of presumed ovulation.
• The probability of achieving a pregnancy per month increases with the frequency of intercourse during the fertile window